Osteoarthritis (Part 2): Diagnosis and Management

Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis in adults.

Although it can’t be cured, osteoarthritis can be managed with medical treatment to reduce symptoms and prevent further damage to your joints, thus improving your quality of life. Surgical management is reserved for whom either the disease is in an advanced stage or medicines have failed to relieve symptoms.

1) The Basics - What is osteoarthritis?

Osteoarthritis knee (Image courtesy - Orthoinfo AAOS)

Osteoarthritis is a degenerative joint disease that can cause pain, stiffness, and loss of mobility. It's a progressive condition that gets worse over time, and it affects men and women equally.

OA can affect weight-bearing joints such as your hips, knees, and spine, but it can also occur in non-weight-bearing joints such as your shoulders, hands, or fingers.

There are different types of OA based on which joint(s) is/are affected and how advanced it is (for example rheumatoid arthritis).

Overall, nearly 10% of people worldwide have symptoms consistent with osteoarthritis.

2) Diagnosing Osteoarthritis - Imaging tests

X-Ray of arthritic joint (Image courtesy Orthobullets)

Patients having signs of joint involvement and clinical examination suggest Osteoarthritis is advised for different investigations to diagnose the disease.  Imaging tests can help to identify inflammation in your joints, which is often a cause of pain and other symptoms associated with osteoarthritis.

In addition, imaging tests can help determine if you have rheumatoid arthritis or another condition that affects joint tissue.

Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to create detailed images of your joint.

X-rays.

Osteoarthritis hand (Image courtesy Radiopaedia)

For moderate to severe osteoarthritis, simple x-rays are useful for diagnosing underlying causes and determining whether there are any signs of joint damage. It also helps to classify the disease – Mild, moderate, or severe.

X-rays can also help confirm your condition and identify osteophytes, bony spurs caused by arthritis that jut out from a joint’s surface, though they may not appear until years after symptoms begin.

Magnetic resonance imaging (MRI)

MRI scan

Magnetic resonance imaging is a procedure that uses magnetic fields and radio waves to generate images of organs and structures within your body.

Doctors use MRI scans for both research and medical purposes, including diagnosing diseases such as early stages of osteoarthritis. It can detect cartilage damage at an early stage when an X-Ray fails to identify the involvement, therefore treatment can be initiated before serious damage takes place.

Because MRI scanners produce no radiation, they can be used safely on pregnant women without harming their babies.

3) Lab tests

Because arthritis is often a symptom of another medical condition, your doctor may order various lab tests to help diagnose underlying causes.

These tests reveal underlying pathology and how quickly they’re progressing. Some common lab tests used to manage osteoarthritis include -

Blood tests

Routine blood work is one way to determine the cause of osteoarthritis like rheumatoid, infective, or gout. A full blood count or complete blood cell count tests for levels of red blood cells, white blood cells, and platelets.

A high white blood cell count may indicate an infection in your joints, while a low number could mean immunosuppressive disease.

Apart from blood count, inflammatory markers like ESR or CRP indicate the severity of the disease. However, these markers can rise in other conditions.

Joint fluid analysis.

Joint fluid analysis (JFA) is one of several methods used to diagnose the causes of arthritis. In JFA, a small sample of joint fluid is removed from an arthritic joint via a needle and sent to a lab for testing.

Many tests are conducted on these samples, including synovial cell count, pH level, glucose level, and lipids count.

Taken together, these measurements can provide doctors with insight into what’s happening in your joints that may contribute to pain symptoms and inflammation.

4) Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of medications used to treat pain, swelling, and fever.

These include acetaminophen (paracetamol), ibuprofen, naproxen and diclofenac. They can be purchased over-the-counter or with a prescription.

In some cases, they are recommended to help relieve symptoms while they may not cure osteoarthritis, they can provide some relief from symptoms such as pain.

Acetaminophen.

Unlike NSAIDs, acetaminophen (Paracetamol) does not irritate your stomach and offers some degree of protection against GI bleeding.

