Arthritis is a common condition affecting the adult population in America. It is estimated that over 37 million people are affected by arthritis with the vast majority of these being osteoarthritis. The next most common arthritic condition would be rheumatoid arthritis. There are up to 315 million patient visits per year for arthritis and over 1.5 billion days of restricted activity per year secondary to arthritis. It is estimated that by the year 2020 there will be close to 60 million people with arthritis. In those individuals over the age of 65, up to 30% of them have to limit their activities secondary to their arthritic condition.
It is felt that up to 12% of the adult population has symptomatic osteoarthritis. This incidence tends to rise with increasing age to the point that after the age of 75, over 80% of the people have osteoarthritis. Risk factors for osteoarthritis include aging, obesity, thigh weakness, joint overuse, as well as probably some genetic and developmental susceptibility. Typically, those individuals with osteoarthritis are over the age of 50 with stiffness less than 30 minutes upon wakening and they have crepitus, which is an actual crunching type noise when the joint is moved. This a noninflammatory process in comparison with rheumatoid arthritis. It is felt that, over years, the abnormal loads placed on the cartilage and the joint lead to wear of the cartilage and then bone on bone findings occur.
Patients will typically present with pain, stiffness, and loss of motion. Crepitus may be seen as well as tenderness along the joint itself. There can be malalignment as well as a limp secondary to the pain. Any joint can be involved but most common joints affected would be the hip and knee.
Goals of arthritis therapy are to relieve pain and inflammation
while minimizing the risks of the therapy. Hopefully, these will
retard the disease progression. In addition, patient education
must be given so that patient's are well aware and informed of
the disease process. By doing these things, we hope to prevent
work disability and also enhance the quality of life and functional
independence.
Treatment alternatives include patient education, weight reduction,
physical therapy, as well as medications. The medications can
include over the counter anti-inflammatories and simple analgesics
all the way up to narcotic analgesics. In addition, intra-articular
therapy can be done with Cortisone injections and with a new shot,
known as Synvisc. This is a revolutionary
new shot that is given, which increases cartilage nutrition and
has been found to be beneficial for up to 18 months in selected
patient's. In those individuals who fail conservative measures,
then surgical treatment is indicated. This could include arthroscopic
debridement, which is a "clean out" of the joint all
the way to partial or even total knee replacement.