Introduction

Arthritis is a condition that affects the joints, leading to pain and dysfunction. The joints in our body are located where the ends of our bones meet to allow movement and function. There are many different kinds of joints that allow different types of movement. Some behave like a hinge, like the knee joint,

while others move like a ball and socket, like the hip joint).

The ends of the bones are lined with a smooth, glistening surface called “articular cartilage”.

If you have seen the end of a chicken bone, the white, shiny surface is the articular cartilage. This cartilage allows the bones to move smoothly relative to each other and also provides a cushion. Cartilage also has little to no nerve fibers embedded within it and therefore does not transmit potentially painful sensations to your brain. When articular cartilage becomes injured or damaged, the result is arthritis.

According to the Center for Disease Control, arthritis is a common condition that affects one in five adults. In the year 2006, an estimated 46 million Americans were diagnosed with arthritis. This condition is the most common cause for disability in the United States. There are over 100 different types of arthritis, but the three most common are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis is the most common type which is also known as “wear and tear” arthritis. Over time, the cartilage progressively degenerates and results in joint pain and stiffness. Rheumatoid arthritis is an autoimmune disorder affecting the synovium, or joint lining. The synovium becomes excessively inflamed and releases degradative chemicals which result in destruction of the articular cartilage and pain. the exact cause of this autoimmune reaction of the synovium is not known. Post-traumatic arthritis is the result of an injury to the joint (fracture, torn cartilage, or ligament tear) which results in direct damage to the cartilage and can lead to accelerated wearing away of the joint surfaces.

Symptoms of arthritis often start out mild and typically worsen as time progresses. Common symptoms include pain, stiffness, and swelling. Pain is usually associated with activity, but as arthritis progressively worsens, pain can occur at rest without activity or even awaken you at night. Stiffness is a common complaint and usually coincides with swelling in the joint. When a joint is irritated, the lining of the joint creates extra joint fluid. Just like if you get something in caught in your eye, your eye produces tears; however, unlike in the eye where the tears have some place to exit, the fluid in a joint builds up and causes pain and decreased motion. When joints become severely arthritic, the once smooth shiny cartilage surface becomes rough and pitted, like an old road with potholes and cracks, and grinding can be felt or even heard with movement of the joint. Arthritic symptoms typically wax and wane. As the arthritis worsens, the episodes of pain become more frequent and severe. Initially, arthritis symptoms are more of a nuisance, but with severe, end-stage arthritis, the symptoms can affect your daily activities, your work, and quality of life.

Initial treatment usually begins with simple, non-operative treatment (treatment without surgery). The goal of non-operative treatment is to help you deal with the pain, lessen joint swelling and stiffness, and to prevent further joint destruction. One means of addressing pain is with over-the-counter medications such as anti-inflammatory medications (i.e. ibuprofen or naproxen) or pain medications (i.e. acetaminophen). Various types of injections are also available (i.e. cortisone or hyaluronic acid medications such as Synvisc and Hyalgan) to help reduce pain. Corticosteroid injections (cortisone, etc.) are given to reduce joint inflammation, swelling, and stiffness but can only be safely administered infrequently (two or three times a year). More frequent joint injections with corticosteroids can actually be harmful to the articular cartilage. Hyaluronic acid injections can be helpful if destruction of the articular cartilage is not severe and typically are given at weekly intervals for three to five weeks.

Changing your lifestyle to avoid activities that would cause further cartilage destruction is helpful in minimizing exacerbation of the joint pain. Activities best avoided are those that substantially increase pressure on the arthritic joints such as running, racket sports, and stair walking. Low impact activities such as swimming and bicycling are actually favored as they can help maintain muscle tone and improve nutrition of the articular cartilage. Gait aids such as a cane or walker are helpful in unloading some of the forces going across a painful, arthritic joint. Lastly, maintaining ideal body weight is critical to lessen pressure on arthritic joints. For each pound of body weight gained, the pressure on the hip and knee joints increases approximately 2.5 pounds. When non-operative treatment fails, surgical options are considered.