- Stage 1 – Minor
- Stage 2 – Mild
- Stage 3 – Moderate
- Stage 4 – Severe
- I have osteoarthritis: Now what?
- Physio Works – Physiotherapy Brisbane
- What’s the Treatment of Hip Arthritis?
- What Else Can You Do For Your Hip?
- Related Hip Arthritis Conditions
- Hip Arthritis Products Available
- Common Hip Arthritis Treatment Options
- FAQs about Hip Arthritis
- The Stages of Osteoarthritis Progression
- About the Condition
- Stages of OA
- Treatment of the different Stages
- Alternative Techniques
- Stem Cell Therapy
- Risk Factors and Prevention
- The Progression of OsteoArthritis without Treatment
- Osteoarthritis of the Spine
- Quick Definition of Spinal Arthritis
- Causes of Arthritis in the Lower Back
- Practical Overview of Osteoarthritis
- Everything you need to know about osteoarthritis
Osteoarthritis is the most commonly diagnosed type of arthritic joint disease. It is so common, that doctors now say 1 in 2 people will develop some type of symptomatic OA (osteoarthritis) at some point during their lifetime.
It is a joint related issue, so it can affect the hips, hands, or shoulders, but it is most commonly found in the knees. Fortunately, OA has become increasingly more treatable, especially when diagnosed during the early stages.
Let’s take a look at the four stages of OA and some appropriate treatments during each stage…
Stage 1 – Minor
This is the least severe stage of OA. Patients in stage 1 will develop minor wear-and-tear in their joints, but typically feel little to no pain in the affected area. If you have no history of OA, a doctor will most likely leave your symptoms untreated, but they may advise you take supplements or change up your exercise routine.
Stage 2 – Mild
This is when X-rays will start to show more noticeable bone spur growths (growths that often develop where bones meet each other in the joint). The affected area will start to feel stiff after long, sedentary periods, and will become uncomfortable. Your doctor might suggest a stricter workout routine or a fitted brace to wear.
Stage 3 – Moderate
In stage 3, the cartilage in the affected area starts to erode and narrow the gap between bone and joint. The joint becomes inflamed and starts causing discomfort during normal daily activity. Some treatments include over the counter pain medications, prescription pain relievers, and in severe cases, hyaluronic injections.
Stage 4 – Severe
This is the most severe stage of OA, which means it is also the most painful. At this point, the cartilage is almost completely gone, leading to an inflammatory response from the joint. The bone spurs that developed in the earlier stages have now multiplied, often causing excruciating pain. There are various treatment options that generally include bone realignment surgery and knee/hip replacement.
If you live in Fairfield County and suffer from osteoarthritis, help is available from the medical professionals at Orthopaedic Specialty Group. As the largest and most experienced orthopedic practice in southern Connecticut, we have the knowledge and experience needed to relieve your pain. Visit our website for more information, or call (203) 337-2600 to schedule an appointment with one of our licensed therapists.
I have osteoarthritis: Now what?
Osteoarthritis is the most common form of arthritis and it’s affecting more and more Canadians every year. It’s estimated that by 2035, one in four Canadians with be diagnosed with osteoarthritis – a disease of the whole joint that leads to the breakdown of joint cartilage and the underlying bone.
Osteoarthritis (OA) is sometimes described as degenerative or “wear-and-tear” arthritis. Recent studies suggest there may be an inflammatory component to OA, so it may not just be age-related or caused by overuse. In normal joints, cartilage – the tough elastic material that covers and protects the ends of bones – acts as a cushion and provides a smooth, gliding surface for joint motion. OA causes the cartilage to break down, leading to pain, swelling, and problems moving the joint. As it worsens over time, the cartilage wears away and bone rubs against bone, causing joint damage and increased pain.
HOW IS THE SEVERITY OF OA DETERMINED?
OA usually progresses slowly over months or years and early symptoms tend to come and go. It commonly affects the knees, hips, first toes, wrists, thumbs, fingers, and spine. As damage progresses, symptoms can become more constant, occurring at rest and disturbing sleep.
There are a number of methods for classifying the clinical severity of OA, which is important in directing appropriate treatment. The most commonly used is Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) that assesses OA based on pain, stiffness, and physical function.
There are also different methods for determining the severity of OA through imaging.The Whole-Organ Magnetic Resonance Imaging Score (WORMS) method provides a whole-organ assessment of OA using MRI to look at 14 different features of soft tissue within the joint, such as articular cartilage integrity, subarticular bone marrow abnormality, subarticular cysts, etc.
As X-ray is more readily available, the Kellgren-Lawrence grading scale is routinely used to gauge OA disease severity. It is determined by assessing joint space narrowing and bony growths, and is divided into five stages – stage 0 to 4.
WHAT ARE THE STAGES OF OA AND TREATMENT OPTIONS?
STAGE 0 – Joint is healthy and there are no signs of OA.
STAGE 1 – Some development of bony growths (bone spurs) within the joint. At this stage, there is only minor wear on joint components and you rarely experience pain or discomfort.
