of arthritis. It can affect any joint in the body
and is believed to be a problem with
degeneration of cartilage. Initially the
cartilage fragments, then flakes off the bone
which exposes bone against bone in the joints.
Whereas cartilage is smooth and glides over
the opposite cartilage surface, bone is not
smooth and is irregular. This makes the gliding
surface uneven resulting in pain. Joint space
narrowing occurs, surrounding ligaments
weaken and calcify, and pain on movement or
on standing (in a weight bearing joint)
becomes very prominent. Since osteoarthritis
is a wear and tear type of arthritis, joints used
frequently and require weight bearing are the
most affected. Diagnosis is made by standing x-
rays, arthrography (injection of contrast and
local anesthetic into the joint…if pain is
relieved, the joint may be osteoarthritic).
Other means of diagnosis involve MRI and
arthroscopy. Prevention is in weight control,
exercise, and possibly by using antioxidant
vitamins. As little as 20 lbs extra weight
causes an acceleration in cartilage
degeneration and painful osteoarthritis.
Moderate exercise stimulates cartilage growth
by increasing blood flow. Treatment is via joint
injections with hyaluronate, arthroscopy in non-
elderly patient (including meniscectomy if due
to trauma or cartilage regenerative procedures
if due to degeneration or severe trauma) ,
glucosamine/chondroitan, and joint
replacement. Non-steroidal anti-inflammatory
drugs (NSAIDS) such as Feldene, Relafen,
Aspirin, Naprosyn, Motrin, Toradol, etc. all
inhibit cartilage growth and can accelerate
osteoarthritis. Tylenol (acetaminophen) does
not affect cartilage. More recently, the COX2
inhibitors have been used extensively for
treatment of osteoarthritis, but some recent
studies have called into question the
effectiveness of such treatment given their
expense. Currently available COX-2 inhibitors
(less GI bleeds and gastritis vs. NSAIDS)
include Bextra and Celebrex. Vioxx was
withdrawn from the market in 2004.
