Arthritis, at the most basic level, is defined as inflammation of the joints. Although there are more than 100 different types of arthritis, many have common joint symptoms including pain, stiffness, swelling and decreased range of motion.
The incidence of arthritis is expected to continue rising, due in part to aging baby boomers and the obesity epidemic in the US, which is a driver of many chronic conditions. It is estimated that by 2040, the number of adults with arthritis will climb to over 78 million. Most of these will have osteoarthritis (OA), the most common type of arthritis and the most common chronic condition of the joints.
What is Osteoarthritis (OA)?
Osteoarthritis is a chronic condition that occurs when cartilage, a tissue acting as a cushion or shock absorber between bones in a joint, is damaged and breaks down over time causing pain, stiffness and swelling/inflammation. In the later stages, cartilage can wear away completely, leaving bone rubbing against bone. OA most often effects hands/fingers, knees and hips. Symptoms progress at varying rates from person to person. Since there is no cure for OA and the joint damage that occurs is irreversible, ultimately it leads to reduced quality of life and workplace disability.
Although there is no one factor that causes osteoarthritis, excess weight, joint injury, aging, genes/family history can all contribute to the development of the condition. Osteoarthritis is also more common in women than men, especially after age 50.
Certain types of work can put an individual at greater risk for osteoarthritis by putting undue stress on the joints. This includes jobs that involve manual labor such as construction, mining, farming, some sectors of the service industry (e.g. housekeeping, food service). Job tasks that cause biomechanical stresses to the body can also put employees at risk for OA. These include regular kneeling, standing, squatting, heavy lifting and repetitive motion.
People with osteoarthritis often have other chronic conditions, also known as comorbidities. It is estimated that 59% - 87% have at least one other significant chronic condition and 31% have five or more. The most common of these are cardiovascular disease, diabetes and hypertension. Osteoarthritis can exacerbate the challenges already present when trying to manage these comorbid conditions. For example, people with arthritis are much less likely to exercise than those without the condition, which puts them at greater risk of complications from their chronic conditions. It is important to understand the comorbid conditions common in people with arthritis in order to identify key areas where intervention is possible. (OARSI pp. 19, 20)
Pain Management & OA
Pain is a primary symptom of OA and impacts mobility, function, sleep/fatigue level and mood. According to the Arthritis Foundation of individuals with OA, physical pain is a big deal and its management is critical. Fifty percent of those surveyed reported that pain impacts them at least 10 days/month; 32% said at least 20 days/month. As a result of OA-related pain, 48% reported feeling down, depressed or hopeless and 57% said they feel very little interest or pleasure in doing things.
Pain management is the primary objective of most OA treatment strategies. Depending on the patient, this typically starts with acetaminophen (e.g. Tylenol) or non-steroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen) often in combination with lifestyle change including weight loss and increased physical activity, and alternative therapies such as acupuncture and massage therapy. In some instances, joint injections and/or surgery are considered. Opioids are sometimes used to treat the pain associated with OA, but only as a last resort. The general consensus is that the risk of misuse and abuse of opioids outweighs the benefits.
There is no cure for osteoarthritis but there are strategies that can be used both by individuals and employers to prevent it from occurring, slow its progression and/or improve symptoms. These include weight loss/maintenance, physical activity and self-management education. Strategies for non-drug pain management, use of a variety of medications and sometimes surgery are also used to treat the condition.