Osteoarthritis (OA) is the most common joint disease worldwide. It is also known as degenerative joint disease (DJD). Weight-bearing joints are most commonly affected, such as the lumbar spine (lower back), hips, knees, and feet. Fingers and the cervical spine (neck) are also often affected.
There are two main types of OA. Primary OA is usually due to “wear and tear” or other structural abnormalities, while secondary OA is usually due to metabolic disturbances, repetitive joint bleeding, previous trauma to the bone or ligaments, or genetic predisposition.
Both men and women can be affected, but females have a higher risk, especially for knee and hands. Other risk factors include your age, ethnic background, and your genetic predisposition. Obesity, trauma, and occupations involving repetitive activities can also increase your risk. OA becomes more common as you get older. The usual onset is between 45 and 65 years of age, but younger individuals can also develop it.
OA mostly affects the cartilage, a type of connective tissue that is tough and flexible, but relatively easy to damage. When your cartilage is healthy, it covers and protects the ends of your bones, absorbing energy from the shock of physical movement and allowing the bones to glide over each other. With OA, the cartilage becomes thinner and breaks off. This allows bones to rub against each other, causing pain, swelling, and decreasing range of motion. If this persists, the joint may lose its normal shape and pieces of bone or cartilage can break off and float inside the joint space (also called intra-articular loose bodies), causing pain and joint locking.
When OA affects joints, patients usually complain of pain, stiffness, limited range of motion, gradual onset of pain that increases with use of the joint and which is relieved with rest, short periods of morning stiffness or after periods of rest, pain due to changes in barometric pressure or weather, knee instability, limping, and enlarged joint in the hands. Grinding and a crunching sensation with motion can also be heard.
When OA affects the spine, patients can feel pain, stiffness, and radicular symptoms in their arms or legs due to loss of disc height, and possible disc herniation or nerve impingement from enlarged anatomic structures.
This condition can affect people differently. It may progress quickly but, for the majority of the population, the joint damage gradually develops over years. The pain can be mild and interfere with your daily activities or it can cause significant pain and disability.
There is no single test to diagnose OA; however, doctors usually use the combination of clinical history, physical examination, and diagnostic imaging, including X-rays, computer tomography (CT scan), or magnetic resonance imaging (MRI) to confirm a diagnosis of OA or rule out another condition that could be causing your symptoms.
We first start by reviewing the patient’s needs, lifestyle, and health. The most conservative approach includes chiropractic care, with an aim to control the pain and improve joint function. Maintaining a normal body weight and regular exercise to move the joints can also help. In fact, research shows that exercise is one of the best treatments for OA! Other non-pharmaceutical pain relief and alternative therapies may be used, such as joint manipulation and mobilization, massage therapy, acupuncture, the use of heat and cold packs, nutritional supplements, or transcutaneous electrical nerve stimulation (TENS). For more severe cases, over-the-counter pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) may be incorporated as part of the treatment.
For some patients, osteoarthritis can be very severe and disabling; surgery is the only resort and usually the last option. Considering that there are many risks and potential side effects to that kind of treatment, always try a trial of conservative care to see if that can help you.
