By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER PROBABLY DOESN’T NEED SPECIALIST FOR OSTEOARTHRITIS

Question: I just started with a new family doctor (I moved), and he says I have osteoarthritis in my knees. My former doctor said I had degenerative joint disease. Who is right? Should I see a specialist? Both doctors have recommended the same treatment, however. Can you tell me what I have?

Answer: Both of your doctors are probably right. Degenerative joint disease (DJD) and osteoarthritis (OA) are actually just different names for the same disease. Regardless of what name you use, it is the most common type of arthritis, and its incidence increases as we get older. Over 80 percent of people over 65 have OA to some degree. Although it can develop in any joint, large weight-bearing joints like the knees and hips are especially vulnerable as are the hands and spine.

Now, before I go further, I think a quick anatomy lesson about joints is in order. A joint is the place where two bones come together. Usually, at these junctions each bone is covered with a slippery substance called cartilage, which serves as kind of a “joint cushion.” This cartilage is bathed in a special lubricant known as synovial fluid. OA results when due to hard use and/or the aging process, the cartilage wears away, spurs grow on the ends of the bones, and the body tries to compensate by producing extra synovial fluid. Together, these processes can lead to pain, swelling and loss of motion in the joint.

While OA may run in families, it is not a systemic condition like some other forms of arthritis, so only the joints are affected. The symptoms of OA can vary from mild, intermittent joint pain, to severe debilitating pain. The symptoms can be constant or intermittent, and many patients are pain-free for years.

When the knees are affected by OA, the condition can be made worse by obesity and overuse. Many people who have OA in the knees have some congential deformity in this joint, which gets worse as the disease progresses. This form of arthritis is the leading reason people have knee replacement surgery in the United States.

The diagnosis of OA is commonly made with an X-ray. It can show deterioration of the cartilage and narrowing of the joint space. Also, if there is fluid accumulation, the doctor can drain the fluid and send it to the lab. That analysis can exclude other causes of joint swelling such as gout.

The treatment of OA is aimed at lessening joint pain and reducing inflammation while maintaining joint function. Patients need to avoid activities that make the pain worse. Exercise is helpful in maintaining joint function provided it is not done to excess or to the point that it aggravates the pain. Using anti-inflammatory medications like non-steroidal, anti-inflammatory drugs (NSAIDs), can give great pain relief as well as help to decrease inflammation in the joint. Common NSAIDs include aspirin and ibuprofen. Sometimes, steroid injections into the joint can be helpful, but this cannot be done too frequently. If you are overweight, weight loss can help OA pain in the lower extremities.

As I said, it sounds like both of your physicians are correct. Therefore, there’s probably no need to see a specialist. This is usually not necessary unless the diagnosis is in question or more aggressive treatment, like surgery, is needed.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.