Osteoarthritis: An Introduction

Osteoarthritis affects more than just bones and joints. It is also involves ligaments, joint capsules and muscles. Notice the flexion contractures of the distal interphalangeal joints of the 2nd & 3rd fingers of the left hand as well as the wasting of the interosseus muscles and the hyopothenar eminence.


Osteoarthritis is by far the most common type of arthritis as well as one of the most common painful conditions affecting older Americans. It can present in one joint in middle age, but often becomes more generalized, as the patient gets older. The standard teaching for many years has been that osteoarthritis is due to simple mechanical wear and tear on the joints, but in recent years this view has been criticizes as overly simplistic. It doesn’t always explain why symptoms are localized in some cases and why osteoarthritis tends to have a predilection for the small joints of the hands in women, but not in men.


For many years the diagnosis of osteoarthritis was made on primarily clinical grounds and confirmed with plain X Rays. One problem with is approach is that in the early stages of osteoarthritis physical and radiologic findings are often limited and both correlate poorly with the severity of symptoms. Recently work on other biomarkers including serum blood tests for the breakdown products of cartilage, ultrasound examination of the joints and magnetic resonance imaging have allowed for better correlation between disease activity and symptoms, especially in the early stages of the condition.


Treatment for osteoarthritis has been largely symptomatic and often unsatisfying. Acetaminophen has limited effectiveness at doses now felt to be safe with respect to liver toxicity. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are much more effective against the pain of arthritis, but do little to slow the progression of the disease and are associated with significant side-effects and toxicities including changes in blood pressure, alterations in kidney function and gastrointestinal bleeding. Steroid administered orally or directly into the affected joints is very effective in relieving pain and decreasing disease activity. Unfortunately steroids have their own set of side effects and toxicities, which greatly limit their use.


Finally joint replacement surgery can be effective (more for hips and knees than for other joints). Unfortunately this is major surgery for which not all patients are appropriate candidates and the rehabilitation and recovery after these operations can be arduous and prolonged. One of the services we provide at Schlesinger Pain Centers is to combine medical therapy, physical therapies, injection therapies and consultative services to help you decide when and if surgery is right for you.


Leave Your Comment