Osteoarthritis is the most common disease of the joints and affects more than 20 million people in the United States. Over half of the population over the age of 65 is affected by the disease. Osteoarthritis is classified when joint cartilage is damaged and there are bone structure changes. It mainly involves the weight bearing joints such as the neck, feet, hips, knees, and the lower back. It may also affect the hand and fingers. Sometimes osteoarthritis is referred to as degenerative arthritis or “wear and tear” arthritis. This disease generally progresses gradually, and the three stages of the etiopathogenesis of osteoarthritis, as described by Dr. Lozado in his report “Osteoarthritis”,1 can take several years to manifest themselves.
Osteoarthritis Stage 1
The first stage of osteoarthritis occurs when there is a breakdown or thinning of the cartilage which covers joint surfaces. The cartilage also loses its elasticity and is damaged easily. The cartilage surface is inflamed and swollen. The first stage can be caused by overuse, age, or genetic factors. During this stage, a person may have periodic occurrences of joints being stiff and painful to move. The stiffness may last up to thirty minutes. The person generally feels the pain and stiffness as the day progresses. Most people don’t recognize this occasional stiffness as osteoarthritis and usually attribute it to age or a prior injury. Signs of osteoarthritis can show up on an x-ray at this early stage.
Osteoarthritis Stage 2
Water is lost from the joint, and the cartilage hardens. The joints develop osteophytes (also called bone spurs), which are jagged, bony edges. The osteophytes can rub against each other at times and cause pain. The development of these spurs is caused by eroding cartilage and the breaking down of collagen. The patient will feel pain that gets worse throughout the day. Pain may even be felt when the patient is at rest. It is generally in this stage that the patient begins taking anti-inflammatory drugs to relieve the pain and the joint swelling.
Osteoarthritis Stage 3
Stage 3, or late stage osteoarthritis occurs when the joint cartilage is damaged, diseased and worn away. This results in bone rubbing on bone. The joint may is inflamed and swollen and pain, stiffness and swelling are frequent. The joint fluid has disappeared, and the joints cannot absorb shock. The joints are more susceptible to injury. Stronger pain medication is often needed, and sometimes the only relief is to surgically replace the joint.
Osteoarthritis is known as a progressive disease with no known cure, but early diagnosis can lead to successfully managing the disease. People can have the disease for years without realizing it. However, as the stages of osteoarthritis progress, the patient will become more aware of the disease, and seek treatment to relieve the pain and swelling associated with the disease.
1 - Lozado, Carlos J., MD, “Osteoarthritis,” https://emedicine.medscape.com/article/330487-overview
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