- Treatment: If there are minor symptoms, or you have other factors putting you at an increased risk of OA, oral supplements and an exercise regime may be recommended to slow the progression of the disease. Weight loss, bracing to ensure joint stability, and oral pain relief medication may be prescribed at any stage. A Platelet-Rich Plasma (PRP) Injection, which uses plasma from your own blood to stimulate your body to heal itself, may also be recommended to help repair damage during this early stage.
STAGE 2 – This is considered mild OA. X-rays will show larger bone spurs, but cartilage is still thick enough to prevent the bones from rubbing against one another. Synovial fluid, which helps lubricate and cushion joints, is typically still present at sufficient levels for normal joint motion. It’s often at this stage where you may first begin experiencing symptoms. They could include pain after a long day of walking or running, greater stiffness in the joint when it’s not used for several hours, or tenderness when kneeling or bending.
- Treatment: For OA at this stage, effective treatments usually include weight loss, low-impact aerobics and strength training, braces and wraps to help stabilize joints, and oral nonsteriodal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, which help relieve pain and inflammation but can cause stomach irritation. Joint injections with viscosupplements or PRP may also be effective at this stage.
STAGE 3 – Classified as moderate OA, cartilage between bones shows obvious damage and thinning so the space between the bones begins to narrow. You may experience frequent pain when using the joint, or stiffness after long periods of inactivity or when waking up in the morning. Joints may swell after extended periods of motion, as well.
- Treatment: At this point over-the-counter medication or NSAIDs may not be adequate to manage pain relief. Your doctor may recommend steroid injections, which locally introduce a corticosteroid (an anti-inflammatory medication) to decrease inflammation and reduce pain. During this procedure a small dose of steroids is injected into the joint, often under image guidance to keep potential side effects to a minimum. Results can last from weeks to months depending on the joint involved, severity of the arthritis, and the specific cause of pain. Some patients get complete relief after a single injection. Unfortunately, steroids may become less effective with repeated injections and may have effects on the rest of your body over time.
- Sometimes narcotics are prescribed on a short-term basis to treat moderate to severe pain, but they are not recommended for long-term use due to the risk of increased tolerance and possible dependence. Side effects of these medicines include nausea, sleepiness, and fatigue.
- Viscosupplement injections may also be a treatment option, on their own or in conjunction with cortisone injections. This procedure involves the injection of hyaluronic acid (HA) – a viscose substance normally present in healthy joints, but decreased in OA. When injected into affected joints, these gel-like substances improve mobility, reduce pain, and lubricate the joint. They also have a mild anti-inflammatory effect. As with all injections, they are best performed under image guidance to ensure the solution is delivered exactly where you need it. The relief may take a few weeks. Occasionally, patients may experience a post-injection flare after HA with increased pain, and stiffness. This could be due to the viscosity of the injection and settles with oral anti-inflammatories or a subsequent steroid injection.
STAGE 4 – At this stage, OA is considered severe and you may experience great pain and discomfort when using the affected joint, or during rest. The joint space between bones is dramatically reduced and the cartilage is often completely gone, leaving the joint stiff and possibly immobile. Synovial fluid can be decreased dramatically, no longer reducing the friction between the bones, or can be increased, limiting range of motion of the joint.
- Treatment: For stage 4 OA, treatment often involves surgery, such as joint fusion or, more commonly, joint replacement surgery. Steroid or HA injections may provide temporary symptom relief for patients awaiting surgery, or can help manage symptoms longer term for those who decide against or cannot have surgery.
Osteoarthritis is a chronic (long-term) disease and, although there is no cure, treatment can help reduce your symptoms and make it possible for you to lead a full and active life. Studies suggest treatment in early stages of the disease is the most effective way to prevent progression. In most cases, you can manage mild to moderate arthritis symptoms for many years with a treatment plan. It’s also important to thoroughly discuss all your option with your health care practitioner, especially in the later stages of the disease.
For more information on Image-Guided Pain Therapy injections, please speak to your health care practitioner.
Arthritis Foundation (2018) Osteoarthritis: Prevention, causes and treatments. www.arthritis.org. Accessed November 14, 2018.
Arthritis Society & Dr. J. Hochman. (2017) Osteoarthritis. www.arthritis.ca. Accessed November 14, 2018.
Holland, Kimberly (2018) “Stage of Osteoarthritis of the Knee.” Heathline. www.healthline.com. Accessed November 14, 2018.
Iliades, Chris (2011) “The Stages of Osetoarthritis Progression.” Everyday Health. www.everydayhealth.com. November 14, 2018.
Physio Works – Physiotherapy Brisbane
What’s the Treatment of Hip Arthritis?
PHASE I – Pain Relief & Protection
- Managing your hip pain. Hip pain is the main reason that you seek treatment for hip arthritis.
- Regular application of ice packs is highly recommended to reduce your hip pain.
- NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). Use of these medications should be discussed with your doctor.
