Osteoarthritis: Diagnosis, Treatment, and Management

My dad is an activity lover, he often wants to engage in every possible activity. A few years before he turned 60, he was diagnosed with osteoarthritis. Since then, it’s been a struggle for him. Often, I’ve seen him walk with a lot of discomfort as he climbs the staircase, other times, he’s strong and wants to get really active, and then I have to remind him to be careful because of his joints. At such times, I know I sound like a killjoy to him, but it’s all for his good. My dad has always kept a healthy weight (talk of an activity lover). He takes his medications and we always try to ensure that he meets up with doctors’ appointments. Overall, he’s doing quite fine for his age, and he’s had more days of being able to engage in the activities he so loves. Like my dad, a lot of elderly people battle with arthritis. It’s a disease to consciously guard against as you grow older because studies show that by age 65, more than half of us will have X-ray evidence of osteoarthritis.

WHAT IS OSTEOARTHRITIS?

According to the Centre for Disease Control, CDC, osteoarthritis is the most common form of arthritis. Arthritis is simply a painful swelling (inflammation) of the joints. Some people describe osteoarthritis as a degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.

Joints are made up of bone and cartilage (which is softer and more flexible), and covers the bone where it meets another to form a joint, enabling ease of movement.

With osteoarthritis, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time.

WHAT CAUSES OSTEOARTHRITIS?

As part of normal life, the joints of the body are constantly exposed to a low level of damage, as they are being used in movement and other activities. In most cases, your body repairs the damage itself and you do not experience any symptoms.

But in osteoarthritis, the protective cartilage on the ends of your bones breaks down, causing pain, swelling and problems moving the joint. Bony growths may also develop, and the area can become red and swollen.

The exact cause of osteoarthritis is not known, but several things are thought to increase your risk of developing osteoarthritis, including:

1. Joint injury or overuse: Injury or overuse, such as knee bending and repetitive stress on a joint, can damage a joint and increase the risk of osteoarthritis in that joint. Overusing your joint when it has not had enough time to heal after an injury or operation may also contribute.
2. Age: Your risk of developing the condition increases as you get older.
3. Family history: People who have family members with osteoarthritis are more likely to develop osteoarthritis.
4. Obesity: Being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips.
5. Being a woman: Osteoarthritis is more common in women than men, especially after age 50.
6. Other conditions (secondary arthritis): Osteoarthritis can happen in joints severely damaged by a previous or existing condition, such as rheumatoid arthritis or gout.

HOW COMMON IS OSTEOARTHRITIS?

Osteoarthritis affects over 32.5 million US adults.

Among adults 60 years of age or older the prevalence of osteoarthritis is approximately 10% in men and 13% in women.

Studies show that it is common in Nigeria, and more common in women than in men. In Nigeria, most patients are affected at the knee joint.

SYMPTOMS OF OSTEOARTHRITIS

Osteoarthritis symptoms often develop slowly and worsen over time. Commonly affected areas of the body include the:

1. Hands and Feet: The big toe feels painful and tender.The wrist, ankles or toes may swell.
2. Fingertips: Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.
3. Knees: A “grating” or “scraping” feeling when moving the knee.
4. Hips: Pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.
5. Spine, typically at the neck or lower back.

Signs and symptoms of osteoarthritis include:

1. Pain: Affected joints might hurt during or after movement.
2. Stiffness: Joint stiffness might be most noticeable upon awakening or after being inactive for some time.
3. Tenderness: Your joint might feel tender when you apply light pressure to it or near it.
4. Loss of flexibility: You might not be able to move your joint through its full range of motion.
5. Grating sensation: You might feel a grating sensation when you use the joint, and you might hear a popping or crackling sound when you move the affected joint.
6. Bone spurs: These extra bits of bone, which feel like hard lumps, can form around the affected joint.
7. Swelling: This might be caused by soft tissue inflammation around the joint.

HOW IS OSTEOARTHRITIS DIAGNOSED?

A doctor will make a diagnosis of osteoarthritis based on your medical history, a physical examination and lab tests. The doctor will go over your medical information, symptoms, how the pain affects your activities, as well and your medication use. The doctor will also look at, and move the joints. With Flexicare health insurance, you can carry out these tests and get a proper diagnosis. 

These tests help to make the diagnosis:

1. Joint aspiration: After numbing the area, a needle is inserted into the joint to pull out fluid using a syringe. This test will look for infection or crystals in the fluid. The results can help rule out other medical conditions or other forms of arthritis.
2. X-ray: X-rays can show joint or bone damage or changes in the joints that are related to osteoarthritis.
3. MRI:  Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint, to help your doctor determine if you have osteoarthritis.

TREATMENT

There is no cure for osteoarthritis, so doctors usually treat the symptoms with a combination of methods, which may include the following:

1. Increasing physical activity: Physical therapy with muscle strengthening exercises.
2. Weight loss.
3. Medications, including over-the-counter pain relievers and prescription drugs.
4. Supportive devices such as crutches or canes.
5. Surgery, (if other treatment options have not been effective).

PREVENTION

As earlier stated, by age 65, more than half of us will have X-ray evidence of osteoarthritis. Here are some steps you can take now to prevent osteoarthritis or its progression:

1.  Control Weight: Obesity is clearly a risk factor for developing osteoarthritis.
2. Exercise.
3. Avoid joint injuries or treat them properly.
4. Eat right.

If you have been diagnosed with arthritis, there are day-to-day things you can choose to do to manage your condition and stay healthy. The CDC recommends 5 strategies for managing arthritis: 

1. Learn new self-management skills.
2. Be active.
3. Talk to your doctor.
4. Manage your weight.
5. Protect your joints.