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Osteoarthritis causes pain, loss of function

Nearly one-third of older adults have osteoarthritis, a degeneration of the joints that can lead to significant pain and loss of function.

Marked by loss of cartilage and sometimes spur formation, it's the most common form of arthritis, affecting 20 million Americans, a number expected to double by 2020. And it's the subject of the Deseret News/Intermountain Health Care Hotline on Saturday. From 10 a.m. to noon, Dr. Laird Swensen, orthopedic surgeon, and Dave Taylor, physical therapist, both of The Orthopedic Specialty Hospital, will answer questions about the sometimes -disabling condition.

Osteoarthritis develops slowly and its progress can be slowed. The bad news is that genetics and injuries that will turn into osteoarthritis are hard to fight. And without early treatment it can become a disabling condition.

Because it comes on slowly, osteoarthritis isn't always easy to recognize. Early in the disease, the Arthritis Foundation says, joints may ache after physical work or exercise, but not everyone with the disease feels pain, stiffness or the other common warning signs. In fact, one-third of those with osteoarthritis that shows up on x-rays have no symptoms.

It's most apt to occur in the fingers, knees, hips, spine, elbows and wrist. No one knows definitively what causes it, but experts believe that joint damage begins in response to physical stress, releasing chemicals that speed up breakdown of the joint cartilage.

The body may respond by making thicker bone that creates lumps, called spurs, usually on the hands and feet. And it hurts. So does the bone rubbing on bone where cartilage is depleted.

Causes vary. Age is the strongest risk factor and though it usually doesn't show up until someone is 45 or older, it can start in young adulthood. It occurs more often in women than in men (more men than women, however, get osteoarthritis before age 45) and is often hereditary, blamed on one of the genes that create collagen, causing deterioration of the cartilage. But it can also result from injuries, including overuse or sports.

Obesity is the main cause of osteoarthritis in the knee. Carrying that extra load can also affect hips, feet and spine. And sometimes it results from other diseases, like rheumatoid arthritis, which changes cartilage.

Swensen specializes in osteoarthritis of the hands, elbows and wrists and seldom sees it at an early stage. People come to him when it's time to replace joints in the hand or do a partial fusion on the wrist, which allows him to salvage some of the natural motion. Sometimes wrists or fingers require a complete fusion.

The condition is less common in the elbow (that usually results from rheumatoid arthritis) and joint replacement there generally restores good function.

No study has conclusively shown supplements to be effective, though a large multi-university study will be completed in a couple of years.

Repetitive motion without force, such as typing, won't make the condition worse, Swensen said.

Because it progresses slowly, "what you do and the way you take care of it can minimize the effect."

He said it's important for people who have osteoarthritis in the lower extremities to lose weight. And everyone with the condition needs to stay active, finding the middle ground between keeping the joint functional and overusing it and making osteoarthritis worse.

Some arthritic joints eventually arrive at what experts call a "compensated" state, where there are arthritic changes but the joint works reasonably well. That doesn't always happen, though, he warned.