“Arthritis” is a general term that describes
many different diseases causing tenderness, pain, swelling,
and stiffness of joints as well as abnormalities of
various soft tissues of the body. Of the combined
term, “arthros” means a joint and its attachments,
and “–itis” means inflammation.
Various forms of arthritis affect nearly 50 million
Americans and contribute to the majority of all physical
disabilities. Although arthritis is ultimately associated
with a wearing out of joints, nearly a half million
children are also affected.
Of the several varieties of arthritis, the most common,
the most frequently disabling, and often the most painful
is osteo- (meaning bone) arthritis, mostly affecting
the weight bearing joints (hips and knees) plus the
hands, feet and spine. Normal joints are hinges at
the ends of bones usually covered by cartilage and
lubricated inside a closed sack by synovial fluid. Normally,
joints have remarkably little friction and move easily. With
degeneration of the joint, the cartilage becomes rough
and worn out, causing the joint halves to rub
against each other, creating inflammation with pain
and the formation of bone spurs. The fluid
lubricant may become thin and the joint lining swollen
and inflamed.
Osteoarthritis is also known as degenerative joint
disease and affects up to 30 million Americans, mostly
women and usually those over 45 or 50 years of age.
All races in the U.S. appear to be equally affected.
This article focuses on osteoarthritis of the spine,
particularly on facet joint arthritis.
Where osteoarthritis occurs
Cartilage is a form
of usually slick, slightly elastic, connective tissue
that covers the ends of the bone joints. In part, cartilage serves as a
protective shock absorber to minimize the impact of
bouncing, jumping and other types of daily activities
on the joints – and is thus subjected to considerable
wear and tear during life. Indeed, heavy work, sports,
repeated injuries and obesity take a heavy toll on
the joints of the limbs and spine. To be healthy,
all joints should be exercised, but if this is excessive,
joint damage may accumulate slowly. In addition
to the hips, knees and lower back, arthritis commonly
occurs in the neck, small finger joints, the base of
the thumb, and the big toe. In the fingers, nodes
(masses of bone and cartilage) can form on either side
of the nail bed or the margins of joints to become
reddened, tender and swollen. Cartilage breakdown
in the hips and knees can be severe enough to require
joint replacement. Osteoarthritis found in other
joints, such as the hinge of the jaw, is often due
to injury or stress.
Osteoarthritis of the spine
Spinal arthritis
is one of the common causes of back pain. Spinal arthritis
is the mechanical breakdown of the cartilage between
the aligning facet joints in the back portion (posterior)
of the spine that quite often leads to mechanically
induced pain. The
facet joints (also called vertebral joints or zygophyseal
joints) become inflamed and progressive joint degeneration
creates more frictional pain. Back motion and
flexibility decrease in proportion to the progression
of back pain induced while standing, sitting and even
walking. Over time, bone spurs (small irregular
growths on the bone also called osteophytes) typically
form on the facet joints and even around the spinal
vertebrae. These bone spurs are a response to
joint instability and are nature’s attempt to
help return stability to the joint. The enlargement
of the normal bony structure indicates degeneration
of the spine. Bone spurs are also seen as a normal
part of aging and do not directly cause pain, but may
become so large as to cause irritation or entrapment
of nerves passing through spinal structures, and may
result in diminished room for the nerves to pass (spinal
stenosis).
Osteoarthritis in the spine is anatomically divided
into:
Lower back (lumbar spine) osteoarthritis, sometimes
called lumbosacral arthritis, which produces stiffness
and pain in the lower spine and sacroiliac joint
(between the spine and pelvis).
Neck (cervical spine) osteoarthritis, sometimes
called cervical spondylosis (spondy- implies the
spine, and –osis is an abnormal condition),
which can cause stiffness and pain in the upper
spine, neck, shoulders, arms and head.
Causes of osteoarthritis and spinal arthritis
There
are a number of reasons why some people are particularly
disposed to osteoarthritis. However,
as with nearly all abnormal conditions affecting the
body, it is likely that a combination of risk factors
work together to cause osteoarthritis. As indicated
above, repetitive trauma to the spine from repetitive
strains caused by accidents, surgery, sports injuries,
poor posture, or work-related activities are common
causes of spinal arthritis. Therefore, athletes
and people with jobs that require repetitive, and particularly
heavy, motion have been found to be at greater risk. Other
known risk factors for developing spinal arthritis
include:
Aging: steady and advanced aging of spinal
structures, beginning in the 30’s, often
work-related
Gender: osteoarthritis being more common
in post-menopausal women (although below age 45,
it is more common in males)
Excess weight: causing more stress on weight-bearing
joints and the spine, particularly during the middle
age years
Genetics: having a family history of osteoarthritis
or congenital defects of joints, spine, or leg
abnormalities
Associated diseases: the presence of other
associated diseases, infections, diabetes, and
various other forms of circulating arthritis, such
as rheumatoid arthritis or gout
When a specific cause of the osteoarthritis is unknown,
as it is in most cases, it is referred to as primary
osteoarthritis, which appears to be mostly due to aging. Aging
leads to changes in cartilage and synovial fluid -
the tissue water content increases as the protein content
decreases. Long term repetitive joint use has
been shown to lead to joint inflammation with associated
joint pain and swelling, eventually leading to the
loss of cartilage.
When the cause of the osteoarthritis is known, it
is referred to as secondary osteoarthritis, caused
by a particular disease or condition, such as obesity, trauma
or surgery to the joints, or abnormal joints at birth.
Patients with osteoarthritis who take an active role
in their own treatment can prevent additional joint
damage and usually will be able to continue with most
of their normal activities. The key to managing
the condition is to get an accurate diagnosis and start
early, proactive treatment. Most osteoarthritis
treatments are focused on reducing the pain and inflammation
associated with osteoarthritis and maintaining the
joint mobility and flexibility needed to continue with
necessary and desired activities. It is clear
that a combination of proper exercise, joint mobility,
weight control, nutrition and use of appropriate medication
is required to control osteoarthritis.
