Osteoarthritis is a disease that affects joints in the body. It can involve any joint, but usually concerns hands and weight-bearing joints such as hips, knees, feet and spine.

Cartilage is the tough elastic material that covers and protects the ends of bones. In healthy joints cartilage acts as a shock absorber when you put weight on the joint. The slippery surface of the cartilage allows the bones to move smoothly. When a joint develops osteoarthritis the cartilage gradually becomes rough and thin, and the bone underneath thickens.

Osteoarthritis is classified as non-inflammatory arthritis. This suggests that there is no inflammation (swelling), but recent research shows that this is not true. Although there is usually no swelling in the early stage of the disease, as the arthritis progresses there can be inflammation. Bits of cartilage may break off and float around inside the joint. This disturbs other soft tissues inside the joint and can cause pain and swelling between bones. The result is you may have trouble moving the joint.

Over time as the cartilage wears down, the bones may form bumps on their ends. These bumps are called spurs. Or, the cartilage may wear away entirely, and your bones may rub together.

OA may lead to other problems such as:

• The muscles that hold the joint in place weaken because they are not being used.
• Over time, the joint looses its shape and does not work at all.

• There are many kinds of arthritis. The most common kind is called osteoarthritis
  (or OA for short).
• It affects 3,000,000 (1 in 10) Canadians.
• It affects men and women in equal numbers.
• Most people develop osteoarthritis after the age of 45, but it can occur at any age.

Symptoms of OA usually come on slowly, and involve the area around the joints. If you have joint pain, stiffness, or swelling for more than two weeks, see your doctor.

Damage due to OA progresses slowly over time and may result in several problems. You may have pain, especially when moving a joint. Sometimes, you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. Bumps or swelling may appear, especially on the fingers and feet. A joint may feel sore and stiff, and the joint won't move as easily or as far as it once did. All these changes can make it hard to move around and to do everyday tasks, such as opening a jar or walking up stairs.

Joints Affected
OA commonly affects weight-bearing joints such as hips, knees, feet and spine. However, non-weight bearing joints such as finger joints and the joint at the base of the thumb may be affected as well. It usually does not affect other joints, except when they have been injured or been put under unusual stress.

How does the doctor diagnose osteoarthritis?
If you are experiencing persistent joint pain, visit your family doctor. Describe the pain in detail including where the pain occurs and when. The x-ray is the most useful test to confirm osteoarthritis.

Complications of Another Type of Arthritis
Sometimes osteoarthritis is caused by damage from a different kind of joint disease that occurred years before. For example, people with rheumatoid arthritis can develop osteoarthritis in those joints in which the rheumatoid inflammation has largely burnt out.

Wear and Tear?
Osteoarthritis used to be thought of as the inevitable result of “wear and tear” on the joints. Research now shows that normal wear does not actually cause “tear.” Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis.

We do not yet know the causes or the cure for osteoarthritis, but researchers in Canada and around the world are trying to learn why cartilage starts to wear away. In fact, The Arthritis Society funds many leading edge research projects that bring vital new insights and lead to new and better treatments for osteoarthritis.

For example, Canadian researchers have identified some of the enzymes that damage the cartilage in osteoarthritis. Blocking these enzymes may be one way to slow down the progression of the disease.

Establishing the correct diagnosis is very important, because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease.
 
Your doctor may be able to diagnose OA based on your medical history and a physical examination. Sometimes, your doctor may order certain tests to help confirm the diagnosis, to determine how much joint damage exists, or to distinguish among different types of arthritis. These tests may include x-rays, blood tests or joint fluid tests.

Although there is no cure for OA, a lot can be done to help manage the condition. A variety of treatments can help to lessen pain and stiffness and to make movement easier. Your active involvement in developing your prescribed treatment plan is essential.

Medicine

Analgesics
For mild to moderate osteoarthritis doctors often recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc). Acetaminophen is a pain reliever, but does not reduce inflammation. For this reason it can usually be safely taken along with most prescription medications. However, there are daily limits of acetaminophen that you can take, so be cautious, particularly with other medications that contain acetaminophen (for example, it’s found in many cold remedies). A serious overdose of acetaminophen can cause liver damage.

Codeine Preparations
If acetaminophen is not doing enough to ease pain, your doctor may suggest a combination of acetaminophen and codeine. Codeine is a narcotic that affects the central nervous system, reducing sensitivity to pain. It is available in combination with acetaminophen in low doses without a prescription and in higher doses with a prescription. Some examples of codeine preparations are Tylenol 1, 2 and 3; Exdol-8, -15, -30; and Atasol-8, -15, -30.

Codeine may cause constipation, which can be avoided by simple dietary changes (prune juice, bran cereals etc.) and stool softeners.

Creams and Gels
Topical creams and gels that are available over-the-counter may provide temporary pain relief, but only in the areas where they are applied. These creams aren’t as effective as anti-inflammatories. Brands available include: Bengay Arthritis®, Deep Heating Rub Cream®, Minard’s Joint Relief®, Marathon Deep Heat Rub®, Menthacin®, Extra-Strength Deep Heating®, and Arthritis Patch. The majority of creams and gels use heat or cold to distract you from pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) 
These medications can be used to help reduce pain and swelling of the joints, and decrease stiffness. However, they do not prevent further joint damage. NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose.

You can purchase NSAIDs such as acetylsalicylic acid, also known as ASA (Aspirin®, Anacin®, etc.) and ibuprofen (Motrin®, Advil®, etc.) without a prescription. If you have more severe pain and swelling, your doctor may prescribe a different kind of NSAID such as Naprosyn®, Relafen®, Indocid®, Voltaren®, Feldene®, or Clinoril®. You may need to take NSAIDs for several weeks before they take effect completely.

