June 7, 2005
By: Charles D. Ray, MD
Osteoarthritis is characterized primarily by stiffness and pain in the joints, although not everyone with osteoarthritis actually experiences pain and disability. The stiffness and pain tend to be worse in the morning (particularly for about 30 minutes after waking up) and again in the evening, often called Ïfirst movement painÓ with improvement during the day as the person carries on his or her daily activities. Pain that awakens one during the night is often an indicator.
Other symptoms can include:
* Swelling and warmth in one or more joints, particularly during weather changes (which may be related to barometric pressure changes and cooling of the air)
* Localized tenderness when the joint or affected area of the spine is pressed
* Steady or intermittent pain in a joint, which is often described as an aching type of pain. The pain may be aggravated by motion
* Loss of flexibility of a joint, such as inability to bend and pick something off the floor
A crunching feeling or sound of bone rubbing on bone when the joint is moved (called crepitus), particularly notable in the neck
* An abnormal curve in the spine which may be due to unbalanced muscle spasm
* A sensation of pinching, tingling or numbness in a nerve or the spinal cord, which can occur when bone spurs form at the edge of the joints of the spine and irritate the nerves
Osteoarthritis usually develops over time. Early on, a person may only experience joint aches after physical work or exercise, which fades and then returns as the affected joint is used or overused. As the cartilage between the bones gradually thins, the pain often becomes steadier, making it difficult to walk or climb stairs. Joint pain and stiffness can begin to occur after long periods of inactivity, such as while sitting for long journeys or watching a two-hour movie. With advanced osteoarthritis and increased rasping friction between bones, the pain often becomes substantial even at rest or with very little movement.
With progressive osteoarthritis, a single joint may at first be affected, but with time and further activities, many joints of the body may be affectedÛin the base of the neck, or in the knees, hips, hands and/or feet. Although less common, some patients may experience severe deformities of certain joints over time. Osteoarthritis differs from systemic forms of arthritis because it only affects joints (although it may lead to an entrapment of a nerve at any level in the spine or the spinal cord in the neck) and does not affect organs or soft tissue areas of the body.
Low back (lumbar spine) osteoarthritis pain and other symptoms
As with other joint involvement in arthritis, lower back pain is typically most pronounced in the morning and worsens again later in the day. Pain is decreased during the day as the personÌs normal movements stir the fluid lubricant of the joints. Lower back pain commonly may radiate (Ïreferred painÓ) to the pelvis, buttocks, or thighs and sometimes to the groin. Nerve irritation from a herniated disc or from bone spurs can cause weakness, numbness, tingling and/or pain in the legs that often radiates to one foot. Arthritis causing spinal stenosis or narrowing of the spinal canal in the lower back can cause exercise or walking-related symptoms in both legs.
Neck (cervical spine) osteoarthritis pain and other symptoms
Neck pain from osteoarthritis again tends to be worse in the morning and evening, with improvement during the day. This pain often radiates to the shoulder, between the shoulder blades and up the neck to cause headaches. With nerve entrapment or a disc herniation, there may also be weakness or numbness of one hand, certain fingers or sometimes even in both arms. Compression of the spinal cord in the neck can even cause problems with walking as well as in bowel and bladder control in severe cases.
Osteoarthritis is sometimes confused with other conditions causing pain
Because other conditions seem similar to osteoarthritis of the spine, particularly when symptoms are at their worst, it is important to receive an accurate clinical diagnosis from a doctor who specializes in spinal medicine or spinal surgery.
(RA) usually affects multiple joints in a symmetrical pattern (both sides of the body being affected). Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints and may involve other tissues or organs of the body. Therefore, when rheumatoid arthritis flares up, symptoms can include fatigue, poor appetite, low grade fever, muscle and joint aches, and stiffness, again usually most notable in the morning and after periods of inactivity. Joints, usually in the hands, wrists and feet, frequently become red, swollen, painful, and tender.
Osteoarthritis is also sometimes confused or may be associated with degenerative disc disease (or spondylosis), a gradual deterioration of the disc(s) between the vertebrae of the spine. This is because osteoarthritis and degenerated discs are commonly found together. However, they are separate conditions and it is important to know which anatomical changes in the spine are the actual cause of the patientÌs pain or disability.
An x-ray will show degenerative disc disease as a narrowing of the normal disc space between adjacent vertebrae. An MRI scan may show the early changes of a loss of water content in the disc. Degeneration of the disc tissue increases its susceptibility to bulging or herniation. Disc degeneration can occur at any level of the spine and can cause local pain in the affected area with radiation of pain along the nerves emerging from the spinal canal at that level. Symptomatic lumbar disc degeneration is most common in people of working age, usually between 30 and 50. After the age of 50 or 60, the affected area of the spine actually tends to stabilize and degenerative disc disease is less likely to cause pain. In general, one cannot equate disc degeneration or bone spur formation with pain and disability, since about 85% of persons with such findings on an x-ray or scan do not have a clinically significant back problem.
Osteoporosis, or low calcium content of the bones, is another condition that does not cause but can lead to chronic back pain. With osteoporosis, particularly more common in post-menopausal women, bone mineral (calcium) loss may weaken bones in several parts of the body, particularly in the hip and the spine. Spinal fractures with compression (wedging) of vertebral bodies may occur. The pain from an osteoporotic spinal fracture can last for several weeks as the bone heals, and then typically turns into more of a chronic, achy pain concentrated in the area of the back where the fracture occurred. This aching may be similar to the sensation reported by those with osteoarthritis. A bone density test, which measures bone mass, preferably taken of both a long bone and a vertebral body, is used to diagnose osteoporosis. An x-ray can usually identify a compression fracture in the spine. Since the treatments for osteoarthritis and osteoporosis are very different, it is critical to get an accurate diagnosis.