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Osteoarthritis There are more than 100 kinds of arthritis, which literally means joint inflammation. According to the Centers for Disease Control and Prevention (CDC), about 50 million Americans are afflicted, and 27 million have osteoarthritis, by far the most common form, especially among older people. Sometimes called degenerative joint disease, osteoarthritis accounts for most of the hip and knee replacement surgeries performed in the United States. As with other types of arthritis, women are at higher risk than men for the condition. Osteoarthritis affects structures throughout the joint. Among them the cartilage, the slippery tissue that covers the ends of bones in a joint, is usually affected. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away, which allows bones under the cartilage to rub together. This causes bone remodeling and change in boney shape and loss of motion of the joint. Over time, the joint loses its normal shape. Also, bone spurs— small growths called osteophytes—may grow on the edges of the joint. By the time a person has symptoms from osteoarthritis, it is no longer just a disease of cartilage. Bone has changed, muscles across the joint have often weakened and there is occasionally inflammation in the lining of the joint. Unlike some other forms of arthritis, osteoarthritis only affects joints, not internal organs. Rheumatoid arthritis—another common form of arthritis—affects other parts of the body besides the joints. It causes inflammation and may make people feel sick, tired and sometimes feverish, among other symptoms. Some younger people get osteoarthritis from a joint injury, but osteoarthritis most often occurs in people over 40. In fact, at least 80 percent of people over age 55 have X-rayevidence of osteoarthritis in at least one joint, and approximately onethird have symptoms of the disease. Since the number of older Americans is increasing, so is the number of people with osteoarthritis. Before age 55, more men have the condition (often the result of a sports or work injury), while after age 55, osteoarthritis is more common in women.


Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms develop slowly and may be stable for many years. Researchers do not yet know what causes the disease, but they suspect a combination of factors in the body and in the environment. Genetics, weight and stresses on the joints from certain jobs, hobbies or other activities may affect the disease and how a person reacts to it. Usually, osteoarthritis develops slowly. Early on, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint but most often occurs at the joints in the hands, hips and knees. Hands: Osteoarthritis of the fingers is the one type of the disease that seems to be predominantly hereditary. More women than men have it, and risk increases aftermenopause. Small, bony knobs appear on the end joints of the fingers. They are called Heberden’s nodes. Similar knobs (called Bouchard’s nodes) can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled and may ache or be stiff and numb. The base of the thumb joint is also commonly affected by osteoarthritis. This kind of osteoarthritis can be helped by medications, splints or heat treatment. Knees: The knees are among the body’s main weight-bearing joints. They are also among the joints most commonly affected by osteoarthritis. An afflicted knee may be stiff, swollen and painful, making it hard to walk, climb or get in and out of chairs and bathtubs. If not treated, osteoarthritis in the knee can lead to disability. However, even with treatment, osteoarthritis may progress. Medications, losing weight, exercise and walking aids can reduce pain and disability. In severe cases, knee replacement surgery may be required. Research studies show that being overweight increases the risk of developing osteoarthritis of the knees and show that injuries to the knee are a major cause of disease. Hips: Osteoarthritis in the hip can cause pain, stiffness and severe disability. People most often feel the pain in their groin, front of thighs or knees. Walking aids, such as canes or walkers, can reduce stress on the hip. Osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care a challenge. Walking aids, medication and exercise can help relieve


pain and improve motion. A health care professional may recommend hip replacement if the pain is severe and not helped by other treatments. Researchers suspect that genes play a role in some cases of osteoarthritis. In one rare form of disease starting as early as age 20, affected people may have a defect in the gene that helps the body make collagen, the protein that makes up cartilage. More commonly, minor genetic variations may increase the risk of osteoarthritis. They may affect minor molecules in the joint, changing the metabolism of joint structures, or they may change the shape of a joint during growth, leaving slight defects in the way bones that come together in joints fit together. This may cause cartilage to wear away more quickly than normal. Double-jointedness, an inherited trait where the joints bend farther than usual, may also increase risk for osteoarthritis. Diagnosis The warning signs of osteoarthritis include steady joint pain or intermittent pain that usually worsens with activity, brief stiffness after getting out of bed, joint swelling or tenderness in one or more joints and a crunching feeling or sound of bone rubbing on bone. No single test can diagnose osteoarthritis. Most health care professionals use a combination of the following methods to diagnose the disease and rule out other conditions: Clinical history. The health care professional will begin by asking you to describe your symptoms, and when and how the condition started. Be sure to provide an accurate description of pain, such as what makes it worse or better, stiffness and joint function and how they have changed over time. You should also share information on other medical conditions and any medicines you are taking. Physical examination. The health care professional will check your general health and examine joints that bother you, as well as your reflexes and muscle strength. He or she will observe your ability to walk, bend and carry out activities of daily living.


