An Overview of Degenerative Arthritis

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A X-ray showing arthritis of the knee.

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Degenerative arthritis is the most common types of arthritis, affecting around 30 million Americans. Also referred to as osteoarthritis, degenerative joint disease, and wear-and-tear arthritis, it occurs when joint cartilage and underlying bone begin to deteriorate, causing progressive pain, stiffness, and joint malformation. While it can affect any joint, degenerative arthritis typically develops in the weight-bearing joints (such as the hips, knees, and spine) and those of the hands, feet, shoulder, and neck.

Diagnosis is typically made based on the signs and symptoms of the disease and supported by imaging tests. Treatment can vary based on the severity of symptoms, with more modest options like heat or ice application helping mild cases and more significant interventions, like injections and surgery, being used for severe cases.

Symptoms

The central symptoms of degenerative arthritis are pain and stiffness. The pain typically increases with activity and is relieved by rest. Joint stiffness is common in the morning hours but tends to improve as you move about, usually with 30 minutes. Inactivity during the day, such as sitting for long periods of time, can also lead to stiffness and may even cause the locking of joints in some people.

Another common symptom of osteoarthritis is crepitus, in which a joint will make popping and crackling noises with movement. Crepitus most commonly affects the shoulder or knee joint but can also occur in the wrist, fingers, elbow, and ankle.

Unlike other forms of arthritis, only the joint is affected. Moreover, the pattern of impairment is usually asymmetrical (meaning that one knee or shoulder may be affected, but not the other).

As the disease progresses, it can affect a person's posture and gait, leading to instability and a decreased range of motion. As mobility is increasingly impaired, muscle loss may develop (referred to as muscle fiber atrophy). In advanced stages, degenerative arthritis can cause the visible malformation of a joint, particularly in the fingers where hard, bony enlargements can develop on and around the joint.

The abnormal accumulation of fluid, known as an effusion, is also a common occurrence is people with advanced knee arthritis.

In some people, osteoarthritis can become so severe that the pain becomes relentless, making walking or even standing near-impossible. While certain treatments can help ease symptoms, any damage sustained by a joint cannot be reversed without surgery.

Causes

At its very heart, degenerative arthritis is a condition in which the progressive damage to a joint occurs faster than the body's ability to repair it. The condition may be instigated by any number of things, including:

  • A congenital misalignment of bones
  • A joint injury
  • Any disease that causes damage to joint tissue or bone
  • Obesity, which places persistent stress on a joint
  • Loss of muscle strength to support a joint
  • Neurologic disorders associated with uncoordinated movements

Exercise (even extreme sports like endurance running) is not associated with osteoarthritis unless a severe or recurrent injury is involved. And, contrary to the old wives' tale, cracking your knuckles does not cause arthritis.

Osteoarthritis is most common in adults over 65 but can occur at almost any age. While the risk in men increases significantly after 50, the risk in women begins to rise after 40 (due in large part to hormonal changes that promote bone loss).

While genetics is believed to play a part, degenerative arthritis is more often due to a secondary issue that promotes it. This is especially true in children for whom early-onset osteoarthritis is owed to some other condition, such as hemochromatosis or congenital avascular necrosis.

What Happens in the Body

The biological mechanisms of osteoarthritis involve more than the deterioration of cartilage and bone. Once these structures have been compromised, the body will respond with a process known as ossification, also referred to as bone remodeling. This is the same process that occurs if a bone is broken.

However, with osteoarthritis, the ongoing damage to a joint will outpace the body's ability to repair it. In an effort to keep pace, bone tissue will be built upon bone tissue, leading to a narrowing of the joint space, the development of bone spurs (osteophytes), and the enlargement and malformation of the joint.

The joint pain itself is largely the result of bone rubbing against bone. In some cases, nerves may be pinched, causing localized and/or referred pain (pain felt in another part of the body). Over time, synovial tissues meant to lubricate the joint space will be lost, leading to increased stiffness and immobility.

Diagnosis

Diagnosis of osteoarthritis can be made with reasonable certainty based on a review of your symptoms and medical history. X-rays can be used to confirm the diagnosis and characterize the severity of the disease.

Typically findings on X-ray include a narrowing of the joint space, the development of osteophytes, excessive bone growth (known as subchondral sclerosis), and the formation of fluid-filled nodules in the joint space (called subchondral cysts).

