What Is It?

Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis.

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Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.

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OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.

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There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.

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Causes

Factors that may contribute to the development of OA include 

• Age - The risk of developing OA increases with age.

• Injury - A bone fracture or cartilage or ligament tear.

• Overuse - Excessive joint use such as for a job or sport.

• Obesity. Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.

• Musculoskeletal Abnormalities. Malalignment of bone or joint structures can contribute to faster development of OA.

• Weak muscle - If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA

• Genetics - People with family members who have OA are more likely to develop it.

• Gender -  Women are more likely to develop OA than men.

• Environmental Factors - Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density.

 

What Are The Symptoms?

Symptoms tend to build over time rather than show up suddenly. They include

• Pain or aching in a joint during activity, after long activity or at the end of the day.

• Joint stiffness usually occurs first thing in the morning or after resting.

• Limited range of motion that may go away after movement.

• Clicking or popping sound when a joint bends.

• Swelling around a joint.

• Muscle weakness around the joint.

• Joint instability or buckling (as when a knee gives out).

        

OA may affect different parts of the body in different ways.

• Hip Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.

• Knees. A “grating” or “scraping” feeling when moving the knee. 

• Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.

• Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes.

 

Potential Consequences

Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to health complications that are not caused by the disease itself.

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Obesity, Diabetes and Heart Disease

Painful joints, especially in the feet, ankles, knees, hip or back, make it harder to exercise. But physical activity is not only key to managing OA symptoms, it also can help prevent weight gain, which can lead to obesity. Being overweight or obese can lead to the development of high cholesterol, type 2 diabetes, heart disease and high blood pressure.

Falls

Research indicates people with OA experience more falls and risk of fracture than those without OA. Although study results vary, some research shows they may have up to 30% more falls and have a 20% greater risk of fracture.

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How Is It Diagnosed?

Medical history, a physical examination and lab tests help to make up the OA diagnosis. 

A primary care doctor may be the first person you talk to about joint pain.

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Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.

• X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis.

• MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.

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What Are The Treatment Options?

There is no cure for OA, but medication, assistive devices and other therapies that don’t involve drugs can help to ease pain. As a last resort, a damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic.

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Medications

Pain and anti-inflammatory medicines for osteoarthritis are available as pills, syrups, patches, gels, creams or injectables. They include:  

• Analgesics. These are pain relievers and include acetaminophen and opioids. Acetaminophen is available over the counter (OTC); opioids must be prescribed by a doctor.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, naproxen and celecoxib, available either OTC or by prescription. The OTC versions help with pain but not inflammation.

• Counterirritants. These OTC products contain ingredients like capsaicin, menthol and lidocaine that irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain. 

• Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.

• Viscous Hyaluronic Acid. Hyaluronic acid (HA) is a substance already in the fluid of your joints. When you have OA, the HA in your joints becomes lower and less effective. HA Injection is used to relieve knee pain due to osteoarthritis.

• Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.

• Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.

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Nondrug Therapies

Exercise

Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal, according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:

• Strengthening exercises build muscles around painful joints and helps to ease the stress on them. 

• Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.

• Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.

• Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.

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Weight Loss

Excess weight puts additional force and stress on weight-bearing joints, including the hips, knees, ankles, feet and back, and fat cells promote inflammation. Losing extra weight helps reduce pain and slow joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.

 

Physical Therapies and Assistive Devices
Physical therapists, occupational therapists and chiropractors can provide:

• Specific exercises to help stabilize your joints and ease pain.

• Information about natural treatments and products that can ease pain.

• Instruction to make movement easier and to protect joints. 

• Braces, shoe inserts or other assistive devices.

 

Surgery

Joint surgery can improve pain and function. Joint replacement surgery replaces damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.

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Self-Care

Practicing these habits can slow down OA, keep you healthier overall and delay surgery as long as possible. It is important to pursue a number of different self-care approaches simultaneously. They are listed below.

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Maintain a Healthy Weight

Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

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Control Blood Sugar

Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

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Maintain Range of Motion

Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. But listen to your body and never push too hard.

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Protect Joints

Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.