Degenerative Joint Disease

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Degenerative Joint Disease, also known as Osteoarthritis, is the most common form of arthritis. It may affect over 80% of people over the age of 60. Arthritis is a general term used for many conditions that result from the degenerative changes of the joint and its structures.

In degenerative joint disease, changes describe a slow and progressive loss of the cartilage that acts as a barrier and a shock absorber between two bones, while helping to keep the joints flexible. Once the cartilage is thinned or lost, the constant grinding of bones against each other causes pain and stiffness around the joint. Abnormal and excess bone formations called spurs grow from the damaged bone, causing further pain and stiffness.

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  • Many changes with degenerative joint disease develop without symptoms over a long period of time.
  • symptoms vary when the joint is involved
  • Subtle development of morning stiffness is often an early symptom.
  • As OA progresses, there is pain with movement of the involved joint.
  • Pain and stiffness become more severe with activity, and improve with a proper amount of rest.
  • Decreased range of motion of the joints
  • The patient may have difficulty with brushing teeth, combing hair, or opening a jar
  • The joints, such as the fingers or knees, may become unstable, causing them to buckle or lock.
  • The fingers, spine, hips, knees, or ankles can all be affected, and may be tender to the touch.
  • Neck or back stiffness may be present
  • There may be swollen or painful joints around the fingers or knees
  • Hip or knee pain may cause a limp when walking
  • Popping sound or cracking sounds may be heard when moving the joint
  • With OA of the spine, such as in the neck, there may be headaches, neck stiffness, pain, and pressure on the nerve roots, resulting in a tingling or pins and needle like sensation in the fingertips or hands.

  • Cause:
  • Primary degenerative joint disease effects from years of use leads to degenerative changes of the joints between the ages of 50-60. Cartilage is made up of a protein called collagen. With damage to the cartilage, certain chemicals are released called Enzymes which further damage the collagen structure. As one ages, the ability to restore and repair the collagen matrix declines.
  • Secondary OA can result from a variety of disorders: Hereditary conditions such as defective cartilage or malformed joints, abnormal joint surfaces or metabolic abnormalities can increase the risk for developing OA.
  • Trauma to the joints -- Obesity, joint surgery, and damage to the joints from other forms of arthritis and joint infections as seen with Tuberculosis and bacterial infections. Prolonged and repetitive movements, such as in sports and at work.
  • Congenital conditions -- Congenital hip dysplasia and slipped femoral epiphyses are abnormalities that can increase the risk of developing OA in the future.
  • Other conditions -- Diseases that affect the nerve supply to the joint, excess bone growth, and Bone damage also increase the risk for developing OA in the future.

  • Treatment:
  • Protect the joints from overuse by limiting unnecessary and repetitive activities such as driving or lifting heavy pots and pans.
  • Be sure to keep good posture with the chin up and a straight back.
  • Use a straw to drink if you have neck pain or stiffness.
  • Use crutches, neck collars, wrist braces or walkers to protect the joint if the doctor recommends it
  • Stretch before exercising
  • Exercise of all forms has proven beneficial
  • A good diet and moderate weight loss is extremely important.
  • Tylenol is a good choice for pain. It has no stomach Irritation or bleeding as happens with aspirin, ibuprofen, naproxen, and others from the non steroidal anti-inflammatory Drugs (NSAIDs) family. None of these should be used if there is liver damage.
  • NSAID's are not good for the elderly, those with ulcers, bleeding problems, or kidney damage.
  • Magnesium and Choline Salicylates are similar to NSAIDs, but do not have as many side effects.
  • New COX-2 inhibitors such as Celebrex are more expensive, and used on people unable to take NSAIDs.
  • Codeine and other opiates are habit forming, and are used only for severe pain. They can cause constipation and confusion.
  • Steroids such as prednisone can either be injected into the joint, or taken as a pill. These are reserved for severe cases of OA.
  • Physical and occupational therapy is very helpful in decreasing joint stiffness, pain, and improving mobility and strength.
  • The therapist can also teach the uses of assisting devices such as eating utensils, canes, and crutches.
  • Massage of surrounding muscles, acupuncture, or acupressure may help with pain.
  • Diets and supplements for degenerative joint disease:
    • 1. A diet low in poultry, meat, sugar, eggs, and processed foods has been used in the past, but not researched properly yet.
      2. Tomatoes, potatoes, peppers (except black pepper), and egg plants contain a compound known as Solanine, which may be toxic to some individuals and cause OA.
      3. Supplements such as glucosamine and chondroitin sulfate, and alphatocopherol form of vitamin E, antioxidants, S-adenosyl methionine, Omega 3 fatty acids EPA, DHA (Fish oil), D-phenylalanine, injectable cow collagen, and DMSO cream are all new therapies that may be beneficial, but need to be studied further
  • Surgery is done when there is severe OA that is not responding to the above treatments.
  • Surgery is done to relieve the pressure on nerves. Clean out damaged bone and fibrotic tissue.
  • A bad knee or hip can also be replaced with an artificial one.

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