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Osteoarthritis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A common and chronic condition, osteoarthritis affects the joints, causing discomfort, stiffness, and swelling. When the cartilage that cushions the ends of the bones wears down over time, the bones rub against each other, causing osteoarthritis to occur. The hands, knees, hips, and spine are the most common places to get it.

Causes of Osteoarthritis

In addition to being associated with aging and repeated use of the joints, osteoarthritis is often referred to as wear-and-tear disease. Osteoarthritis does not only result from mechanical damage, but also from inflammation and changes in the bones and connective tissues that support the joints. There are several factors that can increase the risk of developing osteoarthritis, including:

• Age: Osteoarthritis is more common in older adults, as the cartilage becomes thinner and less resilient over time.

• Weight: Being overweight or obese puts extra pressure on the weight-bearing joints, such as the knees and hips, and accelerates cartilage breakdown.

• Genetics: Some people inherit genes that make them more prone to osteoarthritis or affect the shape and stability of their joints.

• Injury: Trauma or injury to a joint can damage the cartilage and trigger osteoarthritis later in life. This can occur due to sports, accidents, or occupational activities.

• Other diseases: Some diseases can affect the joints and cause osteoarthritis, such as rheumatoid arthritis, gout, diabetes, and infections.

Symptoms of Osteoarthritis

Some of the common signs and symptoms of osteoarthritis include: The severity and frequency of symptoms can vary from person to person and depend on the affected joint.

• Pain: The affected joint may hurt during or after movement or when applying pressure.

• Stiffness: The joint may feel stiff or rigid, especially in the morning or after a period of inactivity.

• Tenderness: The joint may feel tender or sore when touched or pressed.

• Loss of flexibility: The joint may have a reduced range of motion or difficulty moving in certain directions.

• Grating sensation: The joint may produce a cracking or popping sound or feel like it is grinding when moving.

• Bone spurs: The joint may develop extra bits of bone around the edges, which can be felt as hard lumps under the skin.

• Swelling: The joint may become swollen or inflamed due to fluid accumulation or tissue irritation.

Diagnosis of Osteoarthritis

In addition to a medical history and physical examination, osteoarthritis can be diagnosed through imaging or laboratory testing. As well as checking for any risk factors or underlying conditions that may contribute to osteoarthritis, the doctor will ask about symptoms, onset, duration, frequency, severity, and factors that worsen or improve them. As part of the physical examination, the doctor will inspect the affected joint for signs of damage, such as tenderness, swelling, redness, warmth, deformity, and reduced mobility, as well as perform some maneuvers to test the joint's stability and function.

In order to confirm the diagnosis or rule out other causes of joint pain, such as rheumatoid arthritis, gout, infection, or fracture, the doctor may order some tests, such as:

• X-rays: X-rays can show the narrowing of the space between the bones in the joint due to cartilage loss. They can also reveal bone spurs or other changes in the bone structure.

• Magnetic resonance imaging (MRI): MRI can provide more detailed images of the joint structures, including the cartilage, bone, ligaments, tendons, and synovial fluid. MRI can help detect early signs of cartilage damage or inflammation that may not be visible on X-rays.

• Joint fluid analysis: The doctor may use a needle to draw fluid from the joint for further examination. The fluid can be tested for signs of infection, gout crystals, blood cells, or other substances that may indicate the cause of joint inflammation.

Treatment of Osteoarthritis

Although osteoarthritis cannot be cured, there are a number of treatments that can help manage the symptoms and slow down the progression of the disease.

• The severity and location of osteoarthritis

• The impact of osteoarthritis on daily activities and quality of life

• The preferences and goals of the patient

• The potential benefits and risks of different treatments

The treatment options for osteoarthritis include:

• Medications: There are several types of medications that can help relieve pain and inflammation caused by osteoarthritis. Some of the common ones are:

• Acetaminophen: This is a pain reliever that can help with mild to moderate osteoarthritis pain. However, it does not reduce inflammation and may cause liver damage if taken in high doses or for a long time.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are drugs that can reduce both pain and inflammation. They include over-the-counter medications like ibuprofen and naproxen as well as prescription drugs like celecoxib and diclofenac. Long-term use or in high-risk patients are more likely to experience stomach upset, bleeding problems, kidney damage, and cardiovascular complications.

• Duloxetine: This is an antidepressant that can also help with chronic pain, including osteoarthritis pain. It works by affecting the levels of certain chemicals in the brain that are involved in pain perception. Duloxetine can cause side effects, such as nausea, drowsiness, dry mouth, and constipation.

• Therapies: There are several types of therapies that can help improve the function and mobility of the affected joint and reduce the need for medications. Some of the common ones are:

• Physical therapy: This involves exercises and stretches that can strengthen the muscles around the joint, increase the flexibility and range of motion of the joint, and reduce pain and stiffness. A physical therapist can design a customized program that suits the patient’s needs and abilities.

• Occupational therapy: This involves learning how to perform daily tasks and activities without putting extra stress on the joint. An occupational therapist can provide tips and tools that can make life easier and more comfortable for the patient, such as using assistive devices, modifying the home or work environment, or changing the way of doing things.

• Heat and cold therapy: This involves applying heat or cold to the affected joint to ease pain and inflammation. Heat can help relax the muscles and improve blood flow to the joint, while cold can help numb the nerve endings and reduce swelling. Heat or cold therapy can be done using hot or cold packs, heating pads, ice packs, warm baths, or showers.

• Injections: There are some injections that can be given directly into the joint to provide temporary relief from pain and inflammation. Some of the common ones are:

• Corticosteroids: These are anti-inflammatory drugs that can reduce swelling and pain in the joint. They are usually given when other treatments have failed or are not suitable. Corticosteroids can provide relief for several weeks or months, but they may also cause side effects, such as infection, bleeding, bone loss, or nerve damage.

• Hyaluronic acid: This is a substance that is naturally found in the joint fluid and helps lubricate and cushion the joint. It can be injected into the joint to supplement the natural hyaluronic acid and improve its function. Hyaluronic acid can provide relief for several months, but it may also cause side effects, such as pain, swelling, or allergic reactions.

• Surgery: There are some surgical procedures that can help repair or replace a damaged joint when other treatments have failed or are not enough. Some of the common ones are:

• Arthroscopy: This is a minimally invasive procedure that involves inserting a thin tube with a camera and instruments through a small incision near the joint. The surgeon can use this to remove loose cartilage fragments, smooth rough surfaces, or trim bone spurs that interfere with the joint movement.

• Osteotomy: This is a procedure that involves cutting and reshaping the bone near the joint to improve its alignment and distribution of weight. This can help relieve pressure on the worn-out part of the joint and shift it to a healthier part.

• Arthroplasty: This is a procedure that involves removing the damaged joint and replacing it with an artificial one made of metal, plastic, or ceramic. This can help restore the function and appearance of the joint and eliminate pain.

Prevention of Osteoarthritis

Osteoarthritis cannot be completely prevented, but there are some measures that can help reduce the risk or delay its onset. Some of these include:

• Maintaining a healthy weight: Being overweight or obese increases the stress on the joints and accelerates cartilage wear. Losing excess weight can help relieve the pressure on the joints and prevent further damage.

• Eating a balanced diet: Eating a nutritious diet that provides adequate amounts of calcium, vitamin D, antioxidants, omega-3 fatty acids, and other nutrients can help support bone health, cartilage health, and overall health.

Exercising regularly: Exercising regularly can help strengthen the muscles around the joints, improve blood circulation, enhance flexibility, and prevent stiffness. Exercising can also help control weight, improve mood, and prevent other diseases.