In most cases, no other form of imaging is needed. The only exception may be for a joint effusion in which magnetic resonance imaging (MRI) is more effective at visualizing soft tissue.

Differential Diagnoses

Of equal importance to the diagnosis of osteoarthritis is the exclusion of all other causes. In the end, osteoarthritis is only one of over 100 different types of arthritis, some of which are caused by infection and others of which are triggered by an autoimmune disorder in which the body attacks its own cells.

Degenerative arthritis is different from all these other causes in that it is not inherently inflammatory. While inflammation can result from the overuse of a joint, it is neither a central nor defining feature of osteoarthritis.

Osteoarthritis can also be differentiated from autoimmune forms of arthritis in that the latter may involve specific joints and/or develop bilaterally (on the same joint on both sides of the body). Moreover, autoimmune forms are characterized by persistent inflammation even when the outward symptoms are under control.

Among some of the alternative conditions a doctor may explore:

Degenerative arthritis can be differentiated from these other conditions by evaluating fluid extracted from the joint space. Infectious or autoimmune causes will invariably demonstrate a high white blood cell count (WBC) as a result of the underlying inflammation. With osteoarthritis, the WBC will usually be normal insofar as it is not associated with inflammation.

Blood tests can also be used to rule out infectious or autoimmune causes.

Treatment

There is not much in the way of treatment to prevent the progression of osteoarthritis. Rather, treatment is currently aimed at managing the symptoms. Particularly in the early stages, the condition is managed conservatively with a combination of lifestyle changes, physical therapies, and pain medications. If symptoms progress, more invasive interventions may be needed, including joint injections and surgery.

Lifestyle Changes

Lifestyle changes are primarily focused on weight loss. This would not only involve a low-fat diet, but a routine fitness plan aimed at maintaining joint mobility. A nutritionist may be needed to design an appropriate eating plan and ensure that your nutritional needs are met.

Moderate exercise should be performed three times a week and under the guidance of a doctor who can sign off on an appropriate fitness plan.

Physical Therapies

A physical therapist is often the best person to design a therapeutic exercise plan if you have degenerative arthritis. It may involve strength, gait, and balance training to address specific functional impairments. Massage therapy, hydrotherapy, thermotherapy, and electrotherapy may also be explored.

Occupational therapy may be needed to overcome day-to-day challenges. This may include mobility aids to prevent falls, shoe inserts or knee braces to correct imbalances, and oversized handles to accommodate arthritic hands.

Over-the-Counter (OTC) Remedies

The preferred options for the treatment of arthritis pain are Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen). While beneficial, the drugs must be used with caution over the long term. Tylenol can cause liver toxicity and damage if overused. Similarly, the long-term use of NSAIDs may increase the risk of gastrointestinal bleeding and ulcers.

For severe pain, NSAIDs tend to be more effective than Tylenol. Of these, the drug diclofenac (marketed under the brand names Voltaren, Cataflam, and others) may be the most effective. Topical 3% diclofenac gels, creams, ointments, sprays, and patches are also available.

Some people with arthritis turn to methylated creams like Bengay, while others find relief in capsaicin-based ointments or patches derived from chilis. Their effectiveness in treating osteoarthritis can vary, although they may be appropriate if the symptoms are mild and you are unable to tolerate other forms of analgesic.

Prescriptions

If over-the-counter medications are unable to provide relief, your doctor may prescribe prescription-strength diclofenac. It is often preferred because the drug is not associated with dependence.

Another class of NSAID, known as COX-2 inhibitors, are often more effective in treating arthritis pain and with a far lower risk of gastrointestinal side effects. On the flip side, they are more expensive and are linked to a slightly increased risk of a heart attack. As such, they are used with caution in people with an underlying risk of cardiovascular disease. Celebrex (celecoxib) is the most popularly prescribed COX-2 inhibitor.

If all else fails, your doctor may prescribe a milder opioid drug like Ultram (tramadol) to relieve your pain. The drug is used with caution given the high risk of addiction and other adverse side effects. Stronger opioids are generally avoided.

Joint Injections

Joint injections, also known as intra-articular injections, involve either a corticosteroid drug to decrease inflammation or a lubricating fluid known as hyaluronic acid. Both are commonly used as a means to delay joint surgery.

Corticosteroids work by tempering the immune response and, by doing so, alleviate the swelling and inflammation that can develop in later-stage disease. While the effects generally last for around three months, prolonged exposure to corticosteroids can speed the deterioration of joint cartilage in addition to other side effects.

