Dec 19 2011
Aching Joints
by Dr. Roger E. Hirchak, Vice President, Health & Resident Services
Degenerative joint disease, medically known as osteoarthritis, is the most common form of joint disease, and spares no age, race or geographic area. By the age of 40, ninety percent of all adults have radiographic findings of osteoarthritis in their weight-bearing joints – which is about 20 million adults in the United States at any given time. Heredity and mechanical factors play a big role in the development of this potentially debilitating disease, and as we age, the symptoms of osteoarthritis increase.
Osteoarthritis is normally divided into two types: primary and secondary. The primary type most commonly affects the fingers, hands, hips, the knees, bones in the foot and the joints of the big toe, along with the neck and the lumbar spine. The secondary types of degenerative joint disease usually refer to bone surfaces that are injured or bones in joints that may be broken or fractured. Occupational overuse of a joint and certain neurological or metabolic diseases typically fall into this second category.
Obesity is a risk factor for osteoarthritis of the knee and the hip. So are competitive contact sports, which will hasten the development of osteoarthritis as can plainly be seen by the trauma that the football players endure and the wrestling professionals that are constantly traumatizing their bodies. We find that, pathologically, the articular cartilage is initially roughened and finally worn away.
Often your doctor will say that you have spur formation or lipping, which tends to occur at the edge of the joint surfaces. This is when the development of painful joint movement takes place. What are some of the most common clinical findings that are present? Initially, there is often stiffness lasting less than 15 minutes at a time. At a later date, stiffness develops to pain on motion and is aggravated by activity and weight-bearing, and generally relieved by rest.
Deformities may be absent or sometimes mildly disfiguring. Most often the symptoms are limitation of motion of the affected joint. At times there is effusion or fluid development in the joint along with inflammation that needs to be treated. We will also run laboratory tests to check for inflammation. At other times x-rays may reveal narrowing of various joint spaces or lipping or osteophyte formation, which are invaluable in making the diagnosis.
Prevention:
Weight reduction, especially in women, has been shown to reduce the risk of developing symptomatic knee osteoarthritis. We believe that estrogen replacement therapy has reduced the risk of knee and hip osteoarthritis in many patients. Other studies have shown that maintaining normal vitamin D levels may also reduce the occurrence and progression of osteoarthritis.
Treatment:
For many patients with mild to moderate osteoarthritis of the weight-bearing joints, a supervised walking program may result in clinical improvement. Weight loss always improves the symptoms of osteoarthritis in the knees.
Medication:
For many patients, Tylenol is very effective and certainly has fewer side effects than the non-steroidal drugs that are presently on the market. Patients who do not notice improvement with Tylenol can be treated with aspirin or the nonsteroidal medications that are effective but have gastrointestinal and kidney side effects. The medications are normally prescribed under your doctor’s auspices to make sure that there are no contraindications to that form of therapy. At times surgical measures need to be employed. We all know that total hip replacement provides excellent symptomatic and functional improvement when the joint is seriously affected. Knee replacement has also proven very effective with pain relief and increase in ability to ambulate. Various arthroscopic surgeries are often done for knee degenerative joint disease with various outcomes.
In conclusion, if your joints hurt and your mobility decreases, please do not automatically assume it is part of the aging process. Pain is the body’s way of telling us that there is something wrong.
Here at Shell Point, our physician and nurse practitioner staff is very adept in treating these joint disorders and should be consulted before accumulative damage is done to the joint. Remember to stay active through aerobic exercise and resistance training, paying particular attention to keeping your weight at a reasonable level.