- Your physiotherapist will use an array of treatment tools to reduce your hip pain and inflammation. These may include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
PHASE II – Restoring Normal Hip ROM, Strength
As your hip pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control.
Please ask your physio for their advice.
PHASE III – Restoring Full Hip Function
The final stage of your hip arthritis rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it may be simply to walk around the block.
Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.
PHASE IV – Delaying Hip Surgery
Hip osteoarthritis is a condition that gradually deteriorates even though your pain may come and go in the initial stages.
In addition to your hip muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing your will core abdominal exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Your physiotherapist will guide you.
Fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous daily or leisure activities!
Your aim for any exercise or physiotherapy program is to delay the deterioration of your hip arthritis. Your best chance is to have strong hip muscles and bones performing activities that don’t traumatise your hip joint surfaces.
PHASE V – Hip Surgery
Hip surgery is usually required as your hip joint arthritis deteriorates and your hip joint becomes permanently deformed. The most common surgical procedure for an arthritic hip is a total hip replacement. Your hip surgeon may also recommend arthroscopic surgery or joint resurfacing.
Your prognosis following a total hip replacement is very good. In most cases, you will have no or considerably less pain plus improved hip function.
You will require a post-operative hip strengthening and rehabilitation program to prolong the life of your new hip and resume your most active lifestyle.
For more information about hip surgery, please your physiotherapist or doctor.
What Else Can You Do For Your Hip?
Lose weight. You won’t just look better, you’ll feel better, too. Why? Every extra kilogram you carry around translates to added stress to your hip joints. Excess weight can mean more hip pain, no matter which form of arthritis you have.
When your hip joint is hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.
Follow your doctor’s advice. Some medications will be designed for pain relief and others to reduce inflammation. Since most hip osteoarthritis sufferers normally have other medications, it is always wise to check with your doctor before changing.
Exercise – Keep Moving
Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall.
A well-rounded workout routine for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.
Your physiotherapist is an expert in the assessment and prescription of hip arthritis exercises. Please ask them what is best for you.
General exercise such as swimming, hydrotherapy, Tai Chi, yoga, pilates, balance and walking programs are excellent if pain-free.
The key is to have a regular daily exercise program. The goal is to keep moving.
Strengthen Your Bones
Ask your doctor to check your bone density. If they are concerned they’ll arrange for a test to check if you have osteoporosis (bone thinning).
Follow their advice or the advice of your dietitian on your Calcium and Vitamin D intake. You need normal levels of both plus some form of weight-bearing exercise to strengthen your bones.
Treat Your Muscles with a Massage!
A quality remedial massage may be just the relief your hip muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also decrease stress and depression.
Besides all it that, massage just feels good!
For more advice, please ask your physiotherapist, massage therapist or doctor.
Related Hip Arthritis Conditions
- Hip Pain
- Groin Pain
Hip Joint Pain
- Hip Arthritis – Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement – FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
Lateral Hip Pain
- Gluteal Tendinopathy
- Greater Trochanteric Pain Syndrome
- Trochanteric Bursitis
- Adductor Tendinopathy
- Groin Strain
- Osteitis Pubis
- Inguinal hernia
- Sportsman’s hernia
- Hip Flexor Strain
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
- Rheumatoid Arthritis
- Sacroiliac Joint Pain -SIJ
- Lower Back Pain
- Pinched Nerve
- Hip Replacement
Hip Arthritis Products Available
Common Hip Arthritis Treatment Options
FAQs about Hip Arthritis
2. Fernandes, Storheim, Sandvik, Nordsletten, & Risberg. (2010). Efficacy of patient education and supervised exercise vs patient education alone in patients with hip osteoarthritis: A single blind randomized clinical trial. Osteoarthritis and Cartilage,18(10), 1237-43.
The Stages of Osteoarthritis Progression
Osteoarthritis: Moderate Stage
Jack Stassen, a farmer in Cape Cod, Mass., who suffers from osteoarthritis says, “I first noticed pain and stiffness in my knees about 20 years ago, after working all day in the orchard.” He notes that early in the course of his disease, “the pain would always go away with rest.”
As osteoarthritis progresses, however, “pain tends to worsen as the day goes on, rather than loosen up. Sudden catching or giving way of knee joints is common. Worn hip and knee joints may become painful even to stand on,” notes Dr. Edwards.
When cartilage wears down, the bones underneath become thicker and reactive tissue, known as bony spurs, form along joint margins. In older people, especially if osteoarthritis limits physical activity, muscles eventually become weaker, providing less support for the joints.
Osteoarthritis treatment at this stage usually involves starting medication. The most commonly used medications are nonsteriodal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. NSAIDs are effective in relieving osteoarthritis pain and decreasing joint swelling and inflammation, but their use may be limited by stomach irritation.
At age 62, Stassen remains physically active despite the fact that he has significant joint pain. He notes that his “doctor says my osteoarthritis would be much worse if I wasn’t active.”
