| #ffffff;" /> | | | | range-of-motion exercises and strengthening exercise, |
| Osteoarthritis (OA) is the most common form of | | | | ultrasound, ice or heat treatments, and electrical |
| arthritis and affects more than 30 million Americans. It | | | | stimulation are also important. |
| is also known as degenerative arthritis or degenerative | | | | Weight loss and weight control will prevent excess |
| joint disease. | | | | stress on weight-bearing joints is mandatory. |
| It is characterized by the wearing away of joint | | | | Exercise programs that include training for strength |
| cartilage. Cartilage is the gristle that covers the ends of | | | | and endurance will help patients maintain motion and |
| bones in a joint. When cartilage breaks down, it allows | | | | flexibility. |
| bones to rub against each other, resulting in pain and | | | | Assistive devices such as canes, crutches, and |
| loss of movement. Over time, the joint loses its normal | | | | walkers are often needed. |
| shape. Also, bone spurs, called osteophytes, may grow | | | | Complementary and alternative therapies such as |
| on the edges of the joint. Pieces of bone or cartilage | | | | herbs, nutritional supplements (high quality pure forms |
| can break off and float inside the joint space, causing | | | | of glucosamine and chondroitin sulfate such as Joint |
| more pain and damage. These pieces are called | | | | Food) and acupuncture have data to support their use. |
| “loose bodies” or “joint | | | | There are many different medications used to treat |
| mice.” | | | | OA. |
| OA most often occurs in people over the age of 40, | | | | Acetaminophen (Tylenol) is often tried first since it is |
| but younger people can get it from a previous joint | | | | relatively safe when taken in small doses over a brief |
| injury. While both men and women are prone to | | | | period of time. Other over-the-counter medicines such |
| develop OA, after age 50 women are more | | | | as ibuprofen and naproxen may also be used although |
| commonly affected. OA most often occurs in the | | | | caution should be used since these are non-steroidal |
| neck, low back, hands, hips, and knees. | | | | anti-inflammatory drugs and have a higher risk of |
| Key predisposing factors can lead to OA. These | | | | potential side-effects. |
| include heredity, obesity, joint injury, and overuse of | | | | Topical analgesics (rubs, ointments such as Myorx) are |
| joints. Genetic factors account for about one-half of | | | | often useful. |
| OA in the hands and hips and a smaller percentage of | | | | Non-steroidal anti-inflammatory drugs (NSAIDs) are |
| OA in the knees. | | | | used to treat pain and swelling. They pose a significant |
| High intensity sports such as football, baseball, | | | | risk of gastrointestinal (GI) side effects such as |
| basketball, and soccer also causes increased risk. | | | | stomach or intestinal ulcers and bleeding, liver and |
| Diagnosis is primarily from history and examination. | | | | kidney damage, and also other less common allergic |
| Patients with OA of the hip may present with pain in | | | | side-effects. To prevent GI side effects, proton pump |
| the buttock, pain in the groin, or pain involving the front | | | | inhibitors (PPI) drugs can be used along with NSAIDS. |
| of the thigh down to the knee. Limited range of motion, | | | | Alternatively, COX-2 drugs can be used. |
| especially with internal rotation, is noted on exam. | | | | Steroid injections into the joint are often used to treat |
| Patients will often have a limp or a shortening of the | | | | localized inflammation within the hip joint and are very |
| affected leg because of loss of cartilage in the hip | | | | effective. Ultrasound or fluoroscopy should be used to |
| joint. | | | | ensure proper needle location since the hip is a |
| Laboratory tests should be obtained to exclude other | | | | comparatively deep joint. |
| types of arthritis, particularly if the patient exhibits signs | | | | Viscosupplements (hyaluronate injections) have been |
| of an inflammatory problem. X-rays can help confirm | | | | tried. These also seem to be useful in patients for |
| the diagnosis. MRI scanning can help detect the | | | | whom surgery is not a viable option. Again, ultrasound |
| presence of loose bodies within the joint. | | | | or fluoroscopy are required. |
| Treatment aims to relive pain and conserve function. | | | | Narcotic painkillers occasionally are used in patients |
| Non-pharmacological measures that may be useful are | | | | with OA who cannot have surgery and for those who |
| self-education, appropriate exercise, weight loss in | | | | decide against having surgery. |
| those who are overweight, and acupuncture. Use of a | | | | Total hip replacement is the definitive treatment and |
| cane when walking is reported to improve balance, | | | | reduces both pain and disability. It is generally |
| and shaped insoles to redistribute forces in the joint | | | | considered for patients who have chronic discomfort |
| has been suggested to limit progression, however | | | | and significant impairment of function. One area of |
| neither of these have been subject to controlled trials. | | | | uncertainty is the optimal time to perform hip |
| Patient education is used in all cases and consists of | | | | replacements. |
| modalities such as self-management programs, arthritis | | | | Proper diagnosis is key. Consultation with an expert |
| self-help courses, and home exercise routines. | | | | rheumatologist gives you the best chance for success. |
| Physical and occupational therapy including | | | | |