"In the United States, 100,000 people are unable to walk independently from bed to bathroom because of osteoarthritis of the knee or hip"

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally recognized 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

Information from the American College of Rheumatology and the Arthritis Foundation

Osteoarthritis (OA) is the most common joint disease and represents a growing public health concern.

It is characterized by loss of articulating cartilage, new bone formation, and the formation of bony spurs, called osteophytes.

The cause of osteoarthritis is still unknown but various risk factors including genetics, injury, other disease states (metabolic abnormalities, other kinds of arthritis, blood disorders like hemophilia), and excessive weight all play roles.

Cartilage consists of two components: The first are cells called chondrocytes. The second is the matrix that the chondrocytes are suspended in. Picture grapes inside a gelatin mold. This matrix consists of collagen and proteoglycans. Osteoarthritis starts when biochemical changes lead to a change in water content in the matrix. This is accompanied by a decrease in the number of chondrocytes, and a reduction in the amounts of proteoglycan and collagen. The matrix thins, and the cartilage softens, making it more prone to damage. Soon, the cartilage develops cracks called fibrillations. As the condition worsens, the fibrillated cartilage wears away exposing underlying bone. The underlying bone also undergoes changes. It develops areas of hardening (sclerosis) as well as tiny fractures and cysts. Bone also hypertrophies (expands) leading to bony spurs called osteophytes.

In addition to the changes above, cells within the synovium (joint lining) produce destructive enzymes and cytokines (chemical messengers) which cause further cartilage destruction. Interleukin-1 is the cytokine that seems to play the biggest role in the damage leading to OA. Inflammatory cells accumulate in the synovium and the joint capsule thickens.

Joint cartilage has two major roles. The first is to provide a smooth gliding surface for the joint. The second is to transmit and spread the load so that stress to the joint is limited.

OA develops when the load is excessive or when there is repetitive impact loading and the joint cartilage becomes fatigued.

Clinical features of OA include pain in the involved joint that is worse with activity and relieved by rest. The pain is worse at the end of the day or at night. Morning stiffness is present but usually lasts less than 30 minutes. Stiffness after inactivity, swelling of the joint, limited range of motion, and instability all may occur. Functional impairment, muscle atrophy around the joint, and muscle weakness all may occur.

Hypertrophy of bone can occur in any joint affected by osteoarthritis. It is most apparent in the hands where knots can develop in the middle and last row of joints and at the base of the thumb. It is also apparent in the foot at the base of the great toe where a bunion can form.

OA affects more than 30 million Americans. Twelve per cent of US adults have OA. It is a major cause of disability and the incidence of OA increases with advancing age. After the age of 75, more than 80 per cent of people have OA. Women are affected twice as often as men. Areas that are most involved are the neck, low back, hips, knees, the base of the thumbs, and the great toe.

Interestingly, while x-ray evidence of OA is relatively common in people over the age of 65, fewer than half those with OA on x ray have symptoms.

Laboratory tests tend to be normal. If fluid accumulates in a joint as a result of OA, it is generally non-inflammatory.

Conventional x-ray may help establish the diagnosis. Unfortunately, x-ray findings are a late feature of OA. Magnetic resonance imaging is more sensitive.

The American College of Rheumatology criteria for the diagnosis of OA of the knee include knee pain and osteophytes plus one of the following [age> 50 years, stiffness < 30 minutes, and crepitus (crunchiness)].

The American College of Rheumatology criteria for the diagnosis of OA of the hip include hip pain plus two of the following [x-ray evidence of osteophytes, x-ray evidence of joint narrowing, erythrocyte sedimentation rate (ESR) < 20]

Goals of OA treatment include pain relief, minimizing the risk of therapy, slowing disease progression, preventing work disability, and improving the quality of life.

Non drug therapies include weight loss, exercise, patient education, physical and occupational therapy, the use of splints and assistive devices as needed, and vocational counseling.

Low impact aerobic exercise and isometric exercise may be helpful.

Medications used include non-narcotic analgesic medicines, topical therapies and non steroidal anti inflammatory drugs (NSAIDS).

Corticosteroid injections into joints may provide temporary relief. Injections of hyaluronate – especially into knee joints- may also be helpful.

More recently, one very promising modality is the use of mesenchymal stem cells. These are "blank slate" cells that have the capacity to regrow cartilage. The Arthritis Treatment Center in Frederick, Maryland is one of the leading clinical arthritis stem cell centers in the world.

For those with advanced disease, joint replacement surgery may be an option. Surgical indications include intractable pain, loss of function, or advanced arthritis by x-ray. Proper selection of patients is important since obese individuals, unmotivated patients, and obese individuals tend to do less well.

Get more information about osteoarthritis and related conditions as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

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• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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