Osteoarthritis: Late Stage
In the later stages of osteoarthritis, all the joint structures are affected. Healthy lubricating fluid is lost and the joint affected by osteoarthritis may fill with inflammatory fluids that stretch the joint capsule, causing swelling, more pain, and stiffness. Stronger pain medication may be needed. In some cases, the best osteoarthritis treatment may be surgery to replace the joint.
“Most joint replacement surgery goes like a dream,” says Edwards. “The best way to ensure a rapid recovery is to be as fit as you can before surgery. No smoking, slim down to an ideal weight, and get plenty of exercise of a sort you can manage. All being well, you should be up on your feet in just a few days and ready for most activities within a month or two.”
Osteoarthritis is a progressive disease, and there is no cure. But there are still many ways to manage osteoarthritis effectively. Most people can alleviate their osteoarthritis symptoms with a combination of weight control, exercise, and medication. In cases where osteoarthritis requires surgery, joint replacement surgery has been shown to relieve pain and improve joint function. If you have been diagnosed with osteoarthritis, talk to your doctor about all of the available treatment options so that you can keep moving forward.
Osteoarthritis is a very common form of arthritis. It affects many people around the world, and one of the places where it is the most common is the knee. This ailment has multiple stages greatly differ in symptoms, how they are treated, and how you recover after. In this article, we will go over all of the things related to the different stages of osteoarthritis in the knee.
About the Condition
Osteoarthritis, or OA for short, affects the bones, cartilage, and the synovium of the knee joint. Cartilage is the slippery tissue that makes it easy for the bones to move because it is situated between them. The joint bones move smoothly thanks to a cushion of cartilage. Synovium is also soft, and it lines our joints. It produces synovial fluid that lubricates and gives nutrients to the cartilage. During osteoarthritis, all of these functions slow down and break down, and there is nothing to protect the bones in the knee. This is why bone damage occurs, and we feel pain and lose the free range of movement. The knee becomes stiff, and the symptoms only worsen as time passes.
Stages of OA
Knee OA takes multiple years to develop, and it always comes in four stages. The hard thing about is that the symptoms usually do not appear until the later stages. If you know you have it in early stages, you must pay attention to even the slightest changes.
Source: Spring Loaded Technology
During the first stage, there are small lumps on the bone, called osteophytes. They grow in the area of the knee. At this stage, cartilage is damaged slightly. The space between the bones does not narrow, and you will not feel pain or discomfort. On X-rays, the joint appears normal and fine.
Symptoms begin appearing at this stage, and your doctor will notice some wear signs. The X-rays and scans will show more growth of the lumps, and your cartilage starts to become thinner. However, the space between joint bones still appears normal, but the area where they meet the tissues has already started to harden. When it does, the bones are denser and thicker, and a thin layer of bone develops under the cartilage.
Stiffness and pain begin for some, most notably around the knee when you sit for long. The overall damage is still minor, and the bones have not started rubbing or scraping against each other yet. There is still synovial fluid that reduces friction and supports the movements.
The cartilage damage further progresses, and the gap has finally narrowed. The X-rays show the loss of cartilage. During daily activities like walking, running, bending, and kneeling, there is discomfort and pain in the knee. Early signs of inflammation may also appear around your knee.
The cartilage continues to break down and become thinner if OA is untreated. Your bones respond by further thickening and growing outward, producing even more lumps. The immediate tissue surrounding the join is inflamed and might produce extra synovial fluid. The knee swells. This condition is called synovitis, or water on the knee, as it is referred to more often.
The most advanced and dangerous stage of knee OA is stage 4. The symptoms are visible, while the space between the bones is even more narrow, resulting in more cartilage breaking down. The results and symptoms are even worse, there is constant inflammation, and even less fluid around the joint to protect it. This causes dangerous amounts of friction of the bones and more discomfort and pain in the knee during the most basic activities.
The X-ray will show bone on bone, which means there is no cartilage or very little of it. More bone lumps are there, while in the most severe cases, the whole knee is deformed because of the uneven loss of cartilage. At stage 4 of the knee OA, a surgical procedure is often the only thing that can be done.
Treatment of the different Stages
During the first stage, as the symptoms are only minor, acetaminophens, or over the counter (OTC), medication can be used to relieve you of pain. Exercises can also help to strengthen the legs and the body, increasing mobility and taking the pressure off the knees. Supplements like glucosamine and chondroitin can also be beneficial, but it is not known exactly how much.
Stage 2 treatment includes several things. First, there are pain relievers, similar to the previous stage. However, physical therapy sessions and maintenance of flexibility and strength are crucial in this stage. A knee brace to relieve pressure and support the joints is also recommended. Last but not least, special shoe inserts exist that remove extra stress on the knee in question.
For the third stage, OTC pain relievers remain, including acetaminophen. In addition, prescription pain relievers should be used, mainly codeine and oxycodone. The main thing in this stage, however, are corticosteroid or hyaluronic acid injections. Your doctor will give you three to five injections, over a period of 3 to 5 weeks. Relief from these can last up to 6 months. All of this is usually pricey; however, which is why some people cannot treat their symptoms.
