Osteoarthritis

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Osteoarthritis is the most common type of arthritis, and occurs when the protective cartilage at the ends of the bones gradually wears down. Cartilage is a firm but slippery type of tissue that allows joints to move with virtually no friction at all. When the slick surface of cartilage becomes rough, osteoarthritis occurs. In severe cases of arthritis, cartilage can wear down so much that it essentially disappears, allowing bones within the joint to rub against each other. It can become difficult to perform even the most simple of tasks, and some individuals may even lose the ability to walk. Joint pain may become so severe that joint replacement surgery becomes necessary.

There are a number of risk factors associated with osteoarthritis, with increasing age being one of the most prominent. In addition, women are more likely than men to develop osteoarthritis, however the reasons for this sex difference are not understood. Individuals who are born with deformed joints also run a higher risk for developing osteoarthritis, as are those who suffer injuries to joints from sports or via an accident. Obese individuals also have an increased risk due to the stress that excess body weight places on the joints. Moreover, those who do not get regular physical activity also have an increased risk of developing osteoarthritis. Repetitive motions to joints, for example through occupational-related tasks that involve repetition, can also increase risk. Additionally, certain disorders – such as diabetes, underactive thyroid, and gout – can also increase an individual’s risk of developing osteoarthritis.

Osteoarthritis frequently affects the joints in the hands, neck, lower back, knees, and hips. It is also progressive, with symptoms developing slowly and then growing worse over time. Common symptoms associated with osteoarthritis include pain, tenderness, stiffness (especially upon awakening from sleep or after a period of inactivity), decreased flexibility, grinding sensations when affected joints are used, and bone spurs (tiny bits of bones that form around the affected joint).

The diagnosis of osteoarthritis involves a combination of approaches. A detailed physical exam is performed so that the physician can check the joint for tenderness, swelling, and range of motion. Various imaging tests – such as X-rays or magnetic resonance imaging (MRI) may also be used. Certain blood tests may be helpful to rule out other causes of joint pain. On occasion, a sample of the joint fluid may also be taken and analyzed to determine the cause of the pain.

The pain of osteoarthritis can be adequately controlled for many individuals through the use of common pain relievers such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs; Aleve, Motrin). Sometime narcotic pain medications may be required in cases of extreme pain. Physical therapy can be beneficial, as can lifestyle modifications that decrease the stress placed on affected joints. An occupational therapist can be helpful with behavioral and environmental changes that will make the greatest impact on an individual’s particular joint health. Other methods of pain relief that are generally tried with other options described above have failed, or are insufficient at improving symptoms, include cortisone shots, lubrication injections, and various surgical procedures. Additionally, complementary and alternative therapies, such as acupuncture, glucosamine/chondroitin supplementation, and yoga may also be of additional benefit, though studies regarding the effectiveness of these therapies have produced conflicting findings.

Fibromyalgia and Osteoarthritis

There is a fair amount of scientific research available regarding fibromyalgia and osteoarthritis due to the fact that both are chronic pain conditions; however, nearly all of the studies use patients with osteoarthritis as a control group when evaluating medication effectiveness, symptoms (such as fatigue), and quality of life among fibromyalgia patients. Therefore, there is little information available regarding any possible association between the two conditions, apart from a few studies that suggest that chronic pain conditions, such as osteoarthritis and fibromyalgia, might have similar biological and/or neurological origins (Staud, 2011). Provided below are a sample of some of the research studies that have been conducted using both fibromyalgia patients and individuals with osteoporosis.

Several studies have investigated fatigue and overall quality of life in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. While most researchers agree that fatigue is common among all three conditions, there are significant differences between individual conditions and as such, each condition should be managed in a tailored approach (Zautra et al., 2007; Kratz et al., 2007; Reich et al., 2006; Parrish et al., 2008). In addition, other studies have suggested that fibromyalgia patients are more susceptible to negative effects of stress on their chronic pain than are patients with osteoarthritis (Davis et al., 2001).

Kleinman et al., (2009) compared fibromyalgia patients to osteoarthritis patients while evaluating the burden that fibromyalgia places on employer health costs, as well as determining the impact that fibromyalgia has on  work output, employee absenteeism, and a number of other measures. Although the study found that osteoarthritis was more prevalent than fibromyalgia in the population studied, as well as more costly to employers in terms of health benefits ($8,452 for fibromyalgia vs. $11,253 for osteoarthritis), the study revealed that fibromyalgia and osteoarthritis had comparable impacts on employment in terms of their effects on human capital, with similar decreases in annual work output and absentee days. Other researchers have examined similar cost-related similarities and differences between fibromyalgia, osteoarthritis, and other chronic pain conditions (Sabariego et al., 2011).

Another study by Ozcetin et al. (2007) examined how the effects of depression and anxiety impact quality of life among patients with rheumatoid arthritis, osteoarthritis of the knee, and fibromyalgia. Following analysis, the study showed that in general, quality of life is significantly low in all three groups among patients who have clinically significant depression and/or anxiety.

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References

1.        Davis MC, Zautra AJ, Reich JW. Vulnerability to stress among women in chronic pain from fibromyalgia and osteoarthritis. Ann Behav Med. 2001;23(3):215-226.

2.        Kleinman N, Harnett J, Melkonian A, Lynch W, Kaplan-Machlis B, Silverman SL. Burden of fibromyalgia and comparisons with osteoarthritis in the workforce. J Occup Environ Med. 2009;51(12):1384-1393.

3.        Kratz AL, Davis MC, Zautra AJ. Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients. Ann Behav Med. 2007;33(3):291-301.

4.        Ozcetin A, Ataoglu S, Kocer E, Yazici S, Yildiz O, Ataoglul A, Icmeli C. Effects of depression and anxiety on quality of life of patients with rheumatoid arthritis, knee osteoarthritis and fibromyalgia syndrome. West Indian Med J. 2007;56(2):122-129.

5.        Parrish BP, Zautra AJ, Davis MC. The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis. Health Psychol. 2008;27(6):694-702.

6.        Reich JW, Olmsted ME, van Puymbroeck CM. Illness uncertainty, partner caregiver burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients. Arthritis Rheum. 2006;55(1):86-93.

7.        Sabariego C, Brach M, Stucki G. Determinants of major direct medical cost categories among patients with osteoporosis, osteoarthritis, back pain or fibromyalgia undergoing outpatient rehabilitation. J Rehabil Med. 2011;43(8):703-708.

8.        Staud R. Evidence for shared pain mechanisms in osteoarthritis, low back pain, and fibromyalgia. Curr Rheumatol Rep. 2011;13(6):513-520.

Zautra AJ, Fasman R, Parish BP, Davis MC. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain. 2007;128(1-2):128-135.

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