OSTEOARTHRITIS INTRODUCTION

Joint osteoarthritis pain is a disease that can affect over 200 joints.

JOINT OSTEOARTHRITIS

Introduction

Osteoarthritis (OA) is a painful disease that can affect any of over 200 joints. OA is the most common form of degenerative joint disease and one of the most damaging conditions. This disease is a complicated and varies in joint symptoms and how it progresses in each patient. Osteoarthritis has associated genetic and environmental risk factors as well. Each patient can manifest varying degrees of severity and the disease may impact different joints depending on many factors.

Osteoarthritis often presents slowly and without an obvious cause or injury. This is classified as primary joint osteoarthritis. Primary OA is the most common for of osteoarthritis joint pain is very often related with aging.

When joint osteoarthritis begins secondary to joint trauma, chronic disease, or repetitive use injuries, it is classified as secondary joint osteoarthritis. Additionally, multiple research studies have found that certain populations are at higher risk for joint osteoarthritis. Women, for example, are at a higher risk for developing osteoarthritis and may develop more severe disease.

Osteoarthritis Features

The osteoarthritis patient usually presents with joint pain that is described as aching without any known injury. Typical characteristics include worsening pain with activity and is relieved by rest. A common phenomenon, referred to as “gelling,” can occur when starting joint movements after a period of rest or inactivity. Popping, cracking, and joint “locking” can be present during the later stages of the disease process.

The most common joints affected are the neck, lower back, hips, knees, hands, and feet. Patients may experience joint pain symptoms in one or many of these joints.

Specific Joint Osteoarthritis Symptoms

Stiffness – Decreased Movement

Cervical Spine (Neck)

Stiffness around the neck; pain radiating away from the neck and possibly down the arms; formation of bone spurs that can push on veins, arteries, or nerves of the neck

Lumbar Spine (Lower Back)

Common lower back pain symptoms include stiffness, muscle spasm, decreased range of motion, radiating pain to other areas, and spinal stenosis (narrowing within the spine)

Hip Joint

Onset of joint pain symptoms is gradual and primarily located in the hip, groin, or inner thigh. In addition, reduced hip movement, difficulty walking, and discomfort when sitting and standing from chairs.

Knee Joint

Knee pain symptoms from joint arthritis include pain with motion, limited movement, joint “cracking” or “popping” noises, joint instability, and swelling.

Thumb Joints or First Carpometacarpal Joint

Symptoms include tenderness at the base of the thumb, joint deformity of the thumb, worsening symptoms with repetitive hand activities, and more commonly reported by women.

Big Toe Joint First Metatarsophalangeal Joint

Patients report a slow onset, joint deformity, swelling joints, and pain with walking or tight fitting shoes.

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Symptoms of Osteoarthritis

Joint Pain Symptoms

A variety of signs and symptoms of osteoarthritis occur during the beginning stages of the disease process. These symptoms can change throughout the development and progression of the disease process.

Joint Pain

The pain in osteoarthritis can vary in intensity and/or persistence and progress slowly over the years. The pain usually increases by the use of the joint and gets relieved with rest.

Joint Tenderness

The joints that are affected in each patient can often present with tenderness when palpated. The identification of tenderness can be useful in your treatment plan and could help specifically diagnose for osteoarthritis.

Limitation of Motion

Osteoarthritis causes a significant reduction in the range of motion. This is due to decreased use of the joint. The joint also presents with “cracking and/or popping” when it is moved, known as crepitus.

More Symptoms of Joint Osteoarthritis

Joint Swelling and Deformity

The affected joints can become deformed as the years progress with osteoarthritis. These joints can present with swelling, increasing in size, and misalignment. The cause of this comes from the bony overgrowth formation with occasional collection of fluid around the joint. This defect is a reconstruction of the bone and cartilage on either side of the joint and can be present in small or large joints.

Joint Pain & Stiffness

One of the most notable symptoms that patients recognize is the stiffness of the joint in the early morning. This stiffness usually lasts less than 30 minutes and patients report difficulty with “getting started in the mornings.”

Joint Instability

The affected joints of osteoarthritis, especially weight bearing joints, can progress to the point of “giving away” or buckling. This causes the patient to fall or stumble. This is a sign of muscle weakness surrounding the joint space and advances as the disease progresses.

Osteoarthritis can present in different ways and is not always detected by the patient until well into its development. The patient may be without symptoms or even ignore the symptoms as they progress until a point of pain that can no longer be tolerated. Also, there are specific red flags that a patient should be evaluated for advanced disease.

Red Flags for Osteoarthritis

Serious Joint Findings

1

Repeated and disabling activity related joint pain

2

Severe joint stiffness - inability to move joints

3

Extensive joint swelling - bulging around joint

4

Young people with joint symptoms described here

5

Unusual joint involvement and severe inflammation

6

Severe pain at rest or when sleeping

7

Rapidly worsening pain and disability

8

Arthritis symptoms associated with weight loss

Risk Factors of Osteoarthritis

Aging

As the joint and patient age, the chances for the development of osteoarthritis increases. The changes that occur with the joint aging include the thinning of the cartilage, reduction in hydration of the joint, and an accumulation of proteins. These combined factors cause an increased brittleness of the joint.

Joint injury

Injuries to joints can increase the risk of OA. The onset of OA can occur within 10 years after the injury. Injuries can occur in tendon or ligament tears or even fractures that involve the joint.

Obesity

Excess weight increases the load on the joint. This also increases the possibility of malfunctioning metabolism. A malfunctioning metabolism increases the risk for osteoarthritis.

Genetics

Specific genetic factors can result in the development of premature OA that can occur in as early as adolescence. In fact, forty percent of the risk for less severe forms of OA have a genetic component.

Anatomical Factors

The shape of the joint can change the course of the development of OA. This is true in the case of the hip, which can cause a lower-extremity misalignment. OA in the hip can cause the patient to change the way the patient walks. A change in walking gait can then cause knee and/or ankle joints to misalign.

Gender

Osteoarthritis of the hands and knees has a higher development rate in women when compared to both genders.

Evaluation and Treatment of Osteoarthritis

A combination of history, physical exam, x-ray studies, and laboratory findings are all important in the diagnosis of joint osteoarthritis pain. A history of trauma to the joint or family history of osteoarthritis is important when evaluating for OA. A physical exam ensures visualization and palpation of the joint for tenderness, warmth, and misalignment of joints.

A useful tool that your healthcare provider may utilize to help differentiate osteoarthritic pain from other possible disease processes is blood work. There are many different lab values that can be utilized and your provider will discuss this possibility with you. These lab values can provide critical information in helping to choose the best treatment.

Osteoarthritis Treatment Plan

Osteoarthritis has no cure. The primary goal of treatment is to alleviate the pain symptoms as much as possible while slowing the progression of the disease. A healthy balance of exercise, rest, bracing, and therapy can all be helpful. You can find more information from the Arthritis Foundation’s website here.

For joint pain not responsive to more conservative measures, treatment with interventional pain management and prescription medications offer opportunities to significantly improve pain and functioning. For example, knee pain treatments including viscosupplementation, steroid joint injection, and genicular knee block/nerve ablation are all valuable options. Our Oklahoma pain management specialists provide the most advanced surgery-free joint treatments available.

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