X-rays and other imaging techniques. X-rays can show how much joint damage has been done; they may show such things as cartilage loss, bone damage and bone spurs. But there is often a big difference between the severity of osteoarthritis that the X-ray shows and the degree of pain and disability the patient has. In addition, X-rays may not show early osteoarthritis damage (before much cartilage loss has taken place). Other types of imaging tests may also be used to look for damage that cannot be seen on X-ray, such as magnetic resonance imaging (MRI) or ultrasound. Other tests. A health care professional may order blood tests to rule out other possible causes of your arthritis. Another common test includes “joint aspiration,” or “arthrocentesis,” during which fluid is drawn from the joint for examination. The fluid can be examined to see if it contains the crystals that cause gout or pseudogout or if it is moderately or severely inflamed, which suggests you have rheumatoid arthritis. It is usually not difficult to tell if a patient has osteoarthritis. It is more difficult to tell if the disease is causing the patient’s symptoms. Osteoarthritis is so common, especially in older people, that it may mask other conditions that are actually responsible for symptoms. A health care professional will try to find out what is causing the symptoms, ruling out other disorders and identifying conditions that may make the symptoms worse. Not everyone with osteoarthritis feels pain. In fact, about one-third of people for whom X-rays show evidence of osteoarthritis report pain or other symptoms. The most common way to measure pain is for a health care professional to ask you about it. For example, you may be asked to describe the level of pain you feel on a scale of one to 10. Use specific words to describe your pain-like aching, burning, stinging or throbbing to better convey what is happening. It’s also important to describe if and where the pain travels (for example, from the groin down to the knee).


Since health care professionals rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. On a daily basis, describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain and your reactions to the pain. For example: “On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees.” The diary will give your health care professional some insight into your pain and may play a critical role in the management of your disease. Treatment A successful treatment program for osteoarthritis may involve a combination of therapies tailored to your needs, lifestyle and health. Work closely with your health care provider to help create the most effective treatment for you. In general, osteoarthritis treatment has three general goals:  Control pain through drugs and other measures.  Improve joint care through rest and exercise.  Maintain an appropriate body weight and achieve a healthy lifestyle. In addition to the guidance of your primary health care professional, you may need care from a physical therapist, a rheumatologist (a physician who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and bones) or a physiatrist (a physician who specializes in the diagnosis and management of injuries and diseases causing pain, loss of function and disability). Treatment plans often include the use of exercise, massage, heat, relaxation techniques, splints and braces and local injections to relieve pain. Osteoarthritis treatment plans also often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery and nontraditional treatments.


If you are diagnosed with osteoarthritis, you may be prescribed a variety of medicines to eliminate or reduce pain and to improve functioning. Health care professionals consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and a drug’s potential side effects. You must use medicines carefully, and tell your health care professional about any changes that occur. The following types of medicines are commonly used in treating osteoarthritis: Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some NSAIDs over the counter (for example, aspirin, ibuprofen and naproxen). Other NSAIDs are available by prescription only. These drugs all reduce inflammation or swelling and relieve pain. However, each NSAID is a different chemical and can have slightly different effects in the body.NSAIDs can cause stomach irritation or affect kidney function and blood pressure. Plus, there is the potential for cardiovascular events associated with the use of NSAIDS. The longer you use NSAIDs, the more likely you are to have side effects. Many other drugs cannot be taken with NSAIDs. NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency and hypertension. It’s important to ask your health care professional for safety information associated with pain relievers with your personal health history in mind. A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2), which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. Celecoxib (Celebrex) is currently the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart attack and stroke; discuss these risks with your health care professional. For more information on the risks associated with Celebrex. Recently, NSAIDs have become available in topical form in the United States. Such preparations are much safer to use because lower levels of medication reach the


