Date:
How Do Doctors Diagnose Osteoarthritis
No single test can diagnose osteoarthritis. Most doctors use a
combination of the following methods to diagnose the disease and rule
out other conditions:
Clinical history
The doctor begins by asking the patient to describe the symptoms, and
when and how the condition started, as well as how the symptoms have
changed over time. The doctor will also ask about any other medical
problems the patient and close family members have and about any
medications the patient is taking. Accurate answers to these questions
can help the doctor make a diagnosis and understand the impact the
disease has on your life.
Physical examination
The doctor will check the patient's reflexes and general health,
including muscle strength. The doctor will also examine bothersome
joints and observe the patient's ability to walk, bend, and carry out
activities of daily living.
X rays
Doctors take x rays to see how much joint damage has been done. X rays
of the affected joint can show such things as cartilage loss, bone damage, and bone spurs.
But there often is a big difference between the severity of
osteoarthritis as shown by the x ray and the degree of pain and
disability felt by the patient. Also, x rays may not show early
osteoarthritis damage before much cartilage loss has taken place.
Magnetic resonance imaging
Also known as an MRI, magnetic resonance imaging provides
high-resolution computerized images of internal body tissues. This
procedure uses a strong magnet that passes a force through the body to
create these images. Doctors often use MRI tests if there is pain, if
x-ray findings are minimal, and if the findings suggest damage to other
joint tissues such as a ligament, or the pad of connective tissue in
the knee known as the meniscus.
Other tests
The doctor may order blood tests to rule out other causes of symptoms.
He or she may also order a joint aspiration, which involves drawing
fluid from the joint through a needle and examining the fluid under a
microscope.
It usually is not difficult to tell if a patient has osteoarthritis. It
is more difficult to tell if the disease is causing the patient's
symptoms. Osteoarthritis is so common - especially in older people -
that symptoms seemingly caused by the disease actually may be due to
other medical conditions. The doctor will try to find out what is
causing the symptoms by ruling out other disorders and identifying
conditions that may make the symptoms worse. The severity of symptoms
in osteoarthritis can be influenced greatly by the patient's attitude,
anxiety, depression, and daily activity level.
Four Goals of Osteoarthritis Treatment
- to control pain
- to improve joint function
- to maintain normal body weight
- to achieve a healthy lifestyle
Treatment Approaches to Osteoarthritis
- exercise
- weight control
- rest and relief from stress on joints
- nondrug pain relief techniques
- medications to control pain
- surgery
- complementary and alternative therapies
How Is Osteoarthritis Treated?
Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle, and health. Most programs include ways to manage pain and improve function. These can involve exercise, weight control, rest and relief from stress on joints, pain relief techniques, medications, surgery, and complementary and alternative therapies. These approaches are described below.
Exercise
Research shows that exercise is one of the best treatments for osteoarthritis. Exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Exercise is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise prescribed will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. Walking, swimming, and water aerobics are a few popular types of exercise for people with osteoarthritis. Your doctor and-or physical therapist can recommend specific types of exercise depending on your particular situation. (See What You Can Do: the Importance of Self-Care and a Good-Health Attitude).
On the Move: Fighting Osteoarthritis with Exercise
You can use exercises to keep strong and limber, improve cardiovascular fitness, extend your joints' range of motion, and reduce your weight. The following types of exercise are part of a well-rounded arthritis treatment plan.
- strengthening exercises: These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.
- aerobic activities: These are exercises, such as walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.
- range-of-motion activities: These keep your joints limber.
- agility exercises: These can help you maintain daily living skills.
Ask your doctor or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should (1) use pain-relieving drugs, such as analgesics or anti-inflammatories (also called NSAIDs or nonsteroidal anti-inflammatory drugs) to make exercising easier, or (2) use ice afterward.
Weight control
Osteoarthritis patients who are overweight or obese should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility. A dietitian can help you develop healthy eating habits. A healthy diet and regular exercise help reduce weight.
Rest and relief from stress on joints
Treatment plans include regularly scheduled rest. Patients must learn to recognize the body's signals, and know when to stop or slow down. This will prevent the pain caused by overexertion. Although pain can make it difficult to sleep, getting proper sleep is important for managing arthritis pain. If you have trouble sleeping, you may find that relaxation techniques, stress reduction, and biofeedback can help, as can timing medications to provide maximum pain relief through the night.
Some people use canes to take pressure off painful joints. They may use splints or braces to provide extra support for joints and-or keep them in proper position during sleep or activity. Splints should be used only for limited periods of time because joints and muscles need to be exercised to prevent stiffness and weakness. If you need a splint, an occupational therapist or a doctor can help you get a properly fitted one.
If joint pain interferes with your ability to sleep or rest, consult your doctor.
Nondrug pain relief
People with osteoarthritis may find many nondrug ways to relieve pain. Below are some examples:
Heat and cold: Heat or cold (or a combination of the two) can be useful for joint pain. Heat can be applied in a number of different ways - with warm towels, hot packs, or a warm bath or shower - to increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.)
