Arthritis is damage, degeneration, or injury to the cartilage that covers the ends of our bones (articular cartilage). When our cartilage is young and healthy, it is a nice, smooth surface that allows our joint to move freely and pain-free. As we age, our cartilage often becomes degenerative, soft, and can become thin or completely worn away. We each get one set of cartilage and it does not regenerate.
For some patients, arthritis is part of the normal aging process. Often, it is the result of the normal wear and tear that we put on our bodies over time. Other times, it is a result of previous injury to the cartilage or the bone underlying the cartilage. The cartilage can become degenerative in response to injury. This process is called post-traumatic arthritis. Obesity can substantially contribute to arthritis of most joints as it causes increased pressure on the joints. There are inflammatory arthropathies (i.e. rheumatoid arthritis) which are often diseases of the lining of the joint (synovium) rather than the articular cartilage.
The most common symptom of arthritis is pain which frequently waxes and wanes or flares up. In between flare-ups, patients may have no pain. As the arthritis progresses, the frequency of the flare-ups can increase and the severity of the pain may increase. Finally, patients can develop chronic pain. Other symptoms of arthritis include joint swelling, decreased range of motion, and resultant functional loss. Sometimes, arthritis is asymptomatic.
Yes, stay active and maintain a normal body habitus (weight and diet).
The treatments are aimed at minimizing symptoms. Non-steroidal anti-inflammatory drugs (NSAIDS), such as Advil, can frequently be helpful in decreasing the inflammation and resultant pain. However, in order for you to use NSAIDs, your primary care physician must give you approval due to negative cardiac affects NSAIDSs may cause. Acetominophen (Tylenol) is a pain reliever as well. Activity modification can frequently minimize symptoms. Selective cortisone shots can dramatically decrease symptoms in the earlier stages and can be administered typically every 3 months with some exceptions. Viscosupplementation (Synvisc, Euflexxa, etc) is often appropriate in knee arthritis and is effectively a “lubricant”. Braces often are effective in keeping a joint warm while minimizing swelling (i.e. knee sleeve), decreasing motion (ankle or wrist brace), or by decreasing pressure on a specific part of a joint (i.e. knee unloader brace). Icing inflamed, painful, swollen joints is often effective in symptom relief.
There are typically very effective surgical treatments for arthritis. These are typically joint-specific and can be some of the most predictable options. Joint replacement (arthroplasty) is often a very predictable, appropriate, and durable treatment for many joints with end-stage arthritis that have failed conservative treatment. Examples of joint replacement are hip, knee, and shoulder replacement. Other joints typically respond very well to resection, such as the acromioclavicular joint (AC joint) in the shoulder. Occasionally, arthroscopic debridement is appropriate although not always and typically is a temporary solution.
The appropriate treatment approach is often multifactorial and patient specific. Our treatment is often dynamic as symptoms change and arthritis progresses. This handout is designed as a reference to improve patient education and awareness about the pathophysiology, pathoanatomy, and treatment of arthritis. Thus, I would be happy to address your specific questions and needs at any point.
Barton R. Branam, MD