Last and final stage is also the hardest to deal with because the cartilage is nonexistent. Surgery is often the only course of action.
Some alternative medicine and practices are available, and they might help you or relax you. They include acupuncture, magnetic therapy, lateral wedge insoles, and needle lavage. A mixture of chondroitin and glucosamine or a larger dose of one can also help. Mind that all of these methods require a lot more study and tests, as there is currently no information on how beneficial they are.
Stem Cell Therapy
The latest breakthrough in the treatment of knee OA is stem cell therapy, which can regenerate cartilage. Still, it is very expensive, several rounds might be necessary, and it may be ineffective if the mass body index of a person is more than 35. Different procedures also exist in this therapy, and overall, it is quite inconsistent. Side effects are also possible, including adverse reactions to the injection, wrong location of cells reproduction, failure of cells to work, and even tumors. A lot of consulting and research is needed if you decide to try this method.
Risk Factors and Prevention
In order to lessen the risk of developing knee OA, you should know what factors benefit this ailment. They include age, obesity, previous injuries, overuse, weak thigh muscles, and genetics. You can directly control some of these, so do your best to prevent OA of your knees through healthy lifestyle and weight, control of your blood sugar, regular activity and stretching, and avoiding the overuse of the knees. As soon as you experience a problem with your knee, turn to a licensed professional for help!
The Progression of OsteoArthritis without Treatment
Some people do not even realize that the cushioning cartilage in their joints is breaking down leading to more serious symptoms of osteoarthritis. They might feel stiffness or pain in their knees or hips, but they might dismiss this pain as nothing more than just normal pain from getting older.
While it is true that there will be pain in joints that occurs as we get older, many people do not realize that the pain they are experiencing is the onset of OsteoArthritis (OA). Although joint pain is common, this pain can be reduced by a variety of treatment options.
Joints do begin to wear out as we get older. Cartilage breaks down and bones begin to rub together. OA is most commonly found in people who are age 65 or older and who have spent many years using the weight bearing joints in their bodies such as hips, knees, hands and lower back.
OsteoArthritis cannot be cured. There are, however, treatments that can help with the management of the symptoms. Problems can arise when those who begin to experience the pain and stiffness of OA and ignore it. This is the worst thing that can happen. Ignoring the pain will not make it go away. In fact, by choosing not to address it, you could be setting yourself up for a much more serious problem down the road.
Here are some of the most common complications that can occur when OsteoArthritis is left untreated:
- Bone Spurs – As the cartilage in joints breaks down, the bone works to create more surface area to support the weight of our bodies. These new growth on the ends of our bones are known as bone spurs and can be the source of major pain.
- Damaged Tendons and Ligaments – The tendons and ligaments found in joints begin to take on extra pressure and weight to try and make up for the degenerating cartilage. They will be pulled and stretched in ways they were not designed for, which can lead to a decrease in their effectiveness. This can lead to injury and weakened bones.
- Septic Arthritis – This is an infection that forms in joints that can lead to joint deformity. Not only will this deformity inflict pain in the area of the joint, but it is almost impossible to fix without reconstructive surgery.
- Osteonecrosis – When damage to the joint reaches a certain point, it can cause an inadequate flow of blood to the bones in joints. Blood is an important part of the nourishment of bones and without it, bones will weaken, break down and die.
You can avoid these issues by taking on your OsteoArthritis symptoms head on. If you are feeling chronic stiffness or pain in your knees or hips, call Arrowhead Health Centers today to learn more about the programs we offer. We can help you manage the problem effectively. 623-334-4000 option 9.
Osteoarthritis of the Spine
Arthritis is the most common cause of low back pain, especially in people over age 50. The low back contains five sets of facet joints, one on the left and one on the right side of each spinal bone. Like joints in any other part of the body the low back facet joints can be injured, or become inflamed.
See Lumbar Spine Anatomy and Pain
Video: Lumbar Osteoarthritis
Lumbar osteoarthritis is a form of degenerative arthritis in the low back that causes pain, stiffness, and inflammation. Watch Now
This article provides a full review of the cause of spinal arthritis, its symptoms, as well as how to get an accurate diagnosis.
Quick Definition of Spinal Arthritis
The word arthritis comes from a combination of the Greek “arthros,” meaning a joint and “-itis,” meaning inflammation. The facets are the only joints in the spine. Spinal arthritis therefore means inflammation of the spinal facet joints.
Watch: Facet Joints Video
Causes of Arthritis in the Lower Back
Arthritis of the spine usually occurs due to internal damage to the facet joints. The surfaces of the facet joints are lined with smooth cartilage to allow for movement as the two sides of the joint rub against one another. However, the joint can become painful through the following process:
- The cartilage on one side of the facet joint gets damaged. Every time the spine moves the injured cartilage rubs against its neighbor, causing friction and further injury to both sides.
See Facet Joint Disorders and Back Pain
- The joint damage and friction leads to inflammation.
See Symptoms and Diagnosis of Facet Joint Problems
- The swollen facet joints transmit this pain signal through a single nerve (the medial branch) that travels through the facet joint.
