Osteoarthritis (Degenerative Arthritis; OA)

Introduction:

 

Osteoarthritis is the most common joint disorder. Unlike rheumatoid arthritis and other inflammatory arthritic illnesses, osteoarthritis is a degenerative, often age-related disease with little to no inflammation. It is one of the leading causes of disability in the US, especially in the elderly. Repetitive trauma or underlying joint damage are risk factors for developing OA.

 

Symptoms:

 

• OA tends to cause a dull pain which worsens with activity and is better with rest. This is in contrast to inflammatory pain from rheumatoid arthritis.

• Morning stiffness in OA tends to last less than fifteen minutes

• Patients report stiffness after prolonged sitting as well, accompanied by a ‘creaking/gritty’ sensation when they move.

• OAt often affects the hands, the spine, and weight-bearing joints such as knees and hips.

• It often affects the hands, the spine, and weight-bearing joints such as knees and hips.

 

Role of Steroids in OA:

 

There is no role for systemic or oral steroids in OA. However, steroid injections are commonly used and are quite helpful.

 

Gel (hyaluronic) injections in arthritis joints are commonly used, although the 2019 American College of Rheumatology (ACR) guidelines recommend against use of gel injections in knee and hip OA due to insufficient evidence of benefit.

 

The ACR also recommends against the use of PRP (platelet-rich plasma) and stem cells for hip and knee OA due to insufficient evidence of benefit.

 

Treatment:

 

Besides anti-inflammatories and painkillers, physicians recommend a multimodality approach which includes an active lifestyle, weight loss, physiotherapy, balance exercises, ambulatory devices, and sometimes steroid injections. If these fail, joint replacement surgeries are frequently performed to restore function, reduce pain, and improve patient quality of life.

 

Newer biologic agents, genicular nerve ablation modalities, and genicular artery embolization are emerging techniques to alleviate pain in severely symptomatic patients.