Arthritis: What is it? How do we treat it?

MGN

Arthritis is among the most common disease processes affecting our population. It can be defined by inflammation and stiffness of a joint as a result of cartilage degradation (damage to the normally smooth surface).

There are several terms used in a physician’s office that are essentially synonymous with arthritis. Some of these terms used in conversation or in written medical reports include chondromalacia, chondral wear, or degenerative joint disease.

The smooth material lining the surface of our joints is called hyaline cartilage. In our early years, it is smooth and durable, designed for congruent frictionless joint motion. This is a different material from the rubbery meniscus cartilage that serves as shock absorbers or stabilizers of our joints.

As time goes on, wear and tear take place and the smooth hyaline cartilage becomes more friable, causing it to gradually break down. As a result of the surface breakdown, we are left with surface contour irregularity. This process of degradation also creates debris and can change the mechanics of a joint as we use it on a regular basis.

The body responds to this process by producing excess joint fluid (swelling) and inflammation resulting in stiffness and discomfort. Collectively, this accounts for the symptoms commonly described by patients: pain, stiffness and swelling.

Various types of arthritis exist, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, pyogenic arthritis, and crystalline arthritis to name a few. These are very different disease processes but can have a similar end results.

For example, the aforementioned degradation process can take place naturally as we age or as a consequence of an overactive immune system creating a harsh environment within the joint.

Unfortunately, damage to hyaline cartilage is an irreversible process. Therefore, we consider the surface material biologically expensive and take great measures to preserve the long-term health of joints in the field of orthopedics.

Treatment of this disease process can depend greatly on the type of arthritis involved and the functional status of the patient. Maintaining a healthy weight and remaining active are among the most important recommendations we can make.

Medically, great progress has been made for those affected by auto-immune processes such as rheumatoid arthritis. Medications that modulate the immune system can offer notably improved control of the inflammation and cartilage degradation for rheumatoid patients.

Options for patients affected by osteoarthritis include anti-inflammatory agents obtained over the counter or via prescriptions. These tend to provide more effective relief when used on a scheduled basis.

We also commonly consider enrollment into physical therapy for evaluation of gait mechanics, strengthening, and balancing of the musculature around the extremities and musculoskeletal core. Braces can be valuable in some cases as well.

When initial treatment modalities no longer provide meaningful relief, we utilize injectable agents to offer a more focal solution. The most common options include corticosteroids or viscosupplements.

Cortisone injections provide local delivery of anti-inflammatory medication to calm the swelling responsible for stiffness and discomfort experienced by patients with arthritis. Viscosupplementation involves injecting a gel-like solution containing hyaluronan, which is an important component of the fluid naturally lubricating our joints. This also can have a calming effect on the joint, offering relief.

Eventually, as the disease process advances these conservative treatment options become less effective. Patients with severe or end-stage arthritis often struggle to perform activities they need to do or desire to accomplish. It can become difficult to maintain an active lifestyle, which has a significant impact on quality of life and overall well-being.

Orthopedic surgeons are then able to discuss arthroplasty or joint replacement. There are many types of joint replacements available, and our technology around this field within medicine continues to expand. Implants available today are often custom designed for individual patient anatomy, and techniques are becoming increasingly precise.

Joint replacement surgery recovery has also been accelerated. In some cases, patients can be discharged home on the day of surgery or stay a single night in the hospital. These highly successful procedures offer definitive treatment for arthritis and provide durable relief, allowing patients to maintain their lifestyle and health status.

Ultimately, arthritis has a considerable impact on our patient population. We are fortunate to have excellent treatment options and continue to make improvements managing this disease process. In orthopedic surgery, we are always striving to help relieve symptoms and restore patients to their desired activity level.

Joel L. Boyd, M.D. earned his medical degree from the Temple University School of Medicine. He is a member of numerous professional organizations and is currently an associate professor in the Department of Orthopaedic Surgery at the University of Minnesota. His clinical interests include sports medicine, specializing in arthroscopy, ACL injuries, multiple ligament injuries, reconstructions, and revision ACL reconstructions. Dr. Boyd has been the team physician for the Minnesota Wild for the past 17 years and previous team physician for the NFL (9 years) and WNBA (15 years). His primary practice is at TRIA Orthopaedic Center in Bloomington, MN.

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