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Spotlight on osteoarthritis

Osteoarthritis is by far the most common type of arthritis. It is estimated to affect more than 3,200,000 Canadians-about 1 in 10.

Osteoarthritis is caused by the breakdown in cartilage in the joints. Cartilage is a protein substance that acts as a cushion between bones in joints, allowing joints to function smoothly.

Osteoarthritis can affect any joint, but hands and weight-bearing joints—including the spine, hips and knees—are most often affected. Other joints, like shoulders, elbows, and ankles, are less likely to be affected unless the joint has been damaged by injury.

Unlike some other forms of arthritis where women are most affected, women and men are equally likely to be affected by osteoarthritis. It strikes most commonly after the age of 45, but people of all ages—from children to senior citizens-are at risk. While osteoarthritis has no known cure, treatments exist that minimize pain and maintain joint health.

Diagnosis of osteoarthritis

Risk factors for osteoarthritis include a family history of the disease, excess body weight, joint injury, repeated overuse of joint, and age.

There are several warning signs for osteoarthritis. These include:
  • Pain and/or stiffness in or around a joint lasting for more than two weeks
  • Swelling in joints, especially in hands and feet
  • Reduced strength and mobility in a joint or joints

If you think you may have osteoarthritis, visit your doctor. Osteoarthritis is most easily diagnosed by performing a physical examination and sometimes an x-ray exam. There is no blood test for osteoarthritis, though in some cases doctors may do tests to rule out other types of arthritis.

As is the case with most forms of arthritis, early diagnosis of osteoarthritis can be a key factor in maintaining joint health and preventing disability and deformity. There are things you can do to slow the progression of joint damage and reduce the potential for future disability, and getting a diagnosis is the crucial first step in an osteoarthritis treatment plan.

Treatment for osteoarthritis

Depending on the severity of the case, there are a number of different treatment options for osteoarthritis. These include lifestyle interventions, exercise, medications and joint surgery.

Weight loss and lifestyle changes are vitally important for mild, moderate and severe osteoarthritis. Before reaching for a pill, people with osteoarthritis must exercise appropriately and, if needed, lose weight.

In mild to moderate cases of osteoarthritis, joint pain may be sufficiently treated with an over the counter pain reliever, like acetaminophen (Tylenol®). Acetaminophen can be effective in reducing pain, but is not an anti-inflammatory medication and cannot stop joint damage.

If a pain reliever like acetaminophen is not enough, doctors may prescribe a non-steroidal anti-inflammatory drug (NSAID). Examples of NSAIDs available without a prescription include ibuprofen (Motrin® or Advil®) and acetylsalicylic acid (Aspirin®). Some more powerful NSAIDs require a prescription. These include naproxen (Naprosyn®). These are potent medications which can reduce joint inflammation and pain, but do not work to prevent joint damage. It is important to note that NSAIDs can rarely cause serious cardiovascular, kidney or gastro-intestinal side effects, like stomach ulcers; for this reason, it is vital to speak with your doctor before adding an NSAID to any treatment plan for osteoarthritis.

Cox-2 inhibitors are a newer class of NSAID, which work to reduce inflammation but do not carry the same risk of gastrointestinal side effects. Celecoxib (Celebrex) is an example of a cox-2 inhibitor. It is important to note that, while cox-2 inhibitors cause fewer gastrointestinal side effects, research has shown that they have the same or higher risk of cardiovascular (heart) side effects compared to traditional NSAIDs.

Sometimes, an injection of corticosteroid (sometimes called 'cortisone') into the affected joint can help to reduce the inflammation of advanced osteoarthritis. Cortisone injections can help in situations where mobility is impacted or pain is severe, but it is important to note that these injections should only be done intermittently (less than three per year) into each affected joint, as multiple corticosteroid injections may actually weaken the cartilage, causing further joint damage. Corticosteroid injections are not a long-term treatment, but rather something to be used very occasionally when pain and inflammation is particularly bad.

As with many forms of arthritis, maintenance of a healthy body weight is a very important part of a well-rounded treatment plan for osteoarthritis. Osteoarthritis often affects load-bearing joints, like the hips and knees, and research has shown that being overweight, by even 10 to 20 lbs, can significantly increase the risk of knee damage. One of the best things a person with osteoarthritis can do to improve their arthritis is work to achieve and maintain a healthy body weight.

Exercise is another important component of a plan to treat osteoarthritis. The key is to participate in the right kinds of exercise. Generally, exercises that put less stress on joints, like swimming and other water-based types of exercise, are ideal.

Many people find it difficult to get started on an exercise program because of their pain. In this case, many doctors recommend taking a pain reliever (such as acetaminophen or Tylenol®) about 30 minutes prior to starting exercise. Depending on a person's joint complaint, using ice or heat, according to one's preference, is a non-medicinal treatment that may be effective at helping people with osteoarthritis exercise effectively-and with enjoyment.

Joint surgery is an option if joint damage progresses to the point where mobility is seriously compromised. The most common type of joint surgery for osteoarthritis is joint replacement; knees and hips are the most common joints to be treated with joint replacement surgery.