Almost everyone who lives beyond middle age can anticipate developing osteoarthritis at some point. It is one of the most common age-related diseases, caused by the breakdown of cartilage in the joints due to wear and tear over time.
“The most common presenting symptom is joint pain that typically worsens with increased use of the joint and improves with rest,” says Dr. Jennifer Knox of Mercy Clinic Family Medicine. “However, as the osteoarthritis progresses, patients often experience pain with less activity and can experience pain at rest and at night while trying to fall asleep. Patients may also notice a phenomenon known as ‘gelling,’ in which they experience joint stiffness that lasts 30 minutes or less after awakening, but can reoccur after periods of inactivity. Some patients may also suffer from intermittent swelling of the involved joint and experience a feeling known as crepitus, which is a grating sensation.”
The pain and grating occurs because cartilage no longer protects the joints or allows for shock absorption and smooth motion. The bone-on-bone condition of larger joints, such as knees and hips, is treated with a progression of medical interventions, sometimes resulting in total joint replacement.
While this is a viable option for knees and hips, the spine is another story. Osteoarthritis of the vertebra, which causes pain primarily in the neck and lower back, is more challenging to treat. “It’s a very complicated area,” notes Dr. John Atkinson, acting chief of the division of rheumatology with Washington University Physicians. He adds that steroids and pain medications injected at the site are typical treatments, but may not help everyone and do not slow the disease process.
Weight loss can help relieve strain on the back, and strengthening the muscles of the legs, core and back helps stabilize the spine, but Atkinson is looking toward revolutionary solutions, such as the creation of new cartilage using stem cells.
Until that happens, patients must continue to try the therapies and lifestyle strategies physicians currently recommend. In addition to those mentioned by Atkinson, Knox advises patients to consider physical therapy, low-impact exercise, adaptive devices such as canes or orthotics, and heat to ease pain. Beyond that, Knox recommends over-the-counter pain relievers and anti-inflammatory medications, such as acetaminophen (Tylenol) and ibuprofen (Advil). The exact strategy depends on the joints most affected and the degree to which daily activities are impacted.
Atkinson remains optimistic that new treatments and even a cure will be developed. “There’s a lot of work going on in the field," he says. “Thirty years ago I wouldn’t have been optimistic, but I’ve seen a lot of advances in that time.”