What Causes Osteoarthritis?
The cause of osteoarthritis is still unknown, but many factors can increase
a person’s risk for developing the disease. These risk factors include:
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A family history of the disease.
Genetics accounts for more than 50 percent of all cases of osteoarthritis.
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Inactivity. If joints aren’t
used in a long time, the cartilage protecting the joints becomes
weak and may eventually lose its function. |
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Age. As the body ages, cartilage
becomes less flexible and loses its ability to regenerate. Also,
the repeated wear and tear on these joints over the years can lead
to osteoarthritis. |
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Traumatic injury to the joint.
Former athletes and ballet dancers in particular are susceptible
to developing the disease from repeated injuries to various joints. |
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Obesity. Extra weight puts
more strain on the joints. |
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Lack of vitamin D. Low levels of vitamin
D make bones more susceptible to osteoarthritis. |
What Are Symptoms of Osteoarthritis?
Osteoarthritis usually develops very slowly. Initially the symptoms are
mild, but they may eventually get worse. Symptoms include:
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Steady or intermittent pain in a
joint |
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Stiffness after getting out of bed |
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Joint swelling or tenderness |
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Crunching feeling or sound in the
joint (called crepitus) |
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Enlarged, gnarled finger joints,
which can be a sign of osteoarthritis in the hands |
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Limited joint movement. |
People with osteoarthritis may experience referred pain, or pain in areas
of the body on the same nerve pathway as the affected joint. For example,
an arthritic hip may cause pain in the groin, buttock, or knee.
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Diagnosing Osteoarthritis
If you think you have osteoarthritis, see your doctor. After a physical
examination and a discussion of your symptoms, your physician might assess
your reflexes, muscle strength, and your ability to walk, bend, and perform
regular day-to-day activities. Depending on the assessment, your physician
might order other tests, including:
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Blood test. A blood test can
rule out other causes of pain in your joints. |
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Joint aspiration. Your physician
might need to test a sample of fluid from your joint. During a joint
aspiration, a needle is inserted into the joint to collect fluid.
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X-rays. X-rays can help detect
cartilage loss, bone damage, and bone spurs. |
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Current Treatments
The goals of osteoarthritis treatment are to improve your joint function
and quality of life. Treatments for osteoarthritis include preventive
measures to stop or slow disease progression, self-management, medication,
and surgery. Some complementary therapies are available, as well.
Prevention
If you have a mild case of osteoarthritis, you and your doctor can develop
a preventive plan to keep the disease from progressing. The following
preventive interventions can help:
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Exercising on a regular basis to
keep the joints moving |
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Managing your weight to reduce the
stress on the joints |
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Increasing your vitamin D intake |
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Limiting your participation in high-risk
sports such as football, tennis, rugby, and basketball. |
Medications
Your physician may prescribe one of the following medications to treat
osteoarthritis pain and help improve joint function:
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Nonsteroidal anti-inflammatory
drugs (NSAIDs). These medications include aspirin (Anacin, Bayer,
Bufferin), ibuprofen (Advil, Motrin IB, Nuprin), ketoprofen (Orudis
KT), and naproxen sodium (Aleve). NSAIDs, which can help relieve
inflammation, joint pain, and swelling, are available by prescription
or over the counter. NSAIDs block the body’s production of
prostaglandins, chemicals that are released when the body is in
pain. Prostaglandins can contribute to the pain, heat, and swelling
that occur after tissue has been damaged. Using NSAIDs for a long
time could lead to ulcers, bleeding, and damage to the stomach lining.
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Acetaminophen (Tylenol and others).
Acetaminophen may be as effective as NSAIDs in relieving pain.
This medication is gentler on the stomach than aspirin and other
NSAIDs, but it can cause liver damage in heavy drinkers. Using acetaminophen
for a long time could cause kidney and liver damage. |
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Topical pain-relieving creams.
