What is Osteoarthritis and what are the symptoms?

By: Dr. Carissa Kirk
DHR Health Orthopedic Institute

Osteoarthritis (OA) is the most common degenerative joint disease and a major cause of pain and disability in adult individuals. The etiology of OA includes joint injury, obesity, aging, and heredity. OA signs and symptoms include articular cartilage degradation, osteophyte formation, subchondral sclerosis and synovial hyperplasia, and the signaling pathway(s) controlling these pathological processes that can accelerate the process. Currently, there are no interventions available to restore degraded cartilage or decelerate disease progression.

The knee joint is a hinge type synovial joint that predominately allows for flexion and extension (and a small degree of medial and lateral rotation). Its function is to bear weight, perform physical activity and exhibit a joint-specific range of motion during movement. During OA development, the entire joint organ is affected, including articular cartilage, subchondral bone, synovial tissue and meniscus. Although OA primarily affects the elderly, sports-related traumatic injuries at all ages can lead to post-traumatic OA. Currently, apart from pain management and end stage surgical intervention, there are no effective therapeutic treatments for OA to prevent or halt its progression. The most common risk factor for OA is age. Patients with obesity develop OA earlier and have more severe symptoms, higher risk for infection, and more technical difficulties for total joint replacement surgery. In addition to the increased biomechanical loading on the knee joint, obesity is thought to contribute to low-grade systemic inflammation through secretion of adipose tissue-derived cytokines, called adipokines.

Major clinical symptoms may include:
• Pain after overuse, after long periods of inactivity, or at the end of the day
• Stiffness in the morning or after periods of rest
• Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)
• Joint swelling
• Limited range of motion that may go away after movement
• Clicking or cracking sound when a joint bends
• Muscle weakness around the joint
• Joint instability or buckling (knee gives out)

Nonpharmacologic interventions may include:
• Patient education
• Heat and cold
• Weight loss
• Exercise
• Physical therapy
• Occupational therapy
• Unloading in certain joints (eg, knee, hip)

Pharmacologic interventions may include:
• Analgesics and anti-inflammatory drugs, Tylenol or NSAIDs
• Intra-articular injections, which may include a corticosteroid, hyaluronic acid [HA] or hyaluronan) or a biologic agent such as platelet-rich plasma [PRP]
• Supplements such as glucosamine and chondroitin sulfate

Ultimately when non-invasive treatment options fail to resolve and/or alleviate some of the symptoms associated with OA, invasive procedures may include:
• Arthroscopy
• Osteotomy
• Fusion
• Arthroplasty

If you or someone you know would like more information on osteoarthritis, please call the DHR Health Orthopedic Institute at (956) 362-6683.