There are over 100 different types of arthritis. Osteoarthritis (OA) is the most common type of arthritis, affecting about 21 million Americans, according to the Arthritis Foundation. Actually, the term osteoarthritis is a bit misleading. “Osteo” comes from the Greek word for bone; you would expect, therefore, that the name refers to an inflammation of the bone. In reality, OA is a degenerative joint disease, characterized by breakdown of the cartilage that surrounds and cushions the bones.
Once the cartilage begins to break down, the joint enters a cycle of pain and deterioration. First, the synovium may become inflamed, causing pain and swelling. In response to the inflammation, the joint produces more synovial fluid to try to lubricate itself, but often this fluid ends up in the joint space, which causes further swelling. With no cushion to stop them, the bones rub against each other, wearing down their surfaces and causing yet more pain, swelling, and loss of movement.
Typically OA develops as people age; however, it may appear earlier in life as a result of an injury or from overuse of a joint. The symptoms can range from very mild to very severe, and they appear primarily in the hands and in weight-bearing joints, such as the knees, hips, feet, and back. All joints may be more affected, though, if they’re used extensively or if they’ve been previously damaged.
Genetics also plays a role in the development of osteoarthritis, particularly when it occurs in the hands. Some people may be born with either defective cartilage or slight defects in the way their joints fit together. As they age, these defects may cause the cartilage to break down, causing inflammation, pain, and swelling.
Symptoms
The early symptoms of arthritis tend to be so mild that many people dismiss them — after all, most people experience joint pain and stiffness from time to time, especially if they’re active. While occasional twinges, stiffness, and pain are probably nothing to be concerned about, if you experience any of the following for two weeks or more, talk with your doctor:
Stiffness when awaking or after being in one position for a period of time
Pain
Swelling
A “popping” or grinding sound when moving
A warm sensation originating from a joint
The more frequently these occur, the greater the likelihood you may have OA.
Diagnosis
Physicians make a diagnosis of OA based on a physical exam, a history of symptoms, and a series of tests, including X-rays, blood tests, and synovial fluid tests.
■ X-Rays
Although X-rays pass right through the body’s soft tissues, the bones and cartilage don’t let them through. This allows doctors to view their structure on a photographic film. On the film, the worn cartilage looks ragged and pockmarked, and it may appear as a black space between the bones. Spurs of bone, known as osteophytes, may also be seen; they’re a further indication of OA.
■ Blood Tests
Blood test results may also help to diagnose — or to rule out — osteoarthritis. The three most common tests look for:
1. Elevated levels of an antibody called rheumatoid factor and an elevated erythrocyte sedimentation rate (ESR or sed rate). These indicate the presence of an infection and are characteristic of rheumatoid arthritis, not osteoarthritis.
2. Byproducts of hyaluronic acid, a joint lubricant. The byproducts indicate that the lubricant isn’t functioning and that the joint is degenerating, symptoms of osteoarthritis.
3. Elevated levels of a factor called C-reactive protein. This protein, produced by the liver in response to inflammation, is a good predictor of osteoarthritic progression, especially in the knees.
■ Synovial Fluid
If both X-rays and blood tests are unable to confirm OA, the doctor may try to withdraw synovial fluid from the joint using a long, thin needle. If the joint is normal, there won’t be enough fluid to withdraw. If the joint isn’t normal, they’ll subject the excess fluid to a number of tests.
A high level of cartilage cells in the fluid occurs when a joint degenerates and is an indication of osteoarthritis. A high white blood cell count signals an infection, and it may signal rheumatoid arthritis. A high uric acid concentration reflects another form of arthritis, called gout. In people with known osteoarthritis, the concentration of other factors, such as sulfated glycosaminoglycan and keratan sulfate, may predict the disease’s severity.
Treatment varies, depending on the symptoms and their severity. Over-the-counter NSAIDs may help with pain and inflammation, physical therapy can help with retaining strength in the joint and range of motion, and joint replacements may become necessary if the degeneration is too severe to treat conservatively.
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