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OSTEOARTHRITIS FACTS
by RL Fielding
What is Osteoarthritis?
Osteoarthritis is a chronic condition in which tissue known as cartilage
breaks down. When this tissue deteriorates, it leaves the bones to rub
against each other, causing pain and stiffness. If you have osteoarthritis,
you’ve probably heard something like this definition from your doctor.
The disease may also be referred to as osteoarthritis, degenerative
joint disease or degenerative arthritis.
In general terms, osteoarthritis is considered to be a chronic condition.
It is important to make the distinction between chronic and acute conditions.
Illnesses such as a cold or the flu are acute conditions, because they
have a clear beginning and end as well as a specific cause, such as
a virus. These illnesses can be diagnosed with special tests, and many
of the most common ones can be treated with drugs or medical procedures.
Chronic conditions like osteoarthritis, on the other hand, often last
for several years or even a lifetime. All of the causes of osteoarthritis
aren’t yet known, so there may be no single, simple treatment.
In fact, treatment for osteoarthritis may require a variety of medications
and other measures, and these may change over time. Because this disease
is long-lasting and can affect your day-to-day life for years, it is
crucial that you take an active role in managing it. You can make a
difference in how you feel by monitoring your symptoms, following your
treatment plan, and dealing with the daily challenges the condition
brings.
What Causes Osteoarthritis?
Like other chronic conditions, osteoarthritis has no single, specific
cause. Instead, there are several factors involved in the disease, including
heredity and lifestyle. It may take a combination of these factors to
eventually result in osteoarthritis.
Heredity - Scientists believe that in osteoarthritis, as in many other
diseases and conditions, heredity may play a role in the disease. Researchers
are studying several genes that may be connected to osteoarthritis.
The outcomes of these studies may help predict who is most likely to
get the disease.
Obesity - You probably already know that being overweight puts you at
risk for heart disease and certain types of cancer, but it can also
have a profound effect on your joints. The reason is that your major
joints, such as knees and hips, already bear the brunt of your body’s
weight as you move through normal daily activities. Being overweight
puts even more pressure on these joints.
Injury and overuse of joints - Sometimes repetitious movements or serious
injuries to joints can lead to osteoarthritis years later. Some full-time
athletes, for example, may injure the same joints over and over again,
causing damage to the joints, tendons and ligaments that speeds up cartilage
breakdown.
What are the Different Types of Arthritis?
There are more than 100 different types of arthritis and related diseases.
It is important to know which type of arthritis you have so you can
treat it properly. If you don’t know which type you have, call your
doctor or ask during your next visit.
Osteoarthritis - The most common type of arthritis is osteoarthritis,
or OA. OA affects about 21 million Americans. OA is sometimes called
degenerative arthritis because it is caused by the breakdown of cartilage
and bones, causing pain and stiffness. OA usually affects the fingers
and weight-bearing joints, including the knees, hips, back and neck.
It affects both men and women and usually occurs after age 45.
Rheumatoid Arthritis - In rheumatoid arthritis, or RA, an abnormality
in the body’s immune system causes inflammation of the joints. Inflammation
begins in the joint lining, or the synovium, and over time leads to
damage of both cartilage and bone. Rheumatoid arthritis often affects
the same joints on both sides of the body. RA affects about 2.1 million
Americans and is more common in women than in men.
Fibromyalgia - Fibromyalgia is a disease that causes widespread pain
and distinct tender points, which are places on the body that are highly
sensitive to touch and produce pain. People with fibromyalgia usually
have fatigue, disturbed sleep and stiffness. Fibromyalgia is a common
condition that usually affects women and it does not cause muscle or
joint damage.
Lupus - Lupus is a disease that affects the skin and joints. In some
people, lupus also affects the internal organs such as the kidneys,
lungs or heart. Lupus affects women about eight to 10 times more often
than men. Symptoms often first appear in women between ages 18 and 45.
Some of the more common symptoms include a rash over the cheeks and
across the bridge of the nose; scaly, disc-shaped sores on the face,
neck and/or chest; abnormal sun sensitivity; kidney problems; and forms
of arthritis.
Bursitis and Tendinitis - Bursitis and tendinitis are caused by irritation
from injuring or overusing a joint. Bursitis affects a small sac called
the bursa that helps to cushion the muscles and tendons surrounding
the joint. Tendinitis affects the tendons that attach muscle to bone.