See Anatomy Of Nerve Pain
- This signal then causes the back muscles to go into spasm.
Watch Video: What Is Your Back Muscle Spasm Telling You?
- The combination of the muscle spasm and inflammation of the joints causes low back pain.
See Treatment Options for Facet Joint Pain
The spinal facet joints in the lower back are prone to developing osteoarthritis. The joints are quite small compared to the amount of body weight they bear. The resulting stress and strain makes them susceptible to damage to the cartilage, and injury. The accumulation of injuries over a lifetime causes the joints to break down, or degenerate.
See Facet Joint Osteoarthritis
In This Article:
- Osteoarthritis of the Spine
- Symptoms of Arthritis of the Spine
- Diagnosis of Spinal Arthritis
- Lumbar Osteoarthritis Video
Facet joint breakdown also comes as a result of torn discs. Discs act as shock absorbers for the spine. They have a tough outer part, and a soft inner part. The soft inner part absorbs the shock. But the hard outer part can tear due to degeneration or even injury. The torn discs don’t absorb stress and strain very well, which leads to excessive force being transmitted to the facet joints.
See Diagnosing Disc Problems
The degenerative process is similar to what happens in a car. If the shocks go out and aren’t replaced, the next thing that happens is the springs break. In the lower back, once the torn disc stops absorbing the stresses and strain of everyday life, the facet joints go out next. Once the facet joints are injured they become inflamed, swell, cause muscle spasm, and the back pain cycle begins.
See How a Disc Becomes Painful
Practical Overview of Osteoarthritis
Symptoms and diagnosis of osteoarthritis (OA) of the spine, hand, hip, knee, and ankle.
Osteoarthritis (OA) is a common cause of pain and disability in adults. Approximately 27 million Americans have clinical OA, which translates to nearly 14% of those over age 25 and 33% of those over 65 years of age.1 OA is a disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone.2 The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands (Table 1).3
The specific causes of OA are unknown but it is believed to result from both mechanical (overuse and wear and tear) and molecular events in the affected joint. Recent studies linked an increased risk of OA with higher levels of C-reactive protein and erythrocyte sedimentation rate, as well as higher prevalence of metabolic syndrome4
There is a highly heritable component associated with OA.5,6 In fact, there is a genetic contribution to OA for 60% of women.7 Among the genes that have been linked to OA are several that are involved in the development and maintenance of joint shape, including members of the Wingless and bone morphogenetic protein families. Important genetic markers for the development and progression of the disease are under research.7
OA impacts quality of life and increases health-related expenditures. For example, OA of the knee is one of the 5 leading causes of disability among non-institutionalized adults.8 About 80% of patients with OA have some degree of movement limitation and 25% cannot perform major activities of daily living; 11% of adults with knee OA need help with personal care and 14% require help with routine needs. About 40% of adults with knee OA report their health as “poor” or “fair.”8
According to the Centers for Disease Control and Prevention, OA costs $3.4 to $13 billion per year.9 The average direct cost of OA per patient is $2,600 per year,10 and the total annual cost is $5,700 per person.11
Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, medications, and, perhaps eventually, total joint replacement. Hospital expenditures for total knee and hip joint replacements in 2009 were estimated to be $28.5 billion and $13.7 billion, respectively.12
This article aims to review the suspected causes and risk factors for OA (Table 2)4-6,9,13 and its symptoms, and to outline the appropriate diagnostic approach for the various types of OA.
Spinal OA (Spondylosis)
Spinal OA, or spondylosis, can occur anywhere along the spine, but most commonly affects the cervical spine (neck) and lumbar spine (low back).14 Like other types of OA, spondylosis is a degenerative disorder. In the normal spine, the vertebrae and cartilage, which cushions the bones as they move, are healthy and in alignment. Every vertebra has two sets of joints called facet joints that help facilitate movement.
Through use (and especially through overuse), cartilage can start to wear down, affecting movement and causing pain. When the cartilage on the facet joints starts to wear down, the bones can start to rub together. In an effort to stop this painful movement, the bones may create bone spurs. This is the body’s attempt to stabilize the joint, but unfortunately, these bone spurs can make movement more difficult. They also can pinch nerves in the spine, causing more pain.