Common side effects of NSAIDs include stomach upset, diarrhea and abdominal pain. Elderly people, people with high blood pressure, people with kidney problems, people who have had a previous stomach ulcer, and people with congestive heart failure or those who have had a previous heart attack or stroke should talk to their doctor before taking any NSAID. NSAIDs can also interact with blood thinners such as warfarin. With the exception of small dose ASA for circulation problems, two different NSAIDs should not be taken at the same time.

COX-2 inhibitors (e.g. Celebrex®) are a specific kind of NSAID that may be prescribed if traditional NSAIDs are hard on your stomach, or if you have an increased risk for stomach or duodenalulcers. People who have had a heart attack or stroke or experienced serious chest pain related to heart disease should not use NSAIDs or COXIBs. If you are unsure, speak to your doctor to determine if this type of treatment is right for you.

To relieve pain, inflammation and minimize gastrointestinal side-effects, NSAIDs can also be delivered topically (by applying it directly to the affected area). At the time of publication, Pennsaid® is the only available prescription NSAID topical solution approved by Health Canada for OA of the knees specifically.

Corticosteroids 
When osteoarthritis progresses to the point where it’s hard to get around, corticosteroid injections may be an option to reduce pain and improve mobility. Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone. They are steroids that can be injected into the joints. An injection can provide almost immediate relief for a tender, swollen and inflamed joint. However, this treatment can only be used rarely, since corticosteroids can weaken the cartilage and remove the minerals from (and therefore weaken) the bone, resulting in further joint weakness.

All medications have potential side effects whether they are taken by themselves or in combination with other herbal, over-the-counter and prescription medications. It is therefore important for patients to discuss the benefits and potential side effects of all their medications with their doctor.

Health Canada’s Marketed Health Products Directorate (MHPD) has recently developed a new website, named MedEffect. MedEffect’s goal is to provide centralized access to new safety information about health products in an easy to find, easy to remember location. It also aims to make it as simple and efficient as possible for health professionals and consumers to complete and submit adverse reaction reports. Finally, it helps to build awareness about the importance of submitting adverse reaction reports to identify and communicate potential risks associated with certain drugs or health products. To find out more, visit: www.healthcanada.gc.ca/medeffect or call toll-free 1-866-234-2345.

Exercise

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Exercise helps lessen the symptoms of OA and can help make you feel better overall. Moderate stretching exercises will help relieve the pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility. While these measures won’t stop the disease from progressing, they can help slow damage to your joints. Combined with good medical care, you can better manage your symptoms.

Protect Your Joints

Protecting your joints means using your joints in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. Three main techniques to protect your joints are:

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.

Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one.  Also, avoid keeping the same position for a long period of time.

Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier.  Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

Staying at your recommended weight or losing weight helps reduce the risk of OA of the knees, and it lessens pain by reducing stress on the joints. If you plan to lose a lot of weight, discuss the best program for you with your doctor and a dietician.

Heat/Cold
Heat applied to an arthritic area can reduce pain, stiffness and muscle spasm. It promotes blood circulation, which nourishes and detoxifies muscle fibers. Having a hot shower before exercise may help you get ready for the workout. You should not apply heat to an inflamed joint. Cold applied to inflamed joints reduces pain and swelling by constricting blood flow.

Viscosupplementation

Viscosupplementation is a relatively new treatment in Canada for people with osteoarthritis of the knee. A clear gel-like substance is injected into the knee that helps the joint fluid regain its viscoelasticity - that is, its ability to lubricate joint cartilage and absorb the mechanical shocks of daily living. Viscosupplementation restores frictionless movement within the joint, thus reducing pain and allowing greater mobility. For more information on this procedure, ask your doctor.

Surgery

Acupuncture

Acupuncture is an ancient Eastern technique that may provide temporary pain relief. Results of a randomized trial in a recent issue of THE LANCET suggest that acupuncture could reduce pain and improve joint functioning in the short-term for people with osteoarthritis of the knee. Lead investigator Claudia Witt (Charite University Medical Center, Berlin, Germany) advised: “Acupuncture treatment had significant and clinically relevant short-term effects when compared to minimal acupuncture or no acupuncture treatment in patients with osteoarthritis of the knee. We now need to assess the long-term effects of acupuncture, both in comparison to sham interventions (superficial needling at non-acupuncture points) and to standard treatment.”

Massage

Massage is widely used for pain relief, but its results are open to question. At best, massage may relieve muscle ache or tension by increasing blood flow, but benefit is relatively short-lived. Massage should be avoided when joints are especially tender or inflamed, since it can actually worsen your condition at such times. If you’re having a massage done by a professional, make sure he or she understands that, because of your arthritis, you want only the gentlest procedure.

The Cochrane Musculoskeletal Review Group (CMSG) is a specialized group of researchers and consumer representatives that belong to the Cochrane Collaboration, an international not-for-profit organization that encourages informed decisions about health care by preparing, maintaining and promoting reviews of the effects of various health care treatments.

CMSG members review the best available literature to determine the best evidence to support specific arthritis treatments. They explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances. The results are medical reviews that are then included in The Cochrane Library and made available to health professionals around the world.

For members of the public who also want to be informed about the evidence concerning health care practices and decisions in their lives, the Cochrane Musculosketal Review Group have summarized their reviews into consumer fact sheets. For the Cochrane consumer reviews related to osteoarthritis, visit www.arthritis.ca/cochrane.

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.
• The Open Forum within this Web site is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.