Other common forms of arthritis and related conditions include:
• Polymyalgia Rheumatica
• Psoriatic Arthritis
• Ankylosing Spondylitis
• Juvenile Rheumatoid Arthritis
• Gout
• Vasculitis
• Scleroderma
How is Osteoarthritis Different?
In osteoarthritis, the cartilage begins to break down, usually gradually.
As the cartilage wears away, the bones become exposed and rub against
each other, which leads to pain. The deterioration of cartilage also
affects the shape and makeup of the whole joint, so that it no longer
functions smoothly. You may notice a limp when you walk, or you may
have trouble going up and down stairs. This deterioration puts additional
stress on the joint as it moves.
Other problems can occur inside the joint as cartilage breakdown affects
the joint components. Fragments of bone or cartilage may float in the
joint fluid, causing irritation and pain. Bony spurs or osteophytes
can develop on the ends of the bones. Fluid inside the joint may not
have enough of a substance called hyaluronan, which may affect the joint’s
ability to absorb shock. And although inflammation is not a main symptom
of osteoarthritis, it can occur in the joint lining in response to the
breakdown of cartilage.
Treatment Plan and New Developments
For some people who suffer from pain associated with arthritis, their
symptoms can be managed with exercise, heat/cold therapy, joint protection,
assistive devices, weight control, or in some severe cases, surgery.
For others, medications are needed to help manage the symptoms associated
with arthritis.
COX-2 inhibitors
COX-2 inhibitors are the newest members of the NSAID class of medications.
Available by prescription only, they became widely used in recent years
to reduce joint pain and swelling. COX-2 inhibitors work by selectively
blocking, or inhibiting, one of the two enzymes associated with inflammation.
Some experts have hypothesized that this selective inhibition may be
the reason for the negative cardiovascular effects currently associated
with COX-2 inhibitors.
Non-selective NSAIDs
Non-selective NSAIDs were developed earlier than COX-2 inhibitors and
have been widely used to relieve arthritis pain and inflammation for
many years. Unlike COX-2 inhibitors, non-selective NSAIDs inhibit both
major enzymes involved in the inflammatory process, COX-1 and COX-2.
The non-selective NSAID category includes a number of different medications
that are available in both prescription and over-the-counter (OTC) products.
However, recent controversy about the safety of pain medications for
arthritis has left patients and health care professionals alike uncertain
about which medications are safe to use. In fact, a recent survey by
the Boston-based Rippe Lifestyle Institute indicated that many people
with arthritis are suffering unnecessarily because they have stopped
or reduced their use of pain relievers due to confusion about which
drugs are considered safe.
To clarify the confusion around recent news about arthritis medications,
here are some facts:
On April 7, 2005, the FDA announced the following:
• Bextra, a COX-2 inhibitor manufactured by Pfizer, was being voluntarily
withdrawn from the market.
• All prescription NSAIDs must revise their labeling to include a “black
box” warning that highlights the potential increased risk for cardiovascular
(CV) events as well as the potentially life threatening gastrointestinal
(GI) bleeding associated with these drugs. Celebrex, the only COX-2
inhibitor remaining on the US market, was included in this directive.
• All OTC NSAIDs (except aspirin) will be required to revise their labeling
to include more specific information about the potential for GI and
CV side effects, a stronger reminder to follow label instructions, as
well as a warning about potential skin reactions.
To further evaluate the potential for increased CV risk, the FDA also
announced that all NSAIDs must conduct and submit to the Agency a comprehensive
review and analysis of pertinent safety data from clinical trials.
The FDA emphasized that when label directions are followed, OTC pain
relievers such as Aleve (naproxen sodium) provide a safe and effective
way to treat mild to moderate pain of minor arthritis. If patients have
questions, they should consult their health care professional about
which treatment option is most appropriate.
More Information
For more information about osteoarthritis, and living with it, visit
the ALEVE website at http://www.aleve.com. ALEVE is an over-the-counter
(OTC) pain reliever that provides relief for a variety of pain conditions,
including minor pains associated with arthritis.
The above information from What is Osteoarthritis?, What Causes Osteoarthritis?,
What are the Different Types of Arthritis?, and How is Osteoarthritis
Different? has been excerpted from The Arthritis Foundation’s Guide
to Good Living with Osteoarthritis, copyright ©2000, Arthritis Foundation.
For more information about this book and other resources about osteoarthritis,
call (800) 283-7800.
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