Osteoarthritis is the most common joint disease around the world. Approximately 20 million individuals in the United States have osteoarthritis, but estimates vary from country to country. With such a high prevalence overall, osteoarthritis incurs significant costs to the individual patient and to the population at large.
Pathophysiology and Risk Factors
Osteoarthritis involves progressive degeneration of joint cartilage with proliferation of bone. Multiple factors are involved in the disease process, including genetics, local inflammation, joint integrity, mechanical forces, and cellular processes. Of the risk factors for osteoarthritis, age is one of the strongest with the disease starting as early as age 45. Being female and/or obesity may also increase the risk for osteoarthritis.
Clinical Manifestations
Osteoarthritis is characterized by joint pain, stiffness, and limited range of motion and may affect any joint in the body. Specifically, pain is typically worsened with activity and relieved with rest. Joint stiffness tends to occur in the morning, resolves after thirty minutes or less, and recurs during any prolonged inactivity. On physical examination, the joints may be tender and, with more serious disease, exhibit bone spurs (osteophytes), fluid in the joints (effusions), and sounds of bone rubbing (crepitus).
Diagnosis
Besides symptoms from a patient history and signs on a physical exam, the diagnosis of osteoarthritis requires x-ray imaging that shows characteristic radiographic findings, such as osteophytes and narrowing of the joint space. Alternatively, magnetic resonance imaging (MRI) can be used if patients have serious joint damage with locking, popping, or instability suggesting damage of associated musculoskeletal tissue..
Treatment
The treatment of osteoarthritis aims to alleviate pain and swelling, improve quality of life, and prevent disease progression. Initial treatment options are nonpharmacologic, including patient education, weight loss, exercise, physical therapy, and occupational therapy. If these modalities do not work, then medications are given. Options for pharmacologiic therapy include acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), topical analgesics such as capsaicin cream, and joint injections of steroids. As a last resort, severe cases of osteoarthritis would require invasive procedures, such as arthroscopic surgery and total joint arthroplasty.
Prognosis
Osteoarthritis is a condition that may stabilize or slowly progress in its course. Progression of the disease tends to occur intermittently rather than continuously in a linear decrease. Worsening may also be related to the way one copes with the disease. For example, joint inactivity may worsen the condition as muscle weakness can make the joint less stable.
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