By: Kathleen A. Hogan, MD
Today I’d like to answer the question, What is arthritis? One of my patients recently expressed concern that her primary care physician had diagnosed her with “degenerative joint disease.” She was worried that this disease was spreading throughout her body causing arthritis in all of her joints, and wondered what she could do to cure it. Unlike the flu, degenerative joint disease is not contagious, nor does it spread like a cancer throughout the body. It is a term to describe arthritis. Arthritis is the result of damage to the articular cartilage of a joint. Normal articular cartilage is smooth, however damage to the cartilage creates small “potholes” and exposes the underlying bone. Articular cartilage functions in a way which is similar to how the sole of your shoe protects your foot. Wear of the sole of your shoes will increase pressure on your foot, causing pain especially with prolonged walking. Likewise, damage to articular cartilage causes pain and swelling in the joints.
Causes of Arthritis
There are many causes of arthritis. Osteoarthritis is a general term which describes arthritis which has no clear cause other than everyday wear and tear on the joints.This is the most common type of arthritis. Anatomic and genetic factors may play a role in why some people get arthritis. Excessive body weight increases the risk of knee arthritis but not hip arthritis. Traumatic damage to the joint as a result of fractures, ligament injuries, or chronic joint instability also result in arthritis. An infection in the joint fluid can also increase your risk of developing arthritis, and for this reason septic joints often require emergent surgery. Having osteoarthritis in one joint does not necessarily increase the risk of arthritis in other joints.
Conditions That Affect the Articular Cartilage
Some medical conditions can affect the articular cartilage in multiple joints. Rheumatoid arthritis, for example, causes a severe inflammatory response which can affect every joint. Gout results in crystals that form in the joint fluid and promote a painful inflammatory response, which can damage cartilage in many joints. In these cases, medications can be given which minimize pain and inflammation, while potentially decreasing the risk of arthritis.
How is Arthritis Treated?
Typically, anti-inflammatory medications such as Ibuprofen, Advil, Voltaren, Meloxicam, or Celebrex are used initially.These medications can reduce pain and swelling. These medications should be taken with caution as there can be serious side effects such as ulcers, and kidney dysfunction.Tylenol is an excellent pain reliever but can not be taken by patients with liver disease. Narcotic pain medications such as Percocet and Vicodin should not be used for chronic arthritis pain. Ice is recommended to reduce inflammation and swelling, while heat is recommended to help warm up the joint before activity. Bio-freeze and topical anti-inflammatories can also help with pain. Physical therapy is often recommended as strengthening the muscles around arthritic joints helps to reduce pressure on the joint. For lower extremity arthritis, using a cane (in the hand opposite the arthritic joint) can help to take some of the pressure off the joint and relieve pain. Braces can sometimes be helpful as well. Steroid injections are frequently very successful in reducing pain and swelling.
Options if Pain Persists
If pain persists despite these treatments, some joints can be replaced (hips, knees, ankles, shoulders, wrist, fingers) or fused (spine, ankle, wrist, fingers). These surgeries are very successful in removing pain and restoring ones ability to participate in activities. However surgery should be considered only when all other treatments fail.
Do you have arthritis? If your joints keep you from doing the activities you enjoy, consider scheduling a visit with an orthopedic surgeon to be evaluated and treated.