An Overview of Secondary Osteoarthritis

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Osteoarthritis (OA) is the most common type of arthritis, affecting millions of people throughout the world. It results when the protective cartilage cushioning the ends of bones starts to wear down over time. OA can be either primary or secondary.

Primary OA is primarily related to aging, whereas secondary OA is osteoarthritis caused by another disease or condition. Examples of conditions leading to secondary OA include repeated trauma or surgery to a joint structure, congenital abnormalities (joint problems at birth), inflammatory arthritis, metabolic disorders, and more. Secondary OA can affect young and old alike.

OA is known for causing moderate to severe disability in an increasing number of people worldwide. It is the 11th most debilitating disease in the world. The global prevalence of knee OA alone is up 3.6% of the population.

Osteoarthritis Symptoms

Both primary and secondary OA involve the breakdown of joint cartilage, which causes bones to rub together, called bone-on-bone pain. The most common symptom caused by OA is pain in the affected joints, especially after repetitive use.

Symptoms in OA tend to occur slowly and affect one or more joints. However, early on, OA will not cause symptoms.

When symptoms of secondary OA do appear, you may experience:

  • Joint swelling and stiffness
  • Loss of range of motion (difficulty moving affected joints)
  • Pain that worsens with inactivity
  • Warmth and tenderness in affected joints
  • Loss of muscle mass
  • Crepitus—grating or cracking sounds in the joints

Secondary OA may progress over time, especially if it causes inflammation.

When osteoarthritis is secondary to a type of autoimmune arthritis, such as rheumatoid arthritis (RA), synovitis—mild inflammation of the soft tissues around the joints—is common.

Additional signs of progression in OA are:

  • Cartilage that has worn away
  • Reduced spacing between joints
  • Warm and inflamed joints
  • Reduction of normal joint lubricating fluid
  • Bony growths and bone rubbing against bone

If your OA has advanced, you will have pain and discomfort when moving affected joints. The pain is often severe enough that it keeps you from carrying out day-to-day activities.

Causes

Unlike primary OA, secondary OA has a specific cause. It also occurs in younger people, usually those under age 35.

The following are primary conditions that are risk factors associated with secondary OA.

Joint Injuries

Repetitive bone fractures increase a person’s chance of developing OA. This can also bring about the disease earlier. This is common in people who repeatedly stress one joint or a group of joints, such as in certain occupations. In fact, occupation is a major risk factor for knee osteoarthritis, especially in jobs where repetitive knee bending is the norm.

Congenital Joint Deformities

Sometimes, a person is born with abnormally formed joints—called congenital abnormalities—that are vulnerable to injury, joint cartilage loss, and early degeneration.

An example of a congenital joint deformity condition is congenital hip dysplasia. This occurs when the hip socket doesn’t fully cover the ball part of the upper thighbone, causing the hip joint to become dislocated —either partially or completely. A person with hip dysplasia may develop severe osteoarthritis in their hip later in life.

Autoimmune Inflammatory Arthritis

Diseases that cause inflammation affecting cartilage, eventually result in damage to joints and lead to osteoarthritis. One such condition is rheumatoid arthritis (RA).

Rheumatoid arthritis is most associated with secondary OA. RA is an autoimmune disease that can affect more than just a person’s joints. In some people, it may also affect other body systems, including the heart, lungs, blood vessels, skin, and eyes.

Being an autoimmune disease, rheumatoid arthritis occurs when the immune system mistakenly attacks its own body’s healthy tissues. Its connection to secondary OA starts when rheumatoid arthritis causes inflammation to the synovium—the soft tissue lining the joints—eventually damaging cartilage and reducing joint stability.

One 2017 report in the journal Arthritis & Cartilage notes secondary OA appears to be a bigger problem than inflammation in rheumatoid arthritis patients. It is also possible RA can be worse in people who have secondary OA, according to the study’s authors. The authors suggest doctors consider measurements of joint damage and distress as they make clinical decisions for their patients.

A study reported in 2019 by the Annals of Rheumatic Diseases finds high a prevalence of secondary OA of the knee in people with rheumatoid arthritits. Here, the researchers reviewed patient histories of 565 people with rheumatoid arthritis in a rheumatology clinic setting. They looked at disease symptoms, medical history, physical examinations, and results of ultrasound and X-ray imaging. The researchers eventually determined 71% of the study participants had secondary OA of the knee, which was more common with increased activity and morning stiffness, and the longer a person had rheumatoid arthritis.

Diseases of Cartilage or Bone

Any number of conditions affecting the structure of cartilage or bone may trigger secondary osteoarthritis. This can include acromegaly and Paget’s disease.

  • Acromegaly causes excess human growth hormone, resulting in the head, face, hands, feet, and/or organs to increase gradually in size. Bone and cartilage problems, inflammation, and gradual degeneration from acromegaly may eventually result in osteoarthritis.
  • Paget’s disease, a condition disrupting normal bone formation, causes bones to be weak and become deformed over time. According to the National Institutes of Health Osteoporosis and Related Bone Diseases, people with Paget’s frequently have osteoarthritis. Paget’s causes OA if it changes the shape of bones, causes long bones to bow and bend, places stress on the joints, changes the curvature of the spine, and/or softens the pelvis, which reduces the stability of hip joints.

Metabolic disorders

Metabolic disorders are the result of abnormal chemical reactions in the body that modify the normal metabolic process. One 2016 report in the Journal of Orthopaedics reported on an earlier published National Health and Nutrition Examination (NHANE) analysis finding that 59% of the population has metabolic syndrome along with OA.

