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House Calls: Osteoarthritis

Osteoarthritis (OA) is a disease of the joints. Osteoarthritis affects nearly 27 million people in the US, accounting for nearly 25 percent of visits to the doctor. It is estimated that nearly 80 percent of the population have evidence found on X-ray of OA by age 65.

In the US there were approximately 970,000 hospitalizations from OA in 2011. The cost was about $15 billion. It is the second most expensive condition seen in US hospitals.

The most common symptoms of OA are pain in the joint due to wear and tear of daily use. Joint pain is usually felt at the end of the day. There can be swelling, warmth, and pain in the affected joints. Pain and stiffness can occur when joints are at rest for prolonged periods of time. In severe OA there can be a complete loss of cartilage due to friction between the bones.

OA can vary greatly from patient to patient. Some patients can have a debilitating case while others may only have mild pain in a joint. OA commonly affects the hands, feet, spine, and large weight bearing joints such as hips and knees. OA of the knees is usually associated with repetitive injury and obesity. Some people can develop a limp. In more severe cases of OA of the knees a total knee replacement may be necessary. OA of the spine can cause pain in the neck and back. Bone spurs can irritate nerves causing pain in affected limbs.

OA causes formation of bony enlargements in the small joints of the fingers. Heberden’s node are bony growths at the end of fingers that are classic for OA. Bouchard’s nodes are enlargements in the middle joint of fingers. These joints may be painful, but more importantly they may limit motion of the fingers. Bunions on the base of the big toe are also a form of OA.

Blood tests and X-rays may be ordered to diagnosis OA. X-rays may show joint narrowing, bone spurs and cyst formation on the bone. An MRI may also be ordered to determine how much bone space there is between bones and the amount of cartilage between the bones.

Lifestyle modification such as weight loss and exercise can be important. Tylenol and Ibuprofen are first line medications used for pain relief. Exercise is beneficial and should occur three times per week. Cortisone injections are also used to give short term relief between a few weeks and months.

If symptoms don’t improve a visit to your physician may be warranted. Your physician will do a history and physical to determine if you have OA. Prescription medicines such as Celebrex, Mobic, and Naproxen may be prescribed to help alleviated pain. In more severe cases Prednisone may be prescribed to reduce inflammation. You may be sent to a Rheumatologist or an Orthopedic physician for consultation. Joint replacement may be needed in more severe cases.

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