Osteoarthritis is the breakdown of articular cartilage in the joints, usually followed by chronic inflammation of the lining of the joint. Healthy cartilage serves as a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.

Osteoarthritis is usually a condition associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience progressive loss of articular cartilage, bone spurs around the joint, and muscle weakness of the extremity.

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Obesity
• Genetic factors
• Injury to the joint surface
• Occupations and physical activities that put stress on joints
• Neuromuscular disorders like diabetes

Symptoms include:

• Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time
• Creaking or grating sound in the joint
• Swelling, stiffness, limited movement of the joint, especially in the morning
• Weakness in muscles around the sore joint
• Deformity of the joint

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• X-rays of the affected joints—to look for cartilage loss, signified by narrowing of the joint, bone damage, or bone spurs
• Blood tests—to rule out other medical conditions
• Arthrocentesis —removal of fluid from the joint for testing

There is no treatment that absolutely stops the degeneration of cartilage or repairs cartilage that is already damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.

Treatments may include:

• Over-the-counter pain medication
  • Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen (Advil, Aleve)
    • A study looked at topical vs. oral ibuprofen to relieve chronic knee pain. Comparing the two groups, there were no significant differences in pain, stiffness, or difficulty. Those in the oral group, however, experienced more side effects. *
• Prescription Pain Relief Medication
  • NSAIDs—Arthrotec is a NSAID that may reduce the risk for gastrointestinal bleeding.
  • Opiates, and opiate-like medications

  ***Please Note: On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx® (rofecoxib) from the US and worldwide market due to safety concerns. A study showed a small but significant increased risk of cardiovascular events (such as heart attack ) in patients taking the prescription medication. Vioxx® is a so-called "selective" nonsteroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation, and other conditions. Since Merck's withdrawal of Vioxx®, evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex® (celecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class.

• Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps to lubricate the joint
• Pain relief creams—capsaicin, methyl salicylate, and menthol

There is some evidence that glucosamine and chondroitin may relieve pain and/or decrease the progression of osteoarthritis. Talk with your doctor before taking any herbs and supplements.

Some clinicians report that acupuncture has been successful in reducing the pain of osteoarthritis, although there is inconsistent evidence on this treatment.

While more studies are needed, balneotherapy (hot water therapy), relaxation therapy, exercise, yoga, and tai chi may be helpful.

Shoes with shock-absorbing soles can provide some relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain, and a firm mattress may help chronic back pain. Canes, crutches, walkers, and orthopedic shoes also can benefit patients with advanced osteoarthritis of the lower extremity.

Losing weight can lessen the stress on joints affected by osteoarthritis. A modest loss of five pounds can eliminate at least 15 pounds of stressful impact for each step taken and thus help the affected joint. The more weight lost, the greater the benefit.

Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and neck) may decrease pain and help absorb energy around the joint. Swimming and water aerobics are particularly good because they don't put stress on the joint.

If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are especially useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you're having difficulty rising after sitting.

Applying heat (with hot water bottles, heating pads, hot paraffin) helps joints and muscles to move more easily and can decrease pain, as can using ice packs after activity.

When less potent pain relievers are ineffective, corticosteroid injections to the inflamed joint may be given. Because repeated cortisone injections can be harmful to the articular cartilage, they are reserved for patients with more pronounced symptoms.

Surgery can:

• Reposition bones to redistribute stress on the joint
• Replace joints
• Remove loose pieces of bone or cartilage from joints