As patients grow older,9 the discs between the vertebrae that cushion the spine’s movement and help it bend and twist can start to wear out—this is called degenerative disc disease. It is a separate spinal condition from spondylosis, but they are closely linked. If, for example, a disc between the vertebrae starts to thin, it can change the way facet joints work—causing the cartilage to wear out and leading to spondylosis. In addition to age, other risk factors that can contribute to degeneration include:
- Occupations that excessively strain the spine
- Past neck or spine injury
- Ruptured or slipped disc
- Being overweight and not exercising (Note: the literature is undecided on this point, but it is important to encourage patients to lose weight and exercise)
- Small fractures to the spine caused by osteoporosis
- A family history of spondylosis
Symptoms of spondylosis tend to come on gradually as the spine changes. Patients may notice that movement has become more difficult or painful. Patients may feel “stiff,” especially in the morning or after sitting for a while. If a bone spur is pressing on a nerve, the patient may have pain that travels away from the spine. For example, if a bone spur is pinching a nerve in the neck, pain may radiate down the arm. Symptom of spondylosis in the neck include:
- Neck pain and stiffness, which may get worse with activity
- Weakness and numbness in the arms, hands and fingers
- Muscle spasms in neck and shoulders
- Grinding and popping sound/feeling in the neck when you move
The hand is one of the parts of the body most frequently affected by OA.15 OA can occur in many areas of the hand and wrist. In a healthy hand, a joint is made of 2 smooth bone surfaces covered in cartilage, a slippery tissue that provides a smooth gliding surface and allows the bone surfaces to fit well together. If the cartilage wears away, the sensitive underlying bone can become exposed. The result is bone-on-bone contact, which leads to pain, stiffness, and difficulty using the hand.
OA of the hand is most likely to develop between the ages of 40 and 70. In people under 40, OA of the hand is usually caused by an injury to the affected joint. For most people, however, the most significant risk factor is age. Other risk factors include having a job or hobby that involves repeated hand motions, being female,13 having a family history of hand OA, and obesity.
The 3 most frequent sites of OA of the hand include:
- The base of the thumb, where the thumb and wrist come together
- The joint closest to the fingertip
- At the middle joint of a finger
An early symptom of hand OA is joint pain. It may produce a burning or a dull sensation. A person often feels the pain after heavy gripping or grasping. The pain may occur hours later, or even the next day. In advanced stages, the pain may wake a person up. Other symptoms include:
- Morning pain and stiffness in the hand
- Increased joint pain in rainy weather
- Difficulty with daily activities such as opening a jar or starting the car
- Swelling of the affected joint
- Warmth in the affected joint, due to inflammation
- A sensation of grating or grinding in the affected joint, caused by damaged cartilage surfaces rubbing against each other
Having arthritis in the hands means the patient is at higher risk for developing arthritis in the knees.
OA of the Hips
The hips often are one of the first joints to develop OA.16 Many middle-aged and older adults experience minor inflammation, pain, and stiffness as the cartilage in the hip wears away. However, for some OA patients, the inflammation progresses and the pain can become severe. A strong family history is a risk factor for the development of hip OA, but much like the knee, an injury to the joint, type of work, over exercise, and obesity also increases the risk of hip OA.
The first symptom of OA is usually a small twinge of stiffness in the hip. But as the OA evolves, the hip may become rigid and painful. Patients may have a harder time doing everyday activities, such as taking a short walk, bending over to tie their shoes, or getting up from a chair. The pain usually develops slowly and gradually gets worse. The pain and stiffness may be worse in the morning, or after prolonged sitting or resting. Pain is often experienced in the thigh and buttock, and can mislead patients into thinking they have a muscle strain in that area.
In patients with suspected OA of the hip, look for signs such as tenderness in the hip, reduced range of motion in the hip, a grating sensation inside the joint when it is moved, pain when pressure is placed on the hip, and problems with the way the patient walks. An x-ray can show whether there is a narrowing of the joint space, changes in the bone, and whether there are bone spurs.
During a lifetime, knees go through considerable wear and tear. As these joint are the center of motion for the legs, and can experience 3 to 5 times a person’s body weight during activities such as descending stairs and running, they are highly susceptible to injury. Over time, this natural wear-and-tear process can lead to OA in the knees. As OA develops, the top layer of cartilage around the joints starts to break down and erode, causing pain, swelling, and loss of movement in the joint.17 As more time passes, the joint affected by OA may lose its normal shape and may develop bone spurs on the edges of the joint. Bits of bone and/or cartilage can break off, then “float” in the joint space—causing more damage and pain,17 as well as sometimes a feeling that the knee is “locking up.”
Currently, researchers don’t understand the exact cause of knee OA. Many factors can lead to the degeneration of the knee cartilage, including overuse and injury. But sometimes, knees can develop OA without a clear cause.
The symptoms of knee OA usually develop gradually. This is because it takes time for the cartilage to wear down and change the way the joints work. However, sudden onset of symptoms is possible—but not as common.
The following symptoms are commonly seen in OA of the knee:
- Stiffness and swelling: Feeling that it’s tough to move the knee(s) when first getting up in the morning or after sitting down for a while is an OA symptom. The swelling makes it hard to bend or straighten the knee. Pain and stiffness often are worse in the morning or after being inactive, whereas swelling usually occurs after a long period of excessive activity.
- Changes in the weather: When it’s rainy and/or cold can make the pain and other OA symptoms in the knee feel worse.
- Pain can be worse in the morning or after a lack of activity. Patients also may notice more pain after certain activities—walking or climbing stairs, for example.
- Limited movement: The pain, stiffness, and swelling can make it harder to sit down, stand up, or walk.
