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Degenerative arthritis, causes, symptoms, and treatment – Osteoarthritis.

Degenerative arthritis is a disease that causes pain to people’s joints. Also, it is a leading cause of disability in the United States.

Several factors play a role in the genesis of this awful disease. So, getting to know them is essential for preventing this condition.

I am a medical doctor, and in this article, I am going to thoroughly explain from head to toes, everything about this disease. Just keep reading, and you would obtain the information most up to date about osteoarthritis directly from a doctor.

What is a joint?

Before we discuss a disease, maybe you want to understand what is the structure that it affects? Well, let us first define and get to know what exactly is a joint, and where they are in the body.

A joint is a connection between two bones through a specialized surface. It would depend on its design and purpose what can and can not do a joint. Generally, they could either maintain a stable union or participate in several movements.

A functional classification would depend on the moves that the joint can accomplish, notwithstanding the existence of synarthrosis joints, which does not allow any movement (as the ones assembling your skull bones). Here we are going to focus on the ones that can move, such as ones in your column, or all the synovial joints, which are freely movable.

A different classification depends on the number of bones involved:

  • Simple joint: just two bones (shoulder or hip joint).
  • Compound joint: three or more bones.
  • Complex joint: two or more bones and the presence of another element as an articular disc (knee joint).

Here are the list of joints we are going to focus the most on:

  • Hand joints.
  • Vertebral joints.
  • Hip joint.
  • Knee joint.
  • Foot joints (the ankle, for example)

To give you a clearer image of our principal joint today. Let me explain it with the image below. The knee is assembled by two bones the femur (on top) and the tibia (below). The binding occurs thanks to the joint cartilage, which covers the bone where it makes contact.

Another essential structure is the joint capsule, which harbors the synovial fluid. The joint fluid allows it to move more freely and receive constant hydration. Plus, it helps absorbing joint impact.

File:Joint.svg
Knee joint.
Source: https://commons.wikimedia.org/wiki/File:Joint.svg

What does it mean to have degenerative arthritis?

Degenerative joint disease or osteoarthritis (OA) develops from the daily stress impacting the joints, specifically the ones that bear most of the body’s weight. Those joints would be, for example, the knee, ankle, and hip.

The primary source for it is the cartilage degeneration, which could stand for excessive stress in a healthy joint, or regular stress in a weakened joint. Overall, the general belief is that external sources can decrease the healthy regeneration of the cartilage when damaged. Similarly, people as grow older lack these repairing mechanisms that aids in recovering from joint degeneration.

Furthermore, recent studies corroborate the fact that not only the cartilage participates in this process but also the bone and the synovium. Besides, the belief that this disease is sole because of the daily struggle is not accurate anymore. In light of this, the term osteoarthritis replaced degenerative arthritis, for involving in this condition other factors that also play a role, such as inflammation, mechanics, or previous surgeries.

Classically, osteoarthritis has a division in primary and secondary based on the source that is prompting it. However, the line between them sometimes can be confusing.

Secondary osteoarthritis is the appropriate term when the disease appears because of a previous reason, such as an earlier trauma on that joint. Hence, it can appear in relatively young people.

Then, there is primary osteoarthritis that has no apparent cause, and it occurs in older people. Therefore, the root of this disease, which occurs in a previously healthy joint, is somewhat more in relation to an aging process.

What is the difference between osteoarthritis and degenerative arthritis?

Degenerative arthritis was a term used for describing cartilage degeneration because of aging, most of the time in association with strenuous work.

However, this way of thinking falls to pieces when studies found that cartilage degeneration could also exist due to other sources, such as inflammation.

Therefore, this old term “degenerative arthritis” changes to a new one, “osteoarthritis,” which genuinely englobes all the aspects of this disease.

How does osteoarthritis differ from other types of arthritis?

Osteoarthritis is the main representative of the noninflammatory types of arthritis. This definition means that typically these patients will have distinct features, despite having the same joint pain as the other ones. For example, patients with this type of arthritis would not have swollen or warm joints, the morning stiffness lengths less than an hour, and the pain improves with rest.

On the other hand, there is inflammatory arthritis, very known, it has many types like rheumatoid arthritis, for example. Here the inflammation is always a leading role and can have other symptoms that are spread throughout the body, like mouth ulcers (Canker sores) and more. Generally, these diseases cause warm or swollen joints, even longer morning stiffness, and the pain can persist even at rest.

It is essential for any doctor that is evaluating a patient to differentiate between them because they have widely different managements and treatment. Also, many other exams exist for achieving that goal of differentiation, which goes beyond the scope of this article.

Does everyone get degenerative arthritis?

Absolutely not. However, it is a very prevalent disease worldwide. Let me get you some numbers.

The World Health Organization estimation is that 10% of the population worldwide who is above 60 years old has symptoms that can be attributed to osteoarthritis. So, it is not a despicable proportion, right?

Furthermore, the problem does not seem to slow down or stop. Given that osteoarthritis is in direct relation to an older age. As life expectancy worldwide is expected to rise, so is osteoarthritis.