Acetaminophen is more effective than NSAIDs in treating OA pain, and it's one of only two medications that have been shown to slow OA progression.

However, acetaminophen is less effective than NSAIDs when it comes to treating swelling and stiffness.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

These work by reducing inflammation and pain. They include ibuprofen, naproxen, celecoxib, diclofenac and others.

Side effects include heartburn, stomach ulcers, and kidney problems; long-term use may increase the risk for high blood pressure, heart attack, or stroke.

Glucosamine and Chondroitin

These are dietary supplements commonly used in the early stage of the disease. They may delay the progression of the disease. However, research has shown no significant benefit in using these for a long time.

Diacerein

Diacerein is anti-inflammatory medicine used for osteoarthritis.

However, it also works as an analgesic, which means that it may help relieve pain. Since many people with osteoarthritis experience joint pain—especially during flare-ups—taking diacerein can help reduce discomfort and keep your mood up.

5) Therapy

When an individual is diagnosed with OA, physical therapy can be used to help slow down further damage and joint deterioration.

Physical therapy.

Physical therapy, also known as physiotherapy or PT, is a popular and effective treatment for osteoarthritis.

Physical therapists can work with patients to develop an exercise routine that will help increase mobility and flexibility while minimizing pain.

While physical therapy isn't an overnight cure, it can often make a big difference in the quality of life for those who suffer from osteoarthritis.

Occupational therapy.

Occupational therapy is a specialty that treats people with impairments in body movement, sensory perception, and other daily living skills.

It's helpful for patients who have pain from osteoarthritis (OA), a degenerative joint disease. Learn more about how occupational therapy can help your OA symptoms—and discover some of these exercises that reduce pain and improve mobility for a better quality of life.

Transcutaneous electrical nerve stimulation (TENS).

TENS devices, which stimulate nerves with low-voltage electrical currents, are often prescribed for people with osteoarthritis.

TENS is thought to decrease joint pain by boosting endorphins and giving people a pain-relieving buzz.

Although evidence from studies on TENS is limited, a 2013 Cochrane review found that it may be effective at reducing pain and improving physical function for chronic knee osteoarthritis.

Side effects may include headaches and itching. In rare cases, allergic reactions have been reported.

6) Injections inside joint

Cortisone injections.

Cortisone injections can be a great temporary pain reliever for those who suffer from an acute flare-up of osteoarthritis, but it’s not an actual cure.

Cortisone injections work by temporarily numbing affected joints, but are no longer effective once you’ve received a few.

More importantly, these types of shots come with side effects that can range from mild to severe—and more often than not include weight gain, water retention, and mood swings.

Lubrication injections.

Some patients may be candidates for lubrication injections also known as viscosupplements, in which a drug that lubricates joints is injected directly into joints.

This option has been used to great effect with arthritic knees, helping reduce pain and stiffness in some cases. It’s an option you might discuss with your doctor.

7) Surgical and other procedures

When medical management to treat osteoarthritis has been exhausted but failed to give any fruitful result, doctors might suggest your operative intervention. Broadly operative procedures are either cartilage regenerating procedures or joint replacement.

Cartilage regenerating procedures

Cartilage regenerative surgery either creates an environment for new cartilage growth inside the joint or cartilage is produced in the laboratory and then transferred to the damaged joints. Many of these surgeries are done by arthroscopy (keyhole surgery), therefore less scar.

Realigning bones.

In theory, the realignment of bone is another cartilage regenerating procedure. The bone is cut and realigned to make equal pressure distribution in the joint.

Joint replacement.

Arthritis is a problem that affects our joints and cartilage, causing pain, stiffness, and swelling. When your joints hurt so much that they become difficult to use and you can’t sleep well at night because of all that pain, it’s time to consider joint replacement.

The damaged joint surface is taken out with help of instruments and a new artificial joint is fixed in its place. Newly formed joints mimic the function of the original joint but without pain.

N.B – The content provided is for information and education purposes only.