Osteoarthritis

Osteoarthritis is the most common arthritis that we all get as we age. Unfortunately, many people can develop it when they are younger. Typically trauma can be a major factor in causing cartilage to wear down in any part of the body. Loss of cartilage particularly in a weight-bearing joint such as the low back, hip or knee will be most painful. Wear and tear clearly play a role but does not explain why we see osteoarthritis in the cervical spine, hands and shoulders. We do not know all the factors involved in causing cartilage to deteriorate but there are some interesting drugs currently in research that may help prevent it.

Low back pain is most commonly associated with osteoarthritis and virtually everybody gets it sooner or later. X-rays are usually not that helpful unless the pain is particularly severe with radiation down one leg or pain that keeps a person up during the night. Compression fractures of the spine can be confused with osteoarthritis but typically compression fractures are more localized and more acute in onset. MRIs generally do not add much but show the surgeon or the anesthesiologist doing an epidural where the problem is. Fortunately very few people need back surgery for osteoarthritis and its associated problem of spinal stenosis. In spinal stenosis, bone spurs grow around the exiting nerve roots or the spinal cord causing pressure on the nerve which can be painful as well as cause weakness in the legs.

For most people, therapy including muscle strengthening exercises for the back and intermittent use of either muscle relaxers or anti-inflammatory drugs can be helpful. The role of manipulation is difficult to quantify but may be helpful in some instances as well.

Occasional injections of corticosteroids or  visco-supplementation drugs such as Synvisc or Orthovisc can be helpful for the knee and can delay surgery. Muscle strengthening exercises and weight reduction are part of the treatment as well. Nonsteroidal anti-inflammatory medication can be helpful but cannot be used in people who have pre-existing kidney disease or a history of peptic ulcers or true aspirin allergies.

There are now 1 million total hips and joints implanted every year in the United States and when all else fails, joint replacement in the appropriate patient can make a significant difference.

The role of the rheumatologist is to guide patients through the tortuous course of therapeutic options to get appropriate relief.