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Ask Dr. Nancy: Osteoarthritis

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My knees hurt more and more as the years go by. How would I know if I have osteoarthritis?

Osteoarthritis (OA), also called degenerative joint disease, is the most common type of arthritis. It is caused by a breakdown of the cartilage that cushions the ends of bones. As that cushion wears down, the tendons and ligaments around the joint may weaken and the bones may rub together which causes pain, stiffness and swelling.

Because cartilage wears down over time, osteoarthritis is more common in older people and in people who have had a previous injury to a joint. Joints that bear the weight of the body such as knees and hips are affected the most. Finger joints at the middle and ends of your fingers can also be affected. Unlike other types of arthritis, osteoarthritis only leads to joint problems; it does not cause problems with the skin, internal organs or any other part of the body. Often there is a family history, and it appears that some people have cartilage that is more prone to wear-and-tear than others.

A recent panel with osteoarthritis experts from 12 countries found that 3 symptoms and 3 signs lead to the diagnosis of osteoarthritis with 99% accuracy. The 3 symptoms are: pain on use, short-lived morning stiffness, and limitations on how the joint functions such as stiffness. The 3 signs on exam are: crepitus (a grinding noised with bending of the joint), restricted movement, and bony enlargement. The most obvious place that bony enlargement can be seen is in the finger joints. When bony knobs form on the middle joint of the finger they are called Bouchard’s nodes and when they form on the end joints they are called Heberden’s nodes. You might want to think about whether or not these symptoms sound like ones you have and check in with your primary care physician.

Treatment for osteoarthritis has more to do with lifestyle than medical intervention. The Agency for Healthcare Quality and Research (www.ahrq.gov) recently published a guide, “Osteoarthritis of the Knee”, based on available scientific evidence.

There is a lot of good information in that guide about what helps. The top recommendations are to lose weight, keep moving with low impact exercises, and take mild pain relievers. You might also ask your physician about physical therapy. Strengthening the muscles that move the knee, particularly the large thigh muscle in front, the quadriceps, can lead to improved function and support of the knee.

The guide also discusses other treatments that usually do not reduce pain or improve knee movement for people with osteoarthritis: Glucosamine/ chondroitin supplements, joint lubricant shots (not the same as cortisone shots) and arthroscopic knee surgery to smooth out cartilage.

Ultimately knee osteoarthritis can lead to surgery for joint replacement but it is best to put that possibility off into the future by protecting your knees now.

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