Osteoarthritis Update: 2015
Osteoarthritis (OA) is one of most common causes of chronic pain and a major cause of reduced activity in middle aged and older patients. It is estimated to affect between 20 and 30 million Americans, but these numbers may be deceiving.
Up to 85% of people older than 65 years of age have radiographic evidence of OA, and autopsy studies indicate evidence of OA in weight-bearing joints in almost all persons by the age of 45 years.1-3 Based on these statistics, it is no wonder that it feels as if every patient being treated for chronic pain has OA as a primary or contributing factor.
Although controversial, some researchers believe OA involves inflammatory mechanisms, not mechanical wear and tear.1 An inflammatory component is most definitely present in most patients with painful OA. The traditional belief that OA is simply a wear-and-tear condition associated with the stress of advancing years is not tenable, but, in my opinion, the extent of the inflammatory component is unclear.
In spite of the evidence of pathologic changes associated with OA, the condition was confused with rheumatoid arthritis (RA) until the turn of the 20th century. It is characterized by involvement of cartilage, varying from fissure and microfibrillations in early disease, to erosive destruction in advanced cases.
As described by one researcher, “Weight-bearing or shearing forces are transmitted to the subchondral bone, leading to sclerosis, cyst formulation, and bone remodeling. Osteophytes (spurs) develop at the margin of joints, and new cartilage proliferates over these bony spurs.”1
Learn more about Osteoarthritis: Overview and Treatment, with “Therapeutic Tips” provided by the Editorial Board of Practical Pain Management. Due to the ubiquitous nature of OA, we welcome any comments from readers and patients.