Degenerative Disease

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

The most common types of arthritis include:

Osteoarthritis

Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.

Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine and knees.

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury, or deformity.

Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness, or heat in a joint, limitation of motion of joint, early morning stiffness and skin changes, including rashes.

Doctors diagnose arthritis with a medical history, physical exam, and x-rays of the knee. There is no blood test for osteoarthritis.

Treatment Options

  • Initial treatment for osteoarthritis of the knee is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti-inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful
  • For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended

Treatment of osteoarthritis focuses on decreasing pain and improving joint movement, and may include:

  • Exercises to keep joints flexible and improve muscle strength
  • Many different medications are used to control pain, including corticosteroids and NSAIDs
  • Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS
  • For mild pain without inflammation, acetaminophen may be used
  • Heat/cold therapy for temporary pain relief
  • Joint protection to prevent strain or stress on painful joints
  • Surgery (sometimes) to relieve chronic pain in damaged joints
  • Weight control to prevent extra stress on weight-bearing joints