What are the risk factors for this?

Several risk factors exist for osteoarthritis; the list includes:

  • Age older than 50 years.
  • Obesity.
  • Previous joint injuries or trauma.
  • Family history of joint diseases.
  • Periods in life with a decrease in sex hormones (menopause, for example).
  • Muscle weakness.
  • Repetitive use of the joint, most of the time in jobs that require heavy labor and bending.
  • Previous joint infection.
  • Diseases that carry crystal deposition like gout.
  • Previous inflammatory arthritis (such as rheumatoid arthritis).
  • Hereditary metabolic diseases like hemochromatosis.
  • Red blood cells’ hemoglobin inherited damage, such as sickle cell disease and thalassemia.
  • Diseases that specifically damage the body’s nerves like diabetes.
  • A body morphologic predisposition, such as born congenital hip dislocation.
  • A bone disease like Paget disease.
  • Previous surgical procedures.

So, you can see, this disease can source from many different factors. As time pass, less is the frequency of primary osteoarthritis cases; hence there are more secondary ones. It is because doctors are finding many more specific causes for it, rather than just an isolated degeneration due to aging.

What causes degenerative arthritis?

Any source of articular cartilage damage could prompt degenerative arthritis. Aging plays a leading role in primary osteoarthritis where there is no identification of any factor, plus it is an otherwise previous healthy joint.

Typically, the constant and extensive use of the joint will lead to abnormal healing mechanisms. These mechanisms would normally repair the joint damage, but it starts to cease in its functions in this type of osteoarthritis. This situation leads to joint cartilage degeneration.

Furthermore, there are all the other specific, hence secondary causes of osteoarthritis, which will cause cartilage degeneration; The list includes:

  • Mechanical stress (obesity).
  • Direct trauma (traumatic arthritis) or surgery to the joint.
  • Infection.
  • Abnormal joints at birth.
  • Hormonal and metabolic disorders, such as diabetes or calcium deposition disorder.
  • Other previous articular diseases (gout, psoriatic arthritis, and rheumatoid arthritis)

What are the signs and symptoms of degenerative arthritis?

Osteoarthritis symptoms develop slowly throughout the years. Most people would cope with their symptoms by reducing physical activity or changing their body’s position to one that does not disturb the affected joint.

The most common complaints among patients with osteoarthritis are:

  • Arthritis pain (joint pain). It is the first symptom, which patients usually say it worsens with movement.
  • A decrease in joint movement.
  • Crepitus in the joint: cracking or popping sounds in the skin above the joint.
  • Stiffness of the joint. It could be either stiffness while on rest, or morning joint stiffness that lasts less than 30 minutes.
  • Muscle atrophy (in severe cases).

Now, spinal arthritis occurs due to the affection of the facet joints (see image below) in the column. It is a pretty common cause of neck and back pain. The location of the latter is mostly in the lumbar spine, which would be the lower back. Also, it is common that the pain extends to the buttock and the thigh. Rarely, it can go beyond the knee. When this occurs, it suggests another disease instead.

File:Facet-joints.png
Source: https://commons.wikimedia.org/wiki/File:Facet-joints.png

When osteoarthritis affects the hip joint, it will develop hip arthritis. The pain location would be on the groin or thigh and can extend to the buttock and knee.

File:916 Hip Joint.jpg
Hip Joint.
Source: https://commons.wikimedia.org/wiki/File:916_Hip_Joint.jpg

Knee osteoarthritis (Knee OA) mainly have knee pain. The pain could appear gradually, or out of a sudden, it could be dull or sharp and be constant or intermittent. This disease will usually manifest on difficulty walking, climbing stairs, and sitting upright, for example.

Hand osteoarthritis will mainly affect three places, the base of your thumb, and the finger joints of the middle and closest to your fingertips portion. It will be difficult to open jars or turning keys.

Does degenerative arthritis get worse?

Yes. The general idea is that it progresses over time, and to this day, no cure or medicine could halt that process. Therefore, the treatment focus would be toward symptoms relief. Let me get you some numbers.

From the people that are older than 55 years, two-thirds of women and half of the men have had an X-ray compatible with osteoarthritis. In people over 80 years, half of the women and a third of men have an X-ray diagnosis of knee osteoarthritis. Despite these scary numbers, not all the patients with an X-ray compatible with osteoarthritis ever show symptoms, or people with symptoms have a positive X-ray exam.

Similarly, not all the patients worsen at the same pace, although some factors are in a relationship with a quicker progression of osteoarthritis. For example, for knee osteoarthritis, there are:

  • Older age.
  • Higher weight (Obesity, Body Mass Index)
  • Congenital deformities (for example, varus deformity)
  • When multiple joints are involved.

Can you get disability for degenerative arthritis?

Indeed, let me show you some numbers. The estimation is that in the United States, osteoarthritis affects nearly 50 million people over seventeen years old.