Creams such as those that contain capsaicin can numb the skin
temporarily. |
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Corticosteroids. Your physician
may inject these powerful anti-inflammatory hormones into the affected
joint to relieve pain, but they’re not recommended for long-term
use. |
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Hyaluronic acid. This new
medicine, used to treat osteoarthritis of the knee, is a normal
component of the joint involved in lubrication and nutrition. Most
patients feel relief from arthritic pain after 3 to 5 injections
of hyaluronic acid. |
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Glucosamine and chondroitin sulfate. These
components of cartilage are available as supplements that can help
ease pain. Initial research showed that taking the supplements for
a month relieved symptoms in some patients with arthritis. |
Self-Management
In addition to preventive measures and medications, patients with osteoarthritis
can work with their doctor to develop habits and skills to manage pain
and disability:
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Warm towels or hot packs, warm-water
therapy, and cold therapy can help ease joint pain and increase
mobility. |
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Supportive shoes with rubber soles
will absorb shock and reduce further damage to your joints. |
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Special exercises can restore joint
movement and strength. Work with your doctor to create an exercise
program for your individual needs and abilities. |
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Weight-management programs help reduce
the amount of stress you put on your joints. |
Surgical Treatments
In some cases, a joint is so damaged that it might need to be surgically
repaired or replaced in one of the following procedures:
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Joint replacement (arthroplasty).
After removing the ends of the damaged bones, a surgeon will
replace them with artificial joints made of metal, ceramic, or plastic.
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Bone repositioning (arthrodesis/fusion).
During this procedure, a surgeon immobilizes the joint to reduce
pain. Because the surgery limits patients’ mobility, it’s
often performed on the smaller joints of the foot and hand. |
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Joint resurfacing (arthroscopic
surgery). Surgeons remove such inflammatory particles as torn
or damaged cartilage or bone from the joint. The procedure offers
short-term relief. |
Complementary Therapies for Osteoarthritis
Some complementary therapies can help ease the pain associated with osteoarthritis:
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Relaxation techniques. Meditation
and yoga help relieve pain by relaxing muscle tension. Relaxation
techniques also can help people manage stress and anxiety. |
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Tai chi. This ancient Chinese
discipline stretches joints in a series of light, controlled movements.
Its emphasis on deep breathing and inner stillness can relieve stress
and anxiety. |
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Acupuncture. Some people have
found pain relief through acupuncture. An acupuncturist inserts
fine needles at specific points on the skin, penetrating just below
the skin’s top layer. The needles do not draw blood or cause
discomfort. |
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Research
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Osteoarthritis detection.
Researchers hope to discover new ways to detect the disease in its
early stages. Scientists are developing noninvasive urine, blood,
and imaging tests that would detect changes in the tissues around
joints. |
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Genetic tests. Scientists
continue to search for more genes associated with the breakdown
of cartilage production. Researchers have identified one genetic
defect that leads to the early onset of osteoarthritis. They hope
to identify more of these genetic markers to develop screening tests
and genetic therapies to help prevent the disease. |
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Cartilage production. Preliminary
evidence links a decreased number of cartilage cells to the development
of osteoarthritis. Researchers are examining why cartilage cells
die faster than new ones can grow, and several studies are examining
the effects of certain proteins and molecules (like chemokines and
insulin-like growth factor-1) that could stimulate growth in cartilage.
A growth factor called human osteogenic protein 1 has been found
to be very successful in stimulating cartilage protein production.
Scientists hope to determine if vitamin C and certain chemicals
called nitric oxide inhibitors can prevent cartilage damage.
Researchers also hope to develop monoclonal antibodies (cells produced
by the immune system) that can identify the breakdown of protein
molecules in the cartilage of people with osteoarthritis. Additionally,
scientists are continuing to learn how certain enzymes called metalloproteinases
break down and destroy cartilage. By understanding this mechanism,
scientists hope to discover new therapies that can block cartilage
destruction by these substances. |
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Joint replacement. To increase
the range of motion after joint replacement, researchers are developing
bioengineered, cell-based materials to replace the metal and cements
currently used. |
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Acupuncture. The National
Center for Complementary and Alternative Medicine (NCCAM) at Harvard
University in Boston is conducting several studies to determine
if acupuncture relieves pain and helps improve joint function. In
one study, researchers are comparing the effects of acupuncture,
fake acupuncture (or placebo), and patient education; another study
will examine acupuncture in combination with exercise and physical
therapy. |
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Glucosamine and chondroitin sulfate. A
study sponsored by the NCCAM and the National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS) will evaluate the
effectiveness of these supplements in relieving pain associated
with osteoarthritis of the knee. |
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Magnetic resonance imaging (MRI). Research
funded by the Arthritis Foundation is exploring the use of MRI to
monitor very early changes in certain cartilage proteins called
proteoglycans. |
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Medications. New medications may help
improve the quality of life of people with osteoarthritis. New compounds
called viscosupplements are injected into the joint to help provide
pain relief for those with osteoarthritis of the knee. Researchers
are studying a drug called doxycycline to determine if it may help
prevent or slow down the progression of osteoarthritis. Scientists
have found that doxycycline works against enzymes that break down
cartilage. |
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Clinical Studies
Interested in participating in a clinical trial to test new medicines
or therapies? We can help. Visit our Treatment
Options and Clinical Trials from Veritas Medicine which offers comprehensive
information on clinical trials and treatment options for more than 40
serious, chronic medical conditions.
