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AGING CONDITIONS: ARTHRITIS

 

Introduction to Arthritis

There are over 100 types of arthritis, and not all are related to age. The most common type – osteoarthritis, followed by rheumatoid arthritis.

Most joints allow smooth movement between bones and to absorb shock from movements. The joint is made up of:

  • Joint capsule - a tough membrane sac that holds all the parts of the joint together.
  • Ligaments, tendons, and muscles - hold the parts of the joint in place and allows the joint to move in the right directions, preventing movement in the wrong directions.
  • Cartilage - a hard slippery coating on the end of each bone. This cartilage breaks down and wears away in osteoarthritis.
  • Synovium - a thin membrane inside the joint capsule.
  • Synovial fluid - a lubricating fluid that assists easy movement and keeps the cartilage healthy.

More information on arthritis

 

Osteoarthritis

Osteoarthritis is the most common of arthritis and is one of the most frequent causes of physical disability among adults. It is also known as degenerative joint disease or the "wear-and-tear" arthritis.

Osteoarthritis is primarily a disease in older people but can occur as a secondary condition in younger people. More than half the population over age 65 have a degree of osteoarthritis in at least one joint. It affects both men and women, with more men before age 45, having the disease, but after age 45, it is more common in women.

 

Causes & Impact of Osteoarthritis

Any factor that causes wear on the joints, can accelerate the onset of osteoarthritis. This includes: injury, excess weight, genetics and occupational factors.

Osteoarthritis mostly affects the cartilage, of the joint. Healthy cartilage provides a lubricating layer to help bones articulate with each other and to absorb energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint. Over time, the joint may also become mishapened.
Osteoarthritis may also be complicated by small growths on the edges of joints called bone spurs [osteophytes]. Bits of bone or cartilage can break off and float inside the joint space, causing greater pain and damage.


Osteoarthritis affects each person differently, and has a highly variable onset rate. Scientists have yet to determine what causes osteoarthritis, but suspect a combination of factors, including: the aging process, being overweight, joint injury and activities putting excessive stresses on joints.

Osteoarthritis most often occurs at the:

  • knees
  • hips
  • lower back
  • neck
  • ends of the fingers
  • thumbs

The movement restriction and pain that accompany osteoarthritis has pervasive lifestyle effects that can lead to limitation of daily and work activities, with depression a not uncommon result. In spite of this, most people with osteoarthritis can lead active and productive lives, controlling the disease and its symptoms.

Usually, osteoarthritis comes on slowly. Early in the disease, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint. Most often it occurs in the hands, knees, hips and spine.

 

Diagnosis of Osteoarthritis

No single test can diagnose osteoarthritis. Most doctors use a combination of the following:

  • Clinical history - To determine history of movement restriction and pain, and any medication taken.
  • Physical examination - general exam including reflexes and muscle strength. Movement ability is also checked.
  • X rays – show much joint damage has been done to cartilage and bones.
  • Blood tests – To rule out other causes
  • Joint aspiration - drawing fluid from the joint for examination.

The complication in diagnosis of osteoarthritis cases, is primarily due to the reality that most adults have some degree of osteoarthritis. Other causes of the symptoms has to be ruled out before a confirmation of osteoarthritis as the cause is required.

 

General Symptoms of Osteoarthritis

  • Steady or intermittent pain in a joint – however, two thirds of those with osteoarthritis don’t complain of plain.
  • Stiffness in a joint after periods of inactivity
  • Swelling or tenderness in one or more joints
  • A crunching feeling or the sound of bone rubbing on bone
    Joints that feel hot, tender and stiff are generally due to rheumatoid arthritis, not osteoarthrtitis.

More Information on Osteoarthritis

 

Specific Joint Symptoms & Treatments

Hands

Osteoarthritis of the fingers is more common in women after menopause and appears to have some hereditary factors. Small, bony knobs appear on the joints of the fingers, with fingers becoming enlarged and gnarled. Aching, stiffness, and numbness are common. Osteoarthritis of the hands can be treated with medications, splints, or heat treatment.

Knees

The knees are the most commonly affected by osteoarthritis, being the body's primary weight-bearing joints. Stiffness, swelling and pain in the knees makes it hard to walk and manoeuvre. Untreated, osteoporosis in the knees can lead to disability, requiring knee replacement. Medications, weight loss, exercise, and walking aids can reduce pain and disability.

