Wear and Repair
Cartilage undergoes a normal cycle of breakdown and repair. As the joint surface wears away, your body attempts to replace it using an inflammatory response.
The fundamental problem of osteoarthritis is thought to be the imbalance between natural degradation and the fresh cartilage production. As the joint swells, new bone is created to increase the surface area of the joint. Osteoarthritis results from the body’s inability to compensate for the lost cartilage.
This is partly normal wear and tear and partly disease process. Since the cartilage is not replaced effectively, the joint lining wears thin.
A Deeper Loss
While osteoarthritis was once thought to be confined to the cartilage surface, it is now known that it goes deeper, affecting the entire joint. All of the cartilage can be lost and you can develop damage to the bone, resulting in the formation of bone spurs, and inflammation of the soft tissues.
Is It Inevitable?
Osteoarthritis tends to affect older people, but researchers don’t yet fully understand why some people develop arthritic changes in their 40s and 50s while others live long lives with few joint problems.
People once thought that osteoarthritis was simply due to the demands they placed on their joints throughout life, attributing their joint deterioration to the activities of their youth. Research has taught us, though, that it’s not that simple. Many avid runners and competitive athletes have no problems with arthritic joints, while others have severe arthritis.
In different people, different factors may play a vital role but it is unusual to have just one underlying problem that causes osteoarthritis.
Treatment
Treatments for osteoarthritis are directed at controlling the inflammatory response and maximizing your body’s ability to compensate for joint wear and tear.
Drugs
Medications serve the dual purpose of helping to reduce inflammation and pain. Your healthcare provider may consider:
Anti-inflammatory medications: Non-steroidal anti-inflammatory medications, also called NSAIDs, are oral medications that help control the cycle of inflammation and reduce pain. Common NSAIDs (both over-the-counter and prescription) include Motrin/Advil (ibuprofen), Naprosyn/Aleve (naproxen sodium), and Celebrex (celecoxib). Cortisone injections: Cortisone is a natural anti-inflammatory molecule produced by your adrenal glands. Injecting a synthetic form of the hormone into an affected joint delivers a very high dose of anti-inflammatory medication right where it’s needed. While not a pain killer itself, cortisone can reduce discomfort by way of reducing inflammation.
Therapies
Physical therapy strengthens the muscles around the joint, relieving some of the burden on the cartilage and bone.
Synvisc (hylan G-F 20), also called hyaluronic acid, may also be considered. It contains substances that are secreted by cartilage cells and help give your joint fluid a slippery quality.
By injecting this substance into the knee, some people believe you are replacing this vital component of joint fluid.
Synvisc is conditionally approved for osteoarthritis by the U.S. Food and Drug Administration (FDA), but it’s considered a treatment or therapy as opposed to a drug.
Long-term studies have yet to show any clear benefit of Synvisc; however, many patients believe that it is effective. Studies have shown that patients who are treated with Synvisc are more likely to go longer before needing a knee replacement.
Lifestyle
Choices you make every day can also have a big impact in managing osteoarthritis:
Weight loss: Weight loss decreases the burden the joint must carry, especially when it comes to the hips, knees, and feet. Activity modification: Limiting certain activities that increase your pain and inflammation may be necessary. You may be able to substitute other activities, though. For example, aquatic exercise is gentler on the joints than, say, jogging or a typical weight circuit at the gym. Diet: Specific diets and dietary supplements have been studied, but little has been proven. In small studies, antioxidants have been shown to decrease the progression of osteoarthritis, but this has not been proven in larger studies, and they have not been shown to change the overall incidence of osteoarthritis. Vitamin D has also been shown to decrease the progression of osteoarthritis. These data suggest that although diet may play an important role in preventing the progression of the disease, other factors may be more vital.
Glucosamine and Chondroitin
The supplements glucosamine and chondroitin became popular for joint pain years ago. The two substances are “building blocks” of cartilage, so it made logical sense. Early studies appeared to yield promising results.
However, as researchers looked into them further, mixed results and large amounts of poor-quality evidence led glucosamine and chondroitin to fall out of favor with many in the medical community. The two just don’t appear to do much in the way of alleviating osteoarthritis symptoms or joint pain in general.
Some researchers have called for higher-dose studies of glucosamine, saying that’s what’s needed to prove its benefits. Others say a form of glucosamine called prescription patented crystalline glucosamine sulfate is superior to other forms.
An important consideration with any treatment is whether the potential benefits outweigh the risks. With studies showing little or no benefit and possible risks, such as negative interactions with medications such as the blood-thinner Coumadin (warfarin), the medical community has largely stopped recommending these supplements.