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Future
Researchers are investigating better ways to prevent and treat osteoarthritis:
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Geneticists will continue to explore
the role of genetic factors in the development and progression of
osteoarthritis. |
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Researchers will determine if estrogen
or hormone replacement therapy (HRT) help prevent the disease. |
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Scientists will continue to investigate
new methods of stimulating cartilage production. |
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Researchers will study various complementary
and alternative therapies to determine their usefulness in easing
symptoms of osteoarthritis. |
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References
1. “Handout
on Health: Osteoarthritis,” National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), February 2000.
2. Hinton, R., et al. “Osteoarthritis:
Diagnosis and Therapeutic Considerations,” American Family Physician,
Vol. 65 (5), March 1, 2002.
3. Senior, K. “Osteoarthritis Research: On the Verge of a Revolution,”
The Lancet, Vol 355 (9199), Jan. 15, 2000.
4. “Progress
and Opportunities in Osteoarthritis,” The Arthritis Foundation,
2002.
5. “Stepping
Away from OA: A Scientific Conference on the Prevention of Onset, Progression,
and Disability of Osteoarthritis,” Conference summary, NIAMS,
July 24, 1999.
6. Palkhivala, A. “Researchers Identify Genes Involved in the Inheritance
of Osteoarthritis,” The Lancet, Vol. 359 (9313), April 6, 2002.
7. Fernandes, J.C., et al. “Gene
Therapy for Osteoarthritis: New Perspectives for the Twenty-First Century,”
Clinical Orthopaedics and Related Research, Vol. 379 Supplement, Oct.
1, 2000.
8. “Major
Review Reveals that Osteoarthritis is a Complex Disease with New Solutions,”
NIAMS, Jan. 5, 2001.
9. “New
Arthritis Drugs for Rheumatoid Arthritis and Osteoarthritis,”
NIAMS, January 2002.
10. Lewis, C. “Arthritis:
Timely Treatments for an Ageless Disease,” FDA Consumer Magazine,
May-June 2000.
11. Schardt, D. “Glucosamine
& Chondroitin: Joint Relief?” Nutrition Action Health Letter,
Vol 27 (8), October 2000.
12. “Alternative
Therapies: Glucosamine and Chondroitin Sulfate,” The Arthritis
Foundation, 2002.
13. Horstman, J. “Meditation,”
Arthritis Today, January-February 2001.
14. Horstman, J. “Tai
Chi,” Arthritis Today, July-August 2000.
15. “Current
Research,” Arthritis Research Campaign, 2002.
16. Chikanza, I., and Fernandes, L. “Novel
Strategies for the Treatment of Osteoarthritis,” Expert Opinion
on Investigational Drugs, Vol. 9 (7), July 1, 2000.
17. Felson, D.T., et al. “Osteoarthritis:
New Insights,” Annals of Internal Medicine, Vol. 133 (8), 635-646,
Oct. 17, 2000.
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Researcher: Linnea Varner, RN, MNA
Writer: Christine Norris
Clinical Reviewer: Patt Panzer, MD, MPH
Editors: Andrea King, Joanne Poeggel, Erin Murphy
Source of Material: Rockhill Communications, 14 Rock Hill Road Bala, Cynwyd,
PA 19004, (610) 667-2040, http://www.rockhillcommunications.com
Date Written: 10/28/02
Date Last Revised: 11/14/02 |