Hips

Osteoarthritis in the hip can cause pain in the hips, groin, inner thigh, buttocks, or knees. Pain in the knees often confuses those into thinking they have knee problems, when in reality, the disease is in the hips. This is due to the stiffness in the hips impacting the normal movement of the limb, causing the knees to strain when trying to compensate for the misalignment. Walking aids, such as canes or walkers, can reduce stress on the hip and knees. Severe cases require hip replacement.

Spine

Weakness or numbness of the arms or legs is a common symptom of osteoarthritis of the spine. The neck and lower back are the most common areas of the spine that experience stiffness and pain. Heat treatments, exercise programs to strengthens the back and abdominal muscles and using supportive mattresses provide relief. In severe cases, surgery is indicated to reduce pain and help restore function.

 

General Osteoarthritis Treatments

There are now many nutritional supplements available containing glucosomine and condrotin that are proving extremely effective in helping prevent deterioration of tissue surrounding the joints and erosion of joint bones.

Osteoarthritis treatment involves a combination of therapies tailored to the patient's needs, lifestyle, and health. Osteoarthritis treatment has four general goals:

  • Improve joint care through rest and exercise.
  • Maintain an acceptable body weight.
  • Control pain with medicine and other measures.
  • Achieve a healthy lifestyle.

A typical treatment plan may include:

Exercise Program Guidelines

The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. Exercises used include :

  • Maintain strength and agility in joints – resistance exercise bands, neck, back and abdominal
  • Extend your range of movement – agility exercises, often using water as a support medium to remove the impact of weight from the joints during movement.
  • Reduce weight – aerobics, keep supple with stretching exercises
  • Relaxation

Learning to recognize the body's signals, are important to use as signals when to stop or slow down. Techniques include simple rest, meditation, biofeedback

Joint Protection and Assistive Devices

Canes, splints and braces can provide extra support for weakened joints and to keep the joint in the correct position during sleep or activity. Use should be balanced with sufficient exercise to prevent stiffness and weakness.

Thermal Treatments

Both warm and cold packs can provide pain relief. Check with a doctor or physical therapist to as to which treatment is best for your condition.

Orthotics

For osteoarthritis in the knee, patients may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

Weight Loss

To reduce stress on weight-bearing joints and limit further injury.

Surgery

Surgery may be performed to:

  • Remove loose pieces of bone and cartilage from the joint if they are causing mechanical symptoms of buckling or locking
  • Resurface (smooth out) bones
  • Reposition bones
  • Replace joints with artificial joints called prostheses. These artificial joints can be made from metal alloys, high-density plastic, and ceramic material and can last 10 to 15 years or more. Choice of material is determined by the patients weight, gender, age , activity level and other medical conditions. The hip or knee joints are the most commonly replaced.

Medication

Medication is used to eliminate or reduce pain and to improve functioning. The most common medications used in treating osteoarthritis are :
Acetaminophen - (Tylenol, Excedrin) to relieve pain. People with liver disease, people who drink alcohol heavily, and those taking blood-thinning medicines or NSAIDs should use acetaminophen with caution.
NSAIDs (non-steroidal anti-inflammatory drugs) – to reduce inflammation and relieve pain.

Movement Therapy

Joint stiffness associated with arthritis is mostly because people with arthritis avoid movements that can increase pain. Two treatment methods of instant benefit are: physical therapy and occupational therapy.

Physical Therapy - by mobilizing arthritic joints, using physical therapy, is often of great benefit for those suffering this disease. The physical therapist will also teach you exercises that work out stiffness, without further damaging your joint. Physical therapy also is useful after an injury, such as from a fall, and after joint surgery, especially for artificial joint replacement.

Occupational Therapy – applies movement to everyday activity. The therapist can teach you how to reduce strain on your joints by modifying your home and workplace environments to reduce motions that may aggravate arthritis. They also may provide splint type supports for your hands or wrists, and recommend other devices to aid in tasks such as preparing food, driving, bathing, dressing, housekeeping and certain work activities.

 

Rheumatoid Arthritis

Osteoarthritis affects only joints, rheumatoid arthritis affects other parts of the body besides the joints. It begins at a younger age than osteoarthritis, with swelling and redness in joints, with accompanying symptoms of feeling sick, tired, and sometimes fever [rheumatic fever].

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Further Resources

Latest News on Arthritis and Treatments

Arthritis Foundation

National Institute of Arthritis Muscoskeletal and Skin [NIAMS]

Arthritis Care [UK]

 


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