Furthermore, here are some numbers of the new osteoarthritis cases depending on the affected joint. Yearly, per every 100,000 people would exist 240, 100, and 88 new cases of the knee, hand, and hip osteoarthritis, respectively.

From all the people suffering from osteoarthritis, nearly half (42%) will report limitations on their activities because of the disease. It is the leading cause of disability in the US, with almost 9 million people qualifying for that category.

This situation is evident in the fact that 5% of all US adult workers have work limitations due to osteoarthritis. It could be slandered in three lost workdays per person each year.

How doctors diagnose it?

The doctor will source its diagnosis on the symptoms and an X-ray exam from the affected joint. However, doctors must differentiate where the pain truly is on their patients because of other situations that could cause pain also, for example, muscle spasm, or other nearby inflammation that could resemble it.

Other blood exams, which are overall body inflammatory markers, are within normal ranges in osteoarthritis. However, the doctor could ask for that exam, probably looking to discard inflammatory arthritis in which they are typically high.

The X-ray or radiography is the exam of choice for diagnosing osteoarthritis. It would yield typical joint changes that plus the symptoms suggest to the doctor osteoarthritis diagnosis:

  • Joint space narrowing. (Normally there is a clear space in the joint, it losses visibility in this disease)
  • Subchondral sclerosis and cysts (bone modification)
  • Osteophytic growths. (bone spur, the bone starts growing outwards)

Then, another essential component in assessing this disease is magnetic resonance imaging (MRI). This exam allows the doctor to confirm all the previous visualization in the X-ray exam, plus, it will enable accurate identification of all joint cartilage. Frequently, most doctors would not ask for an MRI. This mostly occurs when assessing a severe condition or thinking into going for a surgery. Also, it can find joint effusion, which means there would be an increase in the joint fluid.

Arthrocentesis is a technique in which doctors insert a needle in the joint for disrupting the synovial space and aspirating the synovial fluid within. Usually, in osteoarthritis, there would be joint effusion, and the analysis of that joint fluid allows the doctor to differentiate osteoarthritis from other conditions, such as an infection or inflammatory arthritis.

What can be done for degenerative arthritis?

The two goals a doctor would strive for regarding osteoarthritis would be mitigation of pain and to improve the functionality of the joint. This task will require treatment without medicines, medications, and even surgery.

If these first measures result positive, then the patient could stay with them. It includes:

  • Heat and cold compress application.
  • Losing weight.
  • When possible, doing exercise.
  • Physical therapy.
  • Occupational therapy.
  • Learning how to avoid stress on the affected joint.

There are other measures as taking glucosamine or chondroitin sulfate that show some relief, although none in the long term. Also, muscle relaxant medication in patients with muscle spasm is beneficial.

Steroid injections in the joint is another pain reliever option available. Usually, patients with corticosteroid injection benefit from it a week after, and then, it can last between four to six weeks. Therefore, on average, each dose would give a month of relief.

Many other injections exist, including:

  • Sodium hyaluronate.
  • Platelet-rich plasma.
  • Irritant solutions (prolotherapy).

Now, let us move to more invasive treatment. Firstly, there is arthroscopic debridement that comprises the use of a particular device that contains a camera for inserting it in the joint and perform many procedures.

For example, it would help with the cleaning of loose cartilage and putting implants where there is injury, among other options. This method has a variable success rate. It highly relies on the doctor’s experience.

Then, there are two options, osteotomy, and joint replacement. The former is used in younger individuals that will try to avoid a joint replacement until they are older, although it may complicate the surgery later on.

The joint replacement consists of removing the older and putting a new prosthetic one. It is the last resource, but it can provide significant relief. The most common are knee replacement and hip replacement.

Look at this image for getting to know how a joint replacement resembles.

File:Replacement surgery - Shoulder total hip and total knee replacement -- Smart-Servier (cropped).jpg
Source: https://commons.wikimedia.org/wiki/File:Replacement_surgery_-Shoulder_total_hip_and_total_knee_replacementSmart-Servier(cropped).jpg

What is the best painkiller for osteoarthritis?

For pain relief, there are typical pain killers as pain medication options. Let me comment on how it will go for most of the doctors to choose between all of them.

Firstly, for nonsevere osteoarthritis pain, the first option would be acetaminophen. If there is no response or the flare is very severe, then, a nonsteroidal anti-inflammatory drug (NSAID) should be the first option. It is ideal to start with lower doses and increase it according to the patient’s response.

Furthermore, in severe cases, opioids are also an option. However, the evidence supporting their use remains inconclusive.

The problem here is that from the NSAIDs, there are too many drugs available. Sadly, none of them has a clear advantage as a pain reliever compared to the others. Each situation needs to be individualized, and it would totally depend on the patient’s background.

All of them show complications and tend to vary upon their specificity. Therefore, in order to know which of the pain killers suits best for you. Talking with your doctor would entirely help you with that.

What can you do if you are presenting symptoms?

This tool is an osteoarthritis symptoms checker. It will help you to assess how likely it is that your symptoms are because of osteoarthritis. It is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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