As they age, many people find themselves coping with osteoarthritis, the type of arthritis that is associated with inflammation of the tissues in the joints. Osteoarthritis leads to pain and stiffness that can make it difficult to open a jar or climb the stairs. But it doesn’t have to put an end to physical activities. There are a wide variety of treatment options that can allow you to continue with the physical activities you enjoy
“Researchers are still investigating how to literally undo arthritis, but there are many treatments available that can alleviate the pain and disability associated with osteoarthritis,” says Elizabeth Gardner, MD, a Yale Medicine Sports Medicine orthopedic surgeon.
Yale Medicine’s orthopedic surgeons are specialists in nonsurgical approaches. They are also expert at performing minimally invasive arthroscopic surgeries. Because they’re academic clinicians, they are continually researching new and better treatments for both routine and complex cases.
How is osteoarthritis different from other forms of arthritis?
There are actually 100 forms of arthritis, many of them rare. Osteoarthritis is the most common, affecting more than 30 million Americans. Another common type, rheumatoid arthritis, affects only 1.3 million people in the U.S.
Both osteoarthritis and rheumatoid arthritis are chronic diseases that can’t be cured. Both types of arthritis affect the joints, so in the early stages it’s possible to confuse the two diseases. The primary difference is that osteoarthritis is a degenerative disease caused by increased wear and tear on the joints, usually in older patients.
Rheumatoid arthritis is an autoimmune disease that tends to develop between the ages of 30 and 60. It causes inflammation of the joint tissue, which can lead to pain and tenderness in the joints, as well as swelling, redness and warmth, stiffness and deformity.
What causes osteoarthritis?
Wear and tear on the joint leads to the breakdown of cartilage, the rubber-like padding that covers and cushions the ends of the bones, allowing them to easily move against each other.
As the cartilage breaks down, bone becomes more exposed. Eventually one bone starts to rub against another, causing pain, damage, swelling and problems with motion. Pieces of bone or cartilage can actually break off and float in the joint, leading to inflammation and more pain.
Who is at risk for osteoarthritis?
Osteoarthritis is most common in people 65 and over, but it can happen at any age. People who are obese are at high risk, because carrying too much weight over a period of years puts unhealthy pressure on the joints, causing the cartilage that supports that weight to break down faster.
The repetitive movements required in some sports or jobs can also lead to arthritis. If there is a genetic predisposition for arthritis or a history of athletic injury affecting one or more joints, it’s possible to begin developing arthritis at a much younger age, even in the 20s.
While osteoarthritis can develop in any joint, it commonly affects the joints in the big toes, fingers or thumbs; as well as in the hips, knees, lower back, neck and spine. About half of the population will develop osteoarthritis of the knee at some point in their lives.
What are the symptoms of osteoarthritis?
The most common symptoms of osteoarthritis are pain and stiffness, which can get worse gradually. Many people start to notice issues first thing in the morning or after extended activity. Other symptoms include:
- Limited range of motion
- Moving a joint causes clicking or cracking sounds or a sensation of grinding
- Pain that gets worse toward the end of the day
If osteoarthritis is limiting your movement to the extent that you become more sedentary, your overall health may suffer. This can even put you at higher risk for such conditions as diabetes and heart disease.
How is osteoarthritis diagnosed?
The doctor will take a medical history and perform a physical exam. An X-ray is the first step to helping assess severity and determine whether your arthritis is causing other problems, such as a narrowing of the joint space, thinning of the bone or bone spurs. Occasionally an MRI or blood tests may be ordered to rule out injuries or diseases that cause similar symptoms.
When you visit the doctor, you should be prepared to describe your pain, when it occurs and in which parts of the body. You should tell your doctor about your activities and any past injuries in the areas where you are feeling pain.
How is osteoarthritis treated?
There is no cure for osteoarthritis, but, if the disease is diagnosed early, you may be able to slow its progression. Your doctor may suggest that you lose weight.
Exercise can be one of the best treatments. You may want to consider a low-impact exercise, such as walking instead of running, in order to reduce the resulting wear and tear on your joints. Studies have shown that regular yoga practice can decrease pain and improve joint flexibility for people with osteoarthritis.
Other treatments may include:
- Medications, starting with over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDS), and maybe including corticosteroids, which are powerful anti-inflammatories, or hyaluronic acid, which acts as a shock absorber
- Ice packs and/or heating pads
- Physical therapy to improve flexibility, strength and range of motion
- For particularly severe cases, supportive devices, such as splint to provide support and reduce pain and swelling; or a brace, cane or shoe orthotics
How can surgery help osteoarthritis?
Your doctor typically recommends surgery only if your osteoarthritis has progressed to the point where nonsurgical treatments are no longer effective. Depending on your situation, the goals of surgery might include smoothing out or repositioning bone; removing loose pieces of bone and cartilage, or replacing an entire joint. Your doctor will tell you about the type of surgery that is best for your specific problem.
Options may include:
Arthroscopy: This is a quick, minimally-invasive procedure where the surgeon makes a small incision or two, inserts pencil-tip-sized surgical instruments and a tiny video camera, and makes repairs to the joint. Arthroscopy often provides at least temporary relief from pain and stiffness.
Osteotomy: By cutting and reshaping bone, this surgery can correct poor knee alignment and other problems.
Total joint replacement: The surgeon will remove the damaged joint and replace it with an artificial joint. The artificial joints are made of metal or polished ceramic that can be attached with special cement or that the bone can grow into so that it will stay in place. These joints can last up to 15 years or longer.
Joint fusion: The surgeon will remove the damaged cartilage and fuse, or weld together, the bones on either side of it, creating one solid bone. You will no longer have pain, but the joint will no longer be able to move. This procedure is usually considered to be a last resort.
How does Yale Medicine stand out in its treatment of osteoarthritis?
Community physicians refer patients from all over Connecticut to Yale Medicine Orthopedics & Rehabiliation because we offer the most up-to-date treatment options available—and our specialists are continually looking for ways to improve upon them. We can often draw upon the expertise of a range of specialists, from orthopaedic surgeons to neurologists to rheumatologists. We also provide the most advanced diagnostic imaging, blood testing and physical and occupational therapy.
“At Yale Medicine, we have an integrated team of specialists who provide care for osteoarthritis patients across the spectrum of disease,” says Dr. Gardner. “Supported by scientists who are on the cutting edge of research, we aim to offer patients the full range of treatment options, from nonsurgical options such as injections to surgical joint replacement. We tailor the treatment to each individual patient and his or her personal activity goals.”