Hyaluronic acid is a naturally occurring substance produced by the body. The type used for joint injections, referred to as hyaluronan, is either synthesized in the lab or extracted from rooster combs. Research is conflicting on how effective these injections are. Those delivered to the knee tend to be more successful than other joints. Side effects include injection site pain and swelling.

Euflexxa is a popular non-avian form of hyaluronan approved for the treatment of osteoarthritis knee pain.

Some doctors have endorsed the use of platelet-rich plasma (PRP) as a form of treatment, although it appears to improve joint function more than pain. As the platelets and plasma are derived from the person's own blood, the risks tend to be minimal. As with hyaluronan, injection site pain and swelling are the most common concerns.

Surgery

Surgery is only considered if conservative treatments have failed and the pain and disability are diminishing your quality of life. Some of the procedures are performed arthroscopically (with small keyhole incisions) or as an open surgery (with large incisions).

Among the most commonly performed procedures are:

  • Arthroscopic debridement, used to remove excess bone and tissue to restore joint movement
  • Arthrodesis, performed either arthroscopically or as an open surgery; involves the fusing of bones to alleviate pain, primarily in the spine, foot, ankle, or hand
  • Osteotomy, performed as an arthroscopic or open procedure; involves the shortening, lengthening, or realignment of bones
  • Arthroplasty, performed as an open surgery; involves the replacement of a joint with an artificial one

As a prosthetic joint tends to last between 10 and 15 years, arthroplasty surgery is delayed for as long as possible to avoid the need for a second replacement later in life.

Complementary and Alternative Medicine (CAM)

There is a wide variety of traditional, nutritional, herbal, naturopathic, and homeopathic medicines used to treat osteoarthritis. Many of these have little evidence to support their use. Even popular supplements like chondroitin and glucosamine were not shown to improve outcomes, according to a large study conducted by the National Institutes of Health.

With that being said, there a number of complementary treatments that the National Center for Complementary and Integrative Health believe may offer benefits. Among them:

  • Acupuncture has been shown to provide modest arthritis pain relief, particularly of the knee.
  • Boswellia serrata, an herb used in Ayurvedic medicine, is believed to have anti-inflammatory effects beneficial to osteoarthritis.
  • S-Adenosyl-L-methionine (SAMe) is a chemical naturally produced in the body that is sold as a dietary supplement. There is some evidence that SAMe may be as effective as over-the-counter NSAIDs in treating arthritis pain.

Coping

As the joint damage caused by osteoarthritis does not reverse, you need to take steps to slow the progression as much as you can through lifestyle and the proper management of symptoms. Key to this is keeping the joint moving. If you do the opposite and avoid exercise and regular activity, the stiffness and damage will almost invariably progress at a far faster pace.

It is never too late to start exercising. Even if you already have significant impairment, you can find low-impact activities like swimming or cycling that place less strain on the joints. Over time, if you persist with the activity, the muscles supporting a joint will strengthen, providing you greater stability and confidence in your gait.

As you improve, you can move onto other forms of exercises like tai chi and yoga, which are great for improving balance, or strength training to target specific muscle groups.

If your joint is stiff prior to exercise, apply a heating pad or warm, moist cloth for around 10 to 15 minutes. The heat will draw blood to the joint and alleviate stiffness. After you finish, apply an ice pack or cold, moist cloth to the joint if there is any swelling or pain. Doing so may reduce inflammation faster than an NSAID.

Finally, it is important to remember that rest is just as important as exercise when dealing with degenerative arthritis. If you ever experience extreme pain, stop, rest the joint (elevating if possible), and apply ice for no longer than 15 minutes. By listening to your body and treating it appropriately, you can get better control of your symptoms as well as your life.

A Word From Verywell

Degenerative arthritis is a distressing disease, and there is no reason to go it alone. Reach out to friends and family if you need help, an exercise partner, or just someone to share your feelings with. The worst thing you can do is isolate yourself, especially if your mobility is already impaired. Connecting with others may provide you the encouragement to press on with your weight loss or pursue interests that you might otherwise avoid.

You can also connect with an osteoarthritis support group, either on Facebook or Meetup, or through the online support group locator operated by CreakyJoints, a subsidiary of the non-profit Global Healthy Living Foundation.

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