Degenerative Joint Disease
Osteoarthritis, OA, or wear and tear arthritis|
- OA is the most common form of arthritis. It may affect over 80% of people over the age of 60. Arthritis is a general term used for many conditions that result from the degenerative changes of the joint and its structures.
- In OA degeneration, changes
describe a slow and progressive loss of the cartilage (a
rubbery material between two bones) that acts as a barrier
and a shock absorber between two bones, while helping to keep the joints flexible. Once the cartilage is thinned or lost, the constant grinding of bones against each other causes pain and stiffness around the joint. Abnormal and excess bone formations called spurs grow from the damaged bone, causing further pain and stiffness.
- Many changes go on without symptoms developing for a long time.
- Symptoms vary when the joint is involved
- Subtle development of morning stiffness is often an early symptom.
- As OA progresses, there is pain with movement of the involved joint.
- Pain and stiffness become more severe with activity (less than 15 minutes in duration), and improve with a proper amount of rest.
- Decreased range of motion of the joints
- The patient may have difficulty with brushing teeth, combing hair, or opening a jar
- The joints, such as the fingers or knees, may become unstable, causing them to buckle or lock.
- The fingers, spine, hips, knees, or ankles can all be affected, and may be tender to the touch.
- Neck or back stiffness may be present
- There may be swollen or painful joints around the fingers or knees
- Hip or knee pain may cause a limp when walking
- Popping sound or crepitations (cracking sounds) may be heard when moving the joint
- With OA of the spine, such as in the neck, there may be headaches, neck stiffness, pain, and pressure on the nerve roots (Radiculopathy), resulting in a tingling or pins and needle like sensation in the fingertips or hands.
Cumulative effects from years of use
leads to degenerative changes of the joints between the ages
of 50-60. Cartilage is made up of a protein called
collagen. With damage to the cartilage, certain
chemicals are released called Enzymes which further damage
the collagen structure. As one ages, the ability to
restore and repair the collagen matrix declines.
- Secondary OA can result from a variety of disorders:
down from parents) conditions such as defective cartilage or
malformed joints, abnormal joint surfaces or metabolic
abnormalities (Wilson's disease, alkaptonuria, and
hemochromatosis) can increase the risk for developing
- Trauma to the joints -- Obesity, joint surgery, and damage to the joints from other forms of arthritis (gout, Rheumatoid Arthritis) and joint infections as seen with Tuberculosis and
bacterial infections. Prolonged and repetitive
movements (constantly using the same arm or neck movement),
such as in sports and at work (typing, taxi, or truck
- Congenital (present at birth)
conditions -- Congenital hip dysplasia and slipped
femoral epiphyses are abnormalities that can increase the
risk of developing OA in the future.
- Other conditions -- Diseases that affect the nerve supply to the joint (e.g., Charcot's joint), excess bone growth (Acromegaly), and Bone damage (Paget's) also increase the risk for developing OA in the future.
- Examination by a doctor includes a medical history (symptoms, diseases, birth defects, habits, occupation, medicines, surgeries etc.) and a general physical exam.
- The joint involved is then examined for degree and range of motion, stiffness, strength, and presence of fluids or crepitations.
- There may be bony knobs at the end of the fingers (Heberden's nodes), or at the base of the fingers (Bouchard's nodes).
- There may be swollen and tender knee joints.
- If there is swelling and fluid in the joint, the doctor will numb the area with an injection of a local anesthetic such as Xylocaine, then use a second needle to remove the fluid so it can be examined under a microscope. This is helpful in reducing pain and ruling out other causes of arthritis.
- Radiographs (X-rays) may be normal early in the disease, but later they may show narrowed joint spaces, erosions, small cysts (tiny enclosed sacs), and spurs.
- If the doctor needs a detailed view of the joint, or if there is radiculopathy (pressure on nerve roots), a MRI or CAT scan can provide better pictures of the involved joint.
- Ages greater than 50
- OA under the age of 45 is more common in males
- OA over age 45 is more common in females.
- Protect the joints from overuse by limiting unnecessary and repetitive activities such as driving or lifting heavy pots and pans.
- Be sure to keep good posture with the chin up and a straight back (shoulders pulled back).
- Use a straw to drink if you have Neck Pain or stiffness.
- Use crutches, neck collars, wrist braces or walkers to protect the joint if the doctor recommends it
- Stretch before exercising
- Exercise of all forms has proven beneficial
- A good diet and moderate weight loss is extremely important.
- Tylenol (regular and extra strength) is a good choice for pain. It has no stomach Irritation or bleeding as happens with aspirin, ibuprofen, naproxen, and others from the non steroidal anti-inflammatory Drugs (NSAIDs) family. None of these should be used if there is liver damage.
- NSAID's are not good for the elderly, those with ulcers, bleeding problems, or kidney damage.
- Magnesium and Choline Salicylates are similar to NSAIDs, but do not have as many side effects.
- New COX-2 inhibitors such as Celebrex are more expensive, and used on people unable to take NSAIDs.
- Codeine and other opiates are habit forming, and are used only for severe pain. They can cause Constipation and confusion (especially in the elderly).
- Steroids such as prednisone can either be injected into the joint (no more than 1-3 times per year), or taken as a pill. These are reserved for severe cases of OA.
- Physical and occupational therapy is very helpful in decreasing joint stiffness, pain, and improving mobility and strength.
- The therapist can also teach the uses of assisting devices (eating utensils, canes, and crutches).
- Massage of surrounding muscles, acupuncture, or acupressure may help with pain.
- Diets and supplements:
- A diet low in poultry, meat, sugar, eggs, and processed foods (white bleached flour) has been used in the past, but not researched properly yet.
- Tomatoes, potatoes, peppers
(except black pepper), and egg plants contain a compound
known as Solanine, which may be toxic to some individuals
and cause OA.
- Supplements such as glucosamine and chondroitin sulfate, and alphatocopherol form of vitamin E, antioxidants, S-adenosyl methionine (SAMe), Omega 3 fatty acids EPA, DHA (Fish oil), D-phenylalanine, injectable cow collagen, and DMSO cream are all new therapies that may be beneficial, but need to be studied further (consult with your doctor).
- Surgery is done when there is severe OA that is not responding to the above treatments.
- Surgery is done to relieve the pressure on nerves. Clean out damaged bone and fibrotic tissue.
- A bad knee or hip can also be replaced with an artificial one.
Try changing your diet and exercising (swimming or Tai chi), change occupation or life style if possible. See your doctor for evaluation and help.
- In the USA, call the Arthritis foundation at 1-800-283-7800 for further information.
- Other arthritic conditions such as rheumatoid or gouty arthritis
- Infections of the joint
- Injury to the joint
- Cancers spread from other sites (breast, prostate, etc.) or form Multiple Myeloma
- Bone diseases such as Paget's
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