Degenerative arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

This is a word which is a synonym for osteoarthritis.

Osteoarthritis is the most common form of arthritis seen in adults. This is due to the progressive loss of cartilage and is accompanied by bony hypertrophy (growth).

The cause of this disease remains unknown.

Biochemical changes in cartilage result in the loss of water, proteoglycans, collagen, and chondrocytes (cells that manufacture cartilage). This leads to softening of cartilage and progressive cartilage loss. The underlying bone undergoes changes with the formation of spurs and cysts. The lining of the joint (synovial capsule) also becomes inflamed.

OA is most common in people after the age of 65. It is more common in women than men. Weight-bearing areas such as the spine (neck and low back), hips, knees, and the base of the thumbs are affected.

OA comes in different varieties. Women tend to have a type where there is involvement of the small joints in the fingers. These forms of OA may cause bony swelling in the distal row of finger joints (Heberden’s nodes) or the more proximal row of finger joints (Bouchard’s nodes). The swelling is accompanied by inflammation early on. Later, the inflammation goes away but the bony swelling remains.

OA may be primary or it may be secondary to trauma, obesity, metabolic disorders such as hemachromatosis, inflammatory arthritis, hemophilia, or neuropathic disorders.

The most common symptom is pain that is increased with use and relieved by rest. While morning stiffness is common, it rarely lasts more than 30 minutes. Pain at night is a common feature.

Laboratory tests are generally within normal limits. X-rays show bony changes late. Magnetic resonance imaging (MRI) shows changes earlier. There is not a good correlation between x-ray findings and symptoms.

OA needs to be differentiated from a whole host of other forms of arthritis.

The goals of treatment are to relieve pain, preserve function, and maintain quality of life.

Patient education, physical and occupational therapy, lifestyle modification, and dietary instruction in the case of obesity are normally initiated early.

Thermal modalities such as heat and ice may be beneficial for symptoms.

Exercise (stretching, strengthening, and non-impact aerobic types) are advised.

Assistive devices such as braces, canes, etc. might be needed in some cases.

Medications used include topical ointments and creams, analgesics, and anti-inflammatory drugs. Corticosteroid injection and injections of viscosupplements (lubricants) occasionally are needed.

A variety of diseases modifying drugs are currently being evaluated in an attempt to slow down (and possibly reverse) the course of disease.

A very promising treatment is the use of stem cell treatment. Much interest has been generated recently on the use of autologous (meaning the patient’s own) therapies in managing osteoarthritis as well as other degenerative conditions.

For osteoarthritis, we have found that combining autologous stem cells – obtained from bone marrow aspirated from the pelvic bone of the patient using local anesthetic- and platelet rich plasma appears to be an effective treatment for the knee and hip. Both the stem cells as well as the platelet rich plasma are injected into the osteoarthritic joint following "irritation" and drilling of bare bone. This combination treatment not only aids in pain relief but there also appears to be stimulation of cartilage regeneration. This treatment is available at the Arthritis Treatment Center located in Frederick, Maryland.

Arthritis Treatment Center

Surgical solutions in the form of joint replacement is advised for advanced osteoarthritis. Approximately 150,000 knee and 200,000 hip replacements are performed annually in the United States. The timing of these procedures is important. Patients with uncontrolled underlying medical problems are considered to be at high risk.

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