Osteoarthritis

As we naturally age, osteoarthritis is the most common arthritis for sufferers. Unfortunately, many people can develop osteoarthritis at younger ages. 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 at night. Compression fractures of the spine can be confused with osteoarthritis, but typically compression fractures are more localized and more acute, in onset. MRIs show the surgeon or the anesthesiologist conducting an epidural, where the problem is located. 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 and 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, delaying 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, 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. When all else fails, joint replacement in the appropriate patient can make a significant difference in their quality of life  

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