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It is characterized by the wearing away of joint cartilage. Cartilage is the gristle that covers the ends of bones in a joint. When cartilage breaks down, it allows bones to rub against each other, resulting in pain and loss of movement. Over time, the joint loses its normal shape. Also, bone spurs, called osteophytes, may grow on the edges of the joint. Pieces of bone or cartilage can break off and float inside the joint space, causing more pain and damage. These pieces are called “loose bodies” or “joint mice.”
OA most often occurs in people over the age of 40, but younger people can get it from a previous joint injury. While both men and women are prone to develop OA, after age 50 women are more commonly affected. OA most often occurs in the neck, low back, hands, hips, and knees.
Key predisposing factors can lead to OA. These include heredity, obesity, joint injury, and overuse of joints. Genetic factors account for about one-half of OA in the hands and hips and a smaller percentage of OA in the knees.
High intensity sports such as football, baseball, basketball, and soccer also causes increased risk.
Diagnosis is primarily from history and examination. Patients with OA of the hip may present with pain in the buttock, pain in the groin, or pain involving the front of the thigh down to the knee. Limited range of motion, especially with internal rotation, is noted on exam. Patients will often have a limp or a shortening of the affected leg because of loss of cartilage in the hip joint.
Laboratory tests should be obtained to exclude other types of arthritis, particularly if the patient exhibits signs of an inflammatory problem. X-rays can help confirm the diagnosis. MRI scanning can help detect the presence of loose bodies within the joint.
Treatment aims to relive pain and conserve function.
Non-pharmacological measures that may be useful are self-education, appropriate exercise, weight loss in those who are overweight, and acupuncture. Use of a cane when walking is reported to improve balance, and shaped insoles to redistribute forces in the joint has been suggested to limit progression, however neither of these have been subject to controlled trials.
Patient education is used in all cases and consists of modalities such as self-management programs, arthritis self-help courses, and home exercise routines.
Physical and occupational therapy including range-of-motion exercises and strengthening exercise, ultrasound, ice or heat treatments, and electrical stimulation are also important.
Weight loss and weight control will prevent excess stress on weight-bearing joints is mandatory.
Exercise programs that include training for strength and endurance will help patients maintain motion and flexibility.
Assistive devices such as canes, crutches, and walkers are often needed.
Complementary and alternative therapies such as herbs, nutritional supplements (high quality pure forms of glucosamine and chondroitin sulfate such as Joint Food) and acupuncture have data to support their use.
There are many different medications used to treat OA.
Acetaminophen (Tylenol) is often tried first since it is relatively safe when taken in small doses over a brief period of time. Other over-the-counter medicines such as ibuprofen and naproxen may also be used although caution should be used since these are non-steroidal anti-inflammatory drugs and have a higher risk of potential side-effects.
Topical analgesics (rubs, ointments such as Myorx) are often useful.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and swelling. They pose a significant risk of gastrointestinal (GI) side effects such as stomach or intestinal ulcers and bleeding, liver and kidney damage, and also other less common allergic side-effects. To prevent GI side effects, proton pump inhibitors (PPI) drugs can be used along with NSAIDS. Alternatively, COX-2 drugs can be used.
Steroid injections into the joint are often used to treat localized inflammation within the hip joint and are very effective. Ultrasound or fluoroscopy should be used to ensure proper needle location since the hip is a comparatively deep joint.
Viscosupplements (hyaluronate injections) have been tried. These also seem to be useful in patients for whom surgery is not a viable option. Again, ultrasound or fluoroscopy are required.
Narcotic painkillers occasionally are used in patients with OA who cannot have surgery and for those who decide against having surgery.
Total hip replacement is the definitive treatment and reduces both pain and disability. It is generally considered for patients who have chronic discomfort and significant impairment of function. One area of uncertainty is the optimal time to perform hip replacements.
Proper diagnosis is key. Consultation with an expert rheumatologist gives you the best chance for success.
Fore more information about Joint Food or Myorx, contact the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800