- Warmth in the knee joint: The knee joint can become inflamed, and warmth around the joint is a sign of that inflammation.
As one ages, it’s common to feel pain and stiffness in the feet and ankles. A sudden injury to the ankle, such as a broken bone, torn ligament, or moderate ankle sprain, can increase the risk for developing OA, even years later. Obesity and a family history of OA also can increase the risk.18
Severe arthritis of the ankle can reduce mobility, but proper treatment can slow the development of arthritis and improve quality of life. The symptoms of ankle arthritis are similar to those of OA in other sites and can include: pain and tenderness, stiffness, reduce motion, swelling, and difficulty walking.
Diagnosing OA requires a detailed medical history of current and past symptoms, including a history of other illnesses or injuries.19 It is possible for a patient to have more than one form of arthritis at the same time.
Questions should include when the pain started, how often and for how long it hurts, whether anything makes it better or worse, and whether the patient has ever been treated for the pain.
To diagnose OA, all that is needed is a thorough history and examination, and simple x-rays. A thorough physical examination should include testing strength, touch sensation, reflexes, blood flow, flexibility, and, if relevant, gait. Blood tests can exclude other conditions such as rheumatoid arthritis. In spinal arthritis, CT scans, MRI, electromyography, and myelograms are sometimes used if the condition is advanced and there are signs of nerve or spinal cord impingement.
View Sources Last updated on: August 23, 2017 Continue Reading: Treatment of Osteoarthritis
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While no treatment can reverse the damage of OA, some can help relieve symptoms and maintain mobility in the affected joints.
Interventions include exercise, manual therapy, lifestyle modification, and medication.
Medication can help reduce pain.
This can relieve pain in people with mild to moderate symptoms. Follow the doctor’s instructions, as overuse can lead to side effects and cause interactions with other medications.
Nonsteroidal anti-inflammatory drugs
If acetaminophen does not help, the doctor may recommend a stronger pain reliever, which may include ibuprofen, aspirin, or diclofenac.
A person can take these orally or topically, applying the medication directly to the skin.
This is a topical medication that contains the active compound in chilies. It creates a sensation of heat that can reduce levels of substance P, a chemical that acts as a pain messenger.
Pain relief can take 2 weeks to a month to fully take effect.
Do not use the cream on broken or inflamed skin, and avoid touching the eyes, face, and genitals after using it.
Intra-articular cortisone injections
Corticosteroid injections in the joint can help manage severe pain, swelling, and inflammation. These are effective, but frequent use can lead to adverse effects, including joint damage and a higher risk of osteoporosis.
Duloxetine (Cymbalta) is an oral drug that can help treat chronic musculoskeletal pain.
Various types of physical therapy may help, including:
Transcutaneous electrical nerve stimulation (TENS): A TENS unit attaches to the skin with electrodes. Electrical currents then pass from the unit through the skin and overwhelm the nervous system, reducing its ability to transmit pain signals.
Thermotherapy: Heat and cold may help reduce pain and stiffness in the joints. A person could try wrapping a hot water bottle or an ice pack in a towel and placing it on the affected joint.
Manual therapy: This involves a physical therapist using hands-on techniques to help keep the joints flexible and supple.
Various tools can provide physical support for a person with OA.
Special footwear or insoles can help, if OA affects the knees, hips, or feet, by distributing body weight more evenly. Some shock-absorbing insoles can also reduce the pressure on the joints.
A stick or cane can help take the weight off of the affected joints and may reduce the risk of a fall. A person should use it on side of the body opposite to the areas with OA.
Splints, leg braces, and supportive dressings can help with resting a painful joint. A splint is a piece of rigid material that provides joint or bone support.
Do not use a splint all the time, however, as the muscles can weaken without use.
Some people may need surgery if OA severely affects the hips, knees, joints, or the base of the thumbs.
A doctor will usually only recommend surgery if other therapies have not helped or if there is severe damage in a joint.
Some helpful procedures include:
This involves a surgeon removing the damaged areas and inserting an artificial joint, made of metal and plastic. Some refer to this procedure as a total joint replacement.
The joints that most often require replacing are the hip and knee joints, but implants can also replace the joints in the shoulder, finger, ankle, and elbow.
Most people can use their new joint actively and painlessly. However, there is a small risk of infection and bleeding. An artificial joint may also come loose or wear down and eventually need replacing.
This involves a surgeon realigning, stabilizing, or surgically fixing the joint to encourage the bones to fuse. Increased stability can reduce pain.
A person with a fused ankle joint will be able to put their weight on it painlessly, but they will not be able to flex it.
This involves a surgeon removing a small section of bone, either above or below the knee joint. It can realign the leg so that the person’s weight no longer bears down as heavily on the damaged part of the joint.
This can help relieve symptoms, but the person may need knee replacement surgery later on.
Septic arthritis is joint inflammation caused by bacteria. Joint replacement surgery slightly increases the risk of this infection.
This is a medical emergency, and hospitalization is necessary. Treatment involves antibiotic medication and drainage of the infected fluid from the joint.