Osteoarthritis, also known as degenerative joint disease, is one of the most common ailments associated with getting older, and it is therefore most common in those parts of the world where people live the longest. More than 15 million Americans receive medical attention for osteoarthritis each year, and more than twice that many are affected by it to some degree. However, it rarely results in serious disability.
Osteoarthritis is essentially a "wear-and-tear" disorder. In typical cases, symptoms appear after the age of 50, and usually in the large joints that bear the most weight--the hips, knees, shoulders and spine.
Pain and stiffness are at their most uncomfortable upon arising in the morning and are likely to be intensified during damp, cold weather. (This does not mean, however, that symptoms are likely to disappear in a warm, dry climate.) Redness and swelling of the affected joints may also occur. Joints, particularly in the fingers, may become permanently gnarled by osteoarthritis, but this almost never interferes with their function. Painless bony bumps, known as Heberden's nodes, may also appear symmetrically on the fingers of both hands or on toe joints as well.
Causes of Osteoarthritis
When a person is young and spry, the joints between the bones swing freely like efficient, well-oiled hinges. Stresses and strains are absorbed by the cartilage pads that provide cushioning and lubrication at the ends of the bones where they constantly come together as the parts of the body make their coordinated movements.
Over the years, these protective layers become eroded, lubricating fluids diminish and the result is a sensation often described as "creaking" at the joints. In addition to a decrease in smoothness of function, small growths, or spurs, may develop on the bones in the area of the joints. These are 10 times more prevalent among women than among men and are likely to aggravate an already uncomfortable condition.
Signs and Symptoms of Osteoarthritis
Since the weight-bearing joints are the ones most commonly affected, stiffness and discomfort in the knees and hips are likeliest to occur first, especially in the overweight person or in someone whose life style involves long stretches of standing or walking. A visit to the doctor for diagnosis normally includes close inspection of painful areas as well as X-ray examination of the joints in question. (when X-ray pictures are taken for diagnosis of some other condition in younger patients, they usually reveal the beginnings of cartilage erosion in the weight-bearing joints at a stage that does not yet produce associated symptoms.) Other than X-rays and visual examination, there are no other diagnostic tests for osteoarthritis.
Treatment of Osteoarthritis
Where overweight exists as a contributing factor, efforts should be made to lose the extra pounds and keep them off. Application of warm, moist heat, slow and gentle massage of the affected joints and a reduction (not a total cessation) of normal activities are ways in which patients can help themselves when there is an intensification of discomfort. Where pressure on the weight-bearing joints can be diminished through postural adjustments, special exercises may be recommended.
Drug Therapy
Although inflammation is not one of the initial symptoms of osteoarthritis, as the joint degeneration progresses, swelling, redness and other signs of inflammation may occur. When this happens, anti-inflammatory drug therapy may be recommended.
Aspirin. Patients who can tolerate high doses of aspirin may be treated with this drug alone. However, patients on anti-inflammatory aspirin therapy, which may involve taking 16 or more tablets a day, should be aware of possible side effects, among which the most common are ringing in the ears, heartburn and other gastrointestinal upsets. To minimize gastrointestinal complications, the aspirin should be scheduled after meals. Acetaminophen, in smaller dosages, may be recommended as an alternative to aspirin.
Non-steroidal anti-inflammatory agents. These are relatively new drugs that relieve the pain and joint inflammation of osteoarthritis. It is the physician's role to match the patient with the particular drug that will be most suitable and effective without adverse effects. Sometimes drugs are used in combination, but whatever the procedure, supervision by the doctor is usually indicated if maximum benefit is to be achieved.
Steroids. In those few cases where other measures fail, steroid drugs (cortisone) may be injected into the damaged joint for temporary relief. However, long-term treatment with steroids is not recommended for osteoarthritis.
Surgery
When an older person suffers such severe osteoarthritis that most normal activity becomes impossible, surgical replacement of the affected joints may be considered. Hip replacement, in which the entire hip joint or head of the femur is replaced, is the most common operation of this type. The replacement joint is made of plastic and metal parts and is held in place by special plastic cements. The artificial joints allow the previously immobilized patient to be relieved of crippling pain, and most activities can be resumed following physical therapy and regaining of muscle function.
More recent joint replacements include the knee--a joint that is more complicated than the hip and, consequently, poses more engineering problems in replacing. However, the newer artificial knee joints are providing good results, both in terms of pain relief and restoration of function.
Traumatic Arthritis
Closely related to osteoarthritis, traumatic arthritis is usually the result of excessive joint use combined with injury. It is commonly seen in athletes. Rest will usually resolve the problem, although in some instances, drugs or surgery may be required, particularly in the case of athletes who need to quickly regain the use of the injured joints.
Summing Up
For millions of people, osteoarthritis is an inevitable condition of aging. Most cases can be handled by rest and common sense. Anti-inflammatory drugs--both non-prescription painkillers such as aspirin or acetaminophen, or prescription non-steroidal anti-inflammatory agents--may be used during flare-ups.
Osteoarthritis rarely turns into a crippling disease, but as newer and more effective drugs are available for reducing aches and pains to a minimum, there is little reason for allowing this particular cause of physical discomfort to be a dominating factor in determining one's life style in advancing years.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
