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It's the most common cause of arthritis pain, the kind that many of us will face as we age, or if we have injured our joints. It's the "wear and tear" kind of arthritis or joint inflammation, called osteoarthritis. It affects 16 million Americans -and more than half of us will get it by age 60.

The hallmark of osteoarthritis -destruction of the resilient, protective cartilage that covers our bones where they meet at joints - has been recognized for many years. Now a growing body of knowledge is helping the medical community understand the nature of the process, who gets it and how to prevent and treat it.

Cartilage, which many of you recognize as the glistening white coating at the ends of the bones of your chicken dinner, is largely composed of three constituents: cells called chondrocytes, collagen fibrils (strands) and a matrix of substances called proteo-glycans, in which the other two are embedded.

Many factors can initiate osteoarthritis - including any injury that alters the carti-lage surface - but once it begins, the process may lead to the destruction of the carti-lage structure. Aging, with or without injury, is a risk factor. So is obesity for knee, and possibly hip, osteoarthritis. Women at menopause often develop osteoarthritis of the finger joints, so estrogen deprivation also seems to play a role.

Genetic factors may also be implicated in certain aspects of cartilage breakdown. In fact, among the most exciting recent discoveries is the finding of an abnormal collagen gene that causes abnormalities in the cartilage of some families that develop osteoarthritis. Diagnosis of osteoarthritis is made primarily by examination and x-ray, sometimes with use of CT scan and MRI, and at times blood tests, to exclude other diagnoses.

Although various treatments for osteoarthritis are available, prevention is still in its infancy. Clearly, avoiding obesity and injury, including injury by repetitive stress, is important. Some studies have shown that women who have previously used estrogen replacement therapy had less osteoarthritis, although it is not currently used for this purpose. A study has also shown that those who previously consumed the least quantities of vitamin C had an increased progression of knee osteoarthritis. But more studies are needed. There are some studies that suggest that taking oral "supplements," such as glucosamine and chondroltin sulfate, which are constituents of cartilage, will retard further breakdown of knee cartilage, or help pain, and a large-scale study is currently investigating this, but the FDA has not yet approved these substances as medications.

New Treatment Options
Traditional treatments include acetaminophen for pain and anti-inflammatory med-ications, including aspirin. Exciting recent research has resulted in the Cox-2 inhibitor class of anti-inflammatory medications, which are as potent as most anti-inflammatory medications, but much less likely to cause ulcers, and often useful for those who require low-dose aspirin for treatment of other conditions. At times, the use of special cortisone preparations instilled into the affected joint may be beneficial. Two forms of joint-fluid-like substances may ease the symptoms of knee osteoarthritis after a course of three to five weekly injections.

Arthroscopic surgery may be helpful for irrigating and "cleaning up" the inside of the joint. When other remedies have failed, replacement of the joint with a plas-tic/metal prosthesis may be necessary and very helpful; these have been particularly effective for the hip and knee. Medications are also being tested to inhibit the many naturally occurring bodily substances-such as the metalloproteinases enzyme pro-teins - that promote cartridge breakdown. The antibiotic tetracycline may have some of these protective properties, but hasn't been approved for use as such, Other med-ications are being evaluated that may stimulate the chondrocyte to repair damaged cartilage more effectively.

Finally, and also very exciting, are reports of transplantation of chondrocytes and cartilage to repair the cartilage damage of osteoarthritis, although the role of this approach remains to be determined.

Remember that if you're having joint pain, it is important that you have your doctor help diagnose its cause, since much can now be done for osteoarthritis and other kinds of arthritis as well.

Dr. Schwartzfarb is a rheumatologist in private practice in New York City. He is on the staffs of the Hospital for Joint Diseases/Orthopedic Institute and Beth Israel Medical Center, and on the faculties of the Albert Einstein College of Medicine and NYU Medical School, all in NYC.

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