Transcutaneous electrical nerve stimulation (TENS): TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.
Massage: In this pain-relief approach, a massage therapist will lightly stroke and-or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.
Medications to control pain
Doctors prescribe medicines to eliminate or reduce pain and to improve functioning. Doctors consider a number of factors when choosing medicines for their patients with osteoarthritis. These include the intensity of pain, potential side effects of the medication, your medical history (other health problems you have or are at risk for), and other medications you are taking.
Because some medications can interact with one another and certain health conditions put you at increased risk of drug side effects, it's important to discuss your medication, and health history with your doctor before you start taking any new medication, and to see your doctor regularly while you are taking medication. By working together, you and your doctor can find the medication that best relieves your pain with the least risk of side effects.
The following types of medicines are commonly used in treating osteoarthritis:
Acetaminophen: A medication commonly used to relieve pain, acetaminophen (for example, Tylenol1) is available without a prescription. It is often the first medication doctors recommend for osteoarthritis patients because of its safety relative to some other drugs and its effectiveness against pain.
1 Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
NSAIDs (nonsteroidal anti-inflammatory drugs): A large class of medications useful against both pain and inflammation, (NSAIDs) 2 are staples in arthritis treatment. Aspirin, ibuprofen, naproxen, and naproxen sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body.
Some NSAIDS are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription.
All NSAIDS can have significant side effects, and for unknown reasons, some people seem to respond better to one NSAID than another. Any person taking NSAIDS regularly should be monitored by a doctor.
2Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health-care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People over age 65 and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.
Other medications: Doctors may prescribe several other medicines for osteoarthritis.
They include the following:
Topical pain-relieving creams, rubs, and sprays: These products, which are applied directly to the skin over painful joints, contain ingredients that work in one of three different ways: by stimulating the nerve endings to distract the brain's attention from the joint pain, by depleting the amount of a neurotransmitter called substance P that sends pain messages to the brain, or by blocking chemicals called prostaglandins that cause pain and inflammation. Examples of topical medications are Zostrix, Icy Hot, Therapeutic Mineral Ice, Aspercreme, and Ben Gay.
Tramadol (Ultram): A prescription pain reliever that is sometimes prescribed when over-the-counter medications don't provide sufficient relief. It carries risks that don't exist with acetaminophen and NSAIDs, including the potential for addiction.
Mild narcotic painkillers: Medications containing narcotic analgesics such as codeine or hydrocodone are often effective against osteoarthritis pain. But because of concerns about the potential for physical and psychological dependence on these drugs, doctors generally reserve them for short-term use.
Corticosteroids: Corticosteroids are powerful antiinflammatory hormones made naturally in the body or man-made for use as medicine. They may be injected into the affected joints to temporarily relieve pain. This is a short-term measure, generally not recommended for more than two to four treatments per year. Oral corticosteroids are not routinely used to treat osteoarthritis. They are occasionally used for inflammatory flares.
Hyaluronic acid substitutes: Sometimes called viscosupplements, these products are designed to replace a normal component of the joint involved in joint lubrication and nutrition. Depending on the particular product your doctor prescribes, it will be given in a series of three to five injections. These products are approved only for osteoarthritis of the knee.
Because most medicines used to treat osteoarthritis have side effects, it's important to learn as much as possible about the medications you take, even the ones available without a prescription. Certain health problems and lifestyle habits can increase the risk of side effects from NSAIDs. These include a history of peptic ulcers or digestive tract bleeding, use of oral corticosteroids or anticoagulants (blood thinners), smoking, and alcohol use.
There are measures you can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants such as alcohol, tobacco, and caffeine. In some cases, it may help to take another medication along with an NSAID to coat the stomach or block stomach acids. While these measures may help, they are not always completely effective.
Questions To Ask Your Doctor or Pharmacist About Medicines
- How often should I take this medicine?
- Should I take this medicine with food or between meals?
- What side effects might occur?
- Should I take this medicine with the other prescription medicines I take?
- Is this medication safe considering other medical conditions I have?
Surgery
For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following:
- removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking
- repositioning of bones
- resurfacing (smoothing out) of bones.
Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. Some prostheses are joined to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone into that surface (a process called biologic fixation) to hold them in place. Artificial joints can last 10 to 15 years or longer. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level, and other medical conditions.
The decision to use surgery depends on several factors, including the patient's age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.
Complementary and alternative therapies
When conventional medical treatment doesn't provide sufficient pain relief, people are more likely to try complementary and alternative therapies. The following are some alternative therapies used to treat osteoarthritis.
Acupuncture: Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some patients. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.
Folk remedies: These include wearing copper bracelets, drinking herbal teas, taking mud baths, and rubbing WD-40 on joints to "lubricate" them. While these practices may or may not be harmful, no scientific research to date shows that they are helpful in treating osteoarthritis. They can also be expensive, and using them may cause people to delay or even abandon useful medical treatment.
Nutritional supplements: Nutrients such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies have been carried out to further evaluate these claims.
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