bloodstream, and they don’t pass through the stomach. They are less effective than oral NSAIDs, however. Acetaminophen (Tylenol). This analgesic and fever-reducer (antipyretic) is not an NSAID and does not reduce inflammation. It is less likely to irritate the stomach than NSAIDs. Its availability over the counter, low cost and mild side effects make it the drug of choice for treating mild to moderate arthritis pain, but NSAIDS are usually more effective for patients with moderate to severe pain. Long-term use of acetaminophen taken multiple times daily may be associated with liver damage or inflammation of the kidneys (nephritis). Patients with liver disease and heavy alcohol drinkers should not use acetaminophen without first talking to a health care professional. Health care professionals may prescribe several other medications for osteoarthritis. They include: Tramadol hydrochloride (Ultram). Ultram is a prescription narcotic analgesic that provides pain relief for short-term acute flare-ups of osteoarthritis with fewer side effects than NSAIDs. Your health care professional may recommend tramadol in combination with acetaminophen for maximum pain relief. Rubs and sprays (for example, capsaicin cream) applied directly to the skin. Mild narcotic medications (opioids), which, while very effective, are potentially addictive and may have multiple side effects. Corticosteroids. These powerful anti-inflammatory hormones are made naturally in the body or produced synthetically. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a short-term measure. Colchicine. This drug is often prescribed to treat crystal arthritis, which sometimes coexists with osteoarthritis. Colchicine may help people who have crystal arthritis (either pseudogout or gout), in addition to their osteoarthritis. People who have kidney or liver disease may be unable to use colchicines. Discuss benefits and risks with your health care professional.


Medicines used to treat osteoarthritis may have side effects, so it is important to learn about the drugs you are taking. Even nonprescription drugs should be reviewed. Certain patients may be at greater risk for side effects, such as those with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke and those who consume alcohol. The risk of certain side effects in some osteoarthritis medications may be reduced by taking the drug with food. Some patients should avoid stomach irritants such as alcohol, tobacco and caffeine. Other medicines may be taken to protect the stomach lining by coating the stomach or blocking stomach acids. These measures help but are not always completely effective. Other options for relieving the pain and damage caused by osteoarthritis include: Viscosupplements. These medications use hyaluronic acid (or hyaluronate) to replace the synovial fluid that helps lubricate the joints, which is lost in patients with osteoarthritis. (Hyaluronic acid is one of the two natural lubricants in synovial fluid.) It is approved by the U.S. Food and Drug Administration for the treatment of knee pain in osteoarthritis patients who are unresponsive to nonpharmacologic measures and analgesic medications and who have significantly increased flares of inflammation or extensive inflammation. Even though FDA approved, controversy remains over the effectiveness of hyaluronic acid injections. The drugs, which include hyaluronan (Hyalgan) and hylan-GF-20 (Synvisc), are injected directly into the joint. These drugs are usually injected into the knee, but their use in other joints is being studied. Injections are typically given weekly over several weeks, and the pain relief may last for a few months. Because it is made from rooster combs, people with sensitivity to birds, feathers or eggs should not receive viscosupplements. Researchers are testing whether hyaluronic acid can slow the progression of osteoarthritis. Physical or occupational therapy. The goals of occupational and physical therapy are to preserve the use of your joints, restore lost abilities, maintain your fitness, help you adapt to new levels of activity and help you maintain the ability to partake in the activities you enjoy. Occupational therapy can teach you how to reduce the strain on your joints during daily activity, and physical therapy can


teach you exercises designed to preserve and strengthen your joints. Some of the therapeutic methods available include rest during flare-ups; applying heat or cold; exercise, including water exercises, strength exercises and recreational exercise; specific exercise to help you prepare for or recover from surgery if surgery is prescribed; joint protection activities and exercises; and assistive devices, such as a bath stool in your shower or a shoe horn. For more Information visit us our website: safegenericpharmacy.com

Osteoarthritis  

Pain is one of the most common human experiences. Yet pain has never been fully accepted as a medical problem.

Osteoarthritis  

Pain is one of the most common human experiences. Yet pain has never been fully accepted as a medical problem.

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