Ask the Doctors June 2007 Issue

Ask The Doctors: 06/07

Iíve suffered from osteoarthritis in my knees for several years. Recently I was diagnosed with OA in my wrists and hands. Can osteoarthritis spread? If so, what can I do to prevent it from

developing in other parts of my body?

As a disease, osteoarthritis is not known to spread.S

ome patients with OA have the disease in just one joint, such as a finger joint or one knee. A significant number of patients have what is referred to as generalized osteoarthritis, which affects three or more joints. Common sites are the hands, base of the thumb, spine, hips, and knees. It is believed that patients who experience stiffness or pain in these areas have a defect in their bodyís cartilage that causes widespread damage. To date, no therapy has been developed that can prevent progression of osteoarthritis.

I have arthritis of my right thumb, for which Iíve been taking cortisone shots for two years. My doctor has told me I can no longer take cortisone injections, so Iím left with the alternative of joint replacement. Iíve read about hip and knee replacements, but Iíve not been able to uncover much information on thumb replacement. I read in one of your recent issues about viscosupplements. Would these injections help my thumb pain?

Viscosupplements have been used with some success in the treatment of arthritic knees and hips, but their effectiveness in the thumb joint has not been established. Two overseas studies noted pain relief and some improvement in grip strength in a relatively small groups of patients, but no such studies have been conducted in the United States to prove or disprove the usefulness of viscosupplements in thumb arthritis.

Currently, viscosupplementaion is approved for use only in the knee joint and its use elsewhere generally is not covered by medical insurance. Thumb arthritis often is surgically treated with a procedure called excision arthroplasty, in which bone at the base of the thumb is extracted and the space filled with a rolled up section of tendon. The soft tissue forms a "false joint." This procedure is successful in relieving pain and improving function in most patients.

Another option is arthrodesis, or fusion, of the thumb joint. This procedure generally provides good pain relief and does not significantly alter the range of motion of the thumb.

Replacement of the thumb joint with an implant has not been as successful as joint replacement in the hip and knee, although a few recent studies have reported patient satisfaction in up to 90 percent of the patients on whom the procedure was performed.

The choice of procedure depends on whether other joints in the hand are affected by arthritis and whether pain relief, strength, or range of motion is the goal. You should discuss with your doctor which of these procedures is most likely to be successful for your specific situation.

I have very painful arthritis of the thoracic spine. I also have chronic pain from two lower back surgeries and from sciatic nerve damage that never regenerated. I take neurontin and hydrocodone, which donít seem to help. Can you tell me where my pain might be coming from?

Pain from the thoracic spine can be can be attributed to a number of causes, anough evaluation of the possible causes is therefore important. Pain could result from disc disease, from facet arthritis (damage to the joints that join the vertebrae together), from nerve compression (as youíve experienced with sciatic nerve and lumbar problems), from osteoporosis if there are fractures, or from other types of rheumatologic diseases (ankylosing spondylitis, DISH-ligament calcification, and more). The pain might even be referred from some other region, such as the lung. Without knowing the details, I would suggest you seek out a spine center, which is a group of medical and surgical doctors specialized in evaluation and treatment of spinal disorders.