Understanding Cartilage, Joints, and the Aging Process

Osteoarthritis (OA) is the most common form of arthritis. Arthritis causes inflammation and pain in one or more joints in the body. OA is also known as degenerative joint disease. According to the Centers for Disease Control and Prevention (CDC), about 27 million American adults over the age of 25 have osteoarthritis. That makes OA one of the leading causes of disability in adult Americans.

The Structure of a Joint

Cartilage, the smooth, rubbery connective tissue on the end of bones, cushions joints and helps them move smoothly and easily. A lifetime of walking, exercising, and moving takes a toll on your cartilage. The degeneration of cartilage can cause chronic inflammation in the joint. This inflammation can further break down the cartilage over time. The cartilage may wear away completely if it is left untreated.

A membrane called the synovium produces a thick fluid that helps keep the cartilage healthy and makes joints run smoothly. The synovium can become inflamed and thickened as OA progresses. The inflammation produces extra fluid within the joint, resulting in swelling.

As cartilage deteriorates, adjacent bones may no longer have sufficient lubrication from the synovial fluid and cushioning from the cartilage. Once the bone surfaces come in direct contact, this results in additional pain and inflammation to the surrounding tissues. As bones continually scrape one another, they can become thicker and begin growing osteophytes, or bone spurs. The joints most commonly affected by OA are in the hands, feet, spine, and weight-bearing joints, such as the hips and knees.

The Aging Body

The older we get, the more common it is to experience mild soreness or aching when you stand, climb stairs, or exercise. The body does not recover as quickly as it did in younger years.

Another cause for the soreness: Cartilage naturally deteriorates. The smooth tissue that cushions joints and helps them move more easily disappears with age. In a sense, the body’s natural shock absorbers are wearing out, which means you begin feeling more of the physical toll your body is experiencing. In addition, we lose muscle tone and bone strength the older we get. That can make physically demanding tasks more difficult and taxing on the body.

A common factor for developing osteoarthritis is age: Most people with osteoarthritis are over the age of 55. Still, other factors increase a person’s chances for developing the disease. These factors include:

• Excess weight. Being obese or overweight puts additional stress on joints, cartilage, and bones, especially those in the knees. It also means you’re less likely to be physically active.
• Family history. Genetics may make a person more likely to develop OA. If you have family members with the disease, you may be at an increased risk of developing OA, too.
• Gender. Before age 45, men are more likely to develop osteoarthritis. After 50, women are more likely to develop OA than men. The difference becomes almost even around age 80.
• Occupation. Certain occupations, such as those in construction, agriculture, cleaning, and retail, increase a person’s risk for developing OA. Their bodies are used more rigorously as part of their job, which means their joints are worked more and likely age faster than people who have a desk job.

Younger, more active people can also develop osteoarthritis. However, it’s often the result of a trauma, such as a sport injury or accident. A history of physical injuries or accidents can increase a person’s chance of later developing osteoarthritis.

Treatments

Osteoarthritis does not have a cure. Instead, the goal of treatment is to manage pain, then reduce contributing causes that make the symptoms of OA worse. The first step in treating OA is to reduce pain. This is often initially done with a combination of medicines, exercise, and physical therapy.

Second, doctors will help patients adopt lifestyle changes that can prevent their individual OA symptoms. Incorporating low-impact exercise and getting more rest can often extend the life of knees and joints without resorting to more invasive treatments.

Lifestyle and Alternative Treatments for OA
Having osteoarthritis does not mean you’ve reached the end of your physically active years. Instead, you will simply have to adjust the things you currently do to make them easier on your joints and bones. These adjustments not only improve function, but can also boost your quality of life.

• Exercise. Low-impact exercise can help strengthen muscles and keep bones strong. Exercise also improves joint mobility. Forgo heavy-impact exercises, such as tennis and baseball, and begin doing more low-impact exercises. Activities such as playing golf, swimming, yoga, and cycling are all much easier on the joints.
• Heat/cold therapy. Apply warm compresses or cold packs to joints when they are sore or painful. This can help relieve pain and reduce inflammation.
• Assistive devices. Using devices such as braces, splints, and canes can help your body support weak joints.
• Rest. Giving painful, sore joints adequate rest can relieve pain and reduce swelling.
• Weight loss. Losing as little as 5 pounds can help decrease the symptoms of osteoarthritis, especially in large joints, such as the hips and knees.

Traditional Treatments

Treatment for osteoarthritis is often tailored to a person’s lifestyle and the factors that trigger pain and soreness. A wide range of treatment options is available. The options include:

• Medication. Over-the-counter pain relievers, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen (Tylenol), are usually all that people with OA need to treat their pain. However, if pain becomes worse or OTC medicines are not effective, stronger pain medicines may be required.
• Injections. Corticosteroid and hyaluronic acid injections can help reduce pain in affected joints. However, these injections are typically not used because they can cause additional joint damage over time.
• Surgery. Surgery is typically reserved for people who have severe and debilitating OA.
• Osteotomy. This bone-removal procedure can reduce the size of bone spurs if they have started to interfere with joint movement. Osteotomy is also a less-invasive option for people who want to avoid joint replacement surgery. If osteotomy is not an option or it does not work, your doctor may recommend bone fusion (arthrodesis) to treat severely deteriorated joints. For the hip and knee joints, the last resort is a total joint replacement (arthroplasty).