Osteoarthritis.
Last updated Thursday, February 10, 2005
Figure 3 - Bouchard's nodes Figure 4 - Heberden's nodes Figure 2 - Joint with severe osteoarthritis SymptomsWhat parts of the body does osteoarthritis affect?
In the hip, DJD may produce pain around the groin or in the inner
thigh. Some people feel referred pain to the buttocks, the knee or
along the side of the thigh. Degenerative joint disease of the hip may
cause a limp and may limit range of motion, for example making it
difficult to spread the legs.
Degenerative joint disease of the knees may produce pain and stiffness
of the knee associated with a grating or catching sensation in the
joint when it is moved. It may make it difficult to walk up and down
stairs and lumps may be noted particularly along the medial (inner
side) of the knee. If the pain prevents you from moving or exercising
your knee, the large muscles around the knee area will become weaker.
Degenerative joint disease of the fingers may produce bony
lumpiness around the joints of the finger and perhaps pain and
stiffness of these joints as well. In the fingers: The breakdown of
joint tissue in the fingers causes bony growths (spurs) to form in
these joints. If spurs occur in the end joints of the fingers, they are
called Heberden's nodes. If they occur in the joints in the middle of
the fingers they are called Bouchard's nodes (see figures 3 and 4).
Degenerative joint disease of the feet most commonly affects
the large joint at the base of the big toe. Stiffness, lumpiness and
pain may be associated. Wearing tight shoes and high heels can make
this pain worse.
Degenerative joint disease of the spine may produce stiffness
of the back and at times, symptoms of pressure on the spinal cord and
nerves running through the spine. The latter are particular important
to notice and may include numbness or weakness of the arms or legs,
difficulty with controlling bowel or bladder, loss of balance and pain
radiating out the arms or down the legs.
Bone spurs
Bone spurs are of two basic types. One is the kind that arises near
a joint with osteoarthritis or degenerative joint disease. In this
situation, the cartilage has been worn through and the bone responds by
growing extra bone at the margins of the joint surface. These "spurs"
carry the formal name "osteophytes." They are common features of the
osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these
osteophytes is an important part of joint replacement surgery, but
removing them without addressing the underlying arthritis is usually
not effective in relieving symptoms.
The second type of bone spur is the kind that occurs when the
attachment of ligaments or tendons to bone become calcified. Thus can
occur on the bottom of the foot, around the Achilles Tendon, and in the
coroacoacromial ligament of the shoulder. Thus spurs often look
impressive on X-rays, but because they are in the substance of the
ligaments, rarely cause sufficient problems to merit excision. What are symptoms of osteoarthritis? Osteoarthritis is characterized by clinical symptoms of joint pain
and aching, limited range of motion and instability, radiographic
evidence of the erosion of the articular cartilage, joint space
narrowing, sclerosis of the subchondral bone, and osteophytes (spurs).
Other symptoms include stiffness and roughness on motion; these
symptoms are worse after heavy use.
OA pathological changes involve both the cartilage and the bones.
Until about 20 years ago, OA was widely assumed to reflect the passive
erosion of the bearing surfaces of cartilage in the joints.
Degeneration of the articular cartilage was viewed as a normal aging
process much like old tires on a car wearing themselves out after
extensive usage. This view is rapidly changing. Degeneration and loss
of the articular cartilage in osteoarthritis is explained in terms of
the pathophysiologic processes involved in the metabolism of cartilage
rather than the inevitable mechanical wear and tear due to aging.
If degenerative joint disease is related to abnormalities of
articular cartilage, it may involve many of the joints of the body. On
the other hand, if the degenerative joint disease is caused by an
injury, only one joint may be involved. The hips, knees, spine, and
shoulders are most commonly involved. This condition may also affect
some finger joints, the joint at the base of the thumb, and the joint
at the base of the big toe.
The typical joint changes in osteoarthritis can be seen by
comparing a healthy joint with a joint with osteoarthritis (see figures
1 and 2). In osteoarthritis, the normally smooth cartilage surface
softens and becomes pitted and frayed. As the cartilage breaks down,
the joint may lose its normal shape. The bone ends thicken and form
bony growths, or spurs, where the ligaments and capsule attach to the
bone.
Stiffness and joint deformity usually progress slowly without general body symptoms. By contrast, rheumatoid arthritis (RA)
usually begins earlier, often developing more suddenly. RA usually
affects same joint on both sides of body (e.g. both knees), causing
redness, warmth, and swelling of many joints. RA is often accompanied
by a general feeling of sickness, fatigue, weight loss, and fever.
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