Examples of metabolic disorders associated with OA are hypertension and diabetes mellitus. Too much iron in the body due to a condition called hemochromatosis is another metabolic condition that can predispose to OA in common joints like the knees. It may also affect joints that are not commonly affected with primary OA, such as the large knuckles of the hand (MCP joints), shoulders, or ankles.

Diagnosis

Whether a person has primary or secondary OA, the diagnosis process is the same. Testing for OA may include:

  • Blood work: There is no blood test that can make a diagnosis of OA, but blood tests are done to rule out conditions that cause secondary OA and other arthritic conditions that may mimic OA.
  • X-rays: X-rays of affected joints are helpful in diagnosing OA. X-ray findings associated with OA will show loss of joint cartilage, joint space narrowing between nearby joints, and bone spurs. X-rays can also exclude other causes of your pain, as well as help your doctor to determine whether you may need surgery.
  • Magnetic resonance imaging (MRI): MRI uses radio waves and a strong magnetic field to produce detailed images of bone, cartilage, and other soft tissues. MRI scanning is utilized to diagnose OA in more serious cases.
  • Arthrocentesis: Often done in your doctor’s office, this involves using a sterile need to remove joint fluid for analysis. Joint fluid analysis can diagnose or rule out inflammatory arthritis. Removal of joint fluid may also help relieve pain, swelling, and inflammation.
  • Arthroscopy: If your doctor finds or suspects you might have joint or cartilage damage, an arthroscopy may be performed. This involves inserting a tube, with a small camera attached to it, to look into the joint space for abnormalities and damage to cartilage. It is possible to repair some of the damage during this procedure, and most people who have arthroscopic surgery usually recover quicker than those who have open joint surgery.

Your doctor will also want to carefully analyze the appearance, location, extent, and duration of joint symptoms.

Bony formations in the joints are characteristic of osteoarthritis. Additionally, nodes—either Bouchard’s nodes, Heberden’s nodes, or both—in the fingers and bunions on the feet can also help in making a diagnosis of OA.

Treatment

Treatment for secondary OA begins with managing the underlying cause and getting it under control. Your doctor will next focus on treating your OA, and treatment is dependent on symptoms, severity, and personal preferences or needs.

Treatment usually starts with simple and non-invasive therapies. You will need more intensive treatment if symptoms aren’t manageable with over-the-counter treatments and lifestyle changes. Some people may need physical therapy, stronger pain relievers, and surgery to manage severe OA.

  • Over-the-counter (OTC) pain relievers: Several types of OTC medications can help to relieve OA symptoms. Tylenol (acetaminophen) is an OTC pain reliever. While it can help reduce pain, it does not help with inflammation, and taking too much can cause liver damage. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with multiple OA symptoms, including pain and inflammation. OTC NSAIDS include aspirin, ibuprofen, and naproxen. Talk to your doctor about whether it is safe for you to take OTC NSAIDs because they are known for significant side effects, including stomach problems, cardiovascular disease, bleeding problems, and liver or kidney damage. Using a topical NSAID (applied to the skin) may reduce the risk of side effects.
  • Lifestyle changes: Many people can control OA symptoms with basic lifestyle changes. This can include losing weight, staying active, not smoking, resting when joints are swollen and hurting, and using hold and cold therapy to relieve pain and swelling. Talk to your doctor about what lifestyle changes might be best for your unique situation.
  • Prescription treatments: Sometimes, OTC pain relievers aren’t enough to reduce pain and swelling or improve quality of life. In this case, your doctor may prescribe stronger medicines to manage symptoms. Corticosteroids can help reduce inflammation, which improves pain and swelling. With OA, corticosteroids are usually given by injection and administered by your doctor or doctor’s nurse. Your doctor can also prescribe a stronger NSAID to reduce pain. Prescription NSAIDs are available in stronger doses and work for longer periods. Both corticosteroids and NSAIDs cause harsh side effects. Talk to your doctor about the best ways to reduce the risk of NSAID side effects.
  • Physical therapy: Physical therapy can be useful for managing OA. It can help with strengthening muscles, increasing range of motion, reducing joint pain and stiffness, and improving balance and gait. A physical therapist can also recommend assistive devices—such as braces, splints, a cane or walker—to provide support for weakened joints, take the pressure off injured joints, and reduce pain.
  • Surgery: Severe cases of OA may require surgery to replace or repair damaged joints. There are several surgery types, including joint replacement, bone realignment, bone fusion, and arthroscopic surgery.

There are many options available to you for treating OA. Work with your doctor to find the right treatments for your unique situation.

Prevention

There is a lot you can do to prevent secondary OA. One of the main ways is by managing risk factors for the condition. This includes managing any condition that increases your risk for secondary OA. A healthy lifestyle can also reduce the risk of developing secondary OA.

For example, diabetes can be a significant risk factor for OA, according to the Arthritis Foundation. High glucose levels may speed up the process that makes cartilage stiff and diabetes may also trigger inflammation, which also speeds up cartilage loss. Keeping diabetes under control and regulating sugar levels can prevent OA.

Making certain lifestyle changes can help improve joint health and prevent OA.

Maintaining a healthy lifestyle includes getting plenty of rest and enough sleep, keeping a healthy diet and managing weight, not smoking and only drinking alcohol in moderation.

A Word From Verywell

The prognosis for secondary osteoarthritis depends on the joints affected and how severe OA is. There are currently no disease-modifying treatments available that could reduce the effects of secondary OA. That means treatment is directed at managing pain and other OA symptoms and managing the underlying condition.

While there is no cure for OA, the outlook with treatment can be positive. You shouldn’t ignore any symptoms of chronic joint pain and stiffness. The sooner you talk to your doctor, the sooner you can begin treatment and improve your quality of life. 

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