Osteoarthritis

Overview

What Is It?
Osteoarthritis affects structures throughout the joint. The cartilage, the slippery tissue that covers the ends of bones in a joint, begins to break down and wear away. This allows bones to rub together, eventually causing inflammation and pain.

There are more than 100 kinds of arthritis, which literally means joint inflammation. According to the Centers for Disease Control and Prevention (CDC), about 54.4 million (one in four) Americans are afflicted, and 27 million have osteoarthritis, by far the most common form, especially among older people. Sometimes called degenerative joint disease, osteoarthritis accounts for most of the hip and knee replacement surgeries performed in the United States. As with other types of arthritis, women are at higher risk than men for the condition.

Osteoarthritis affects structures throughout the joint. Among them the cartilage, the slippery tissue that covers the ends of bones in a joint, is usually affected. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away, which allows bones under the cartilage to rub together. This causes bone remodeling and change in boney shape and loss of motion of the joint. Over time, the joint loses its normal shape. Also, bone spurs—small growths called osteophytes—may grow on the edges of the joint. By the time a person has symptoms from osteoarthritis, it is no longer just a disease of cartilage. Bone has changed, muscles across the joint have often weakened and there is occasionally inflammation in the lining of the joint.

Unlike some other forms of arthritis, osteoarthritis only affects joints, not internal organs. Rheumatoid arthritis—another common form of arthritis—affects other parts of the body besides the joints. It causes inflammation and may make people feel sick, tired and sometimes feverish, among other symptoms.

Some younger people get osteoarthritis from a joint injury, but osteoarthritis most often occurs in people over 40. In fact, at least 80 percent of people over age 55 have X-ray evidence of osteoarthritis in at least one joint, but not all of them have symptoms of the disease. Since the number of older Americans is increasing, so is the number of people with osteoarthritis. Before age 55, more men have the condition (often the result of a sports or work injury), while after age 55, osteoarthritis is more common in women.

Researchers suspect that genes play a role in some cases of osteoarthritis. In one rare form of disease starting as early as age 20, affected people may have a defect in the gene that helps the body make collagen, the protein that makes up cartilage. More commonly, minor genetic variations may increase the risk of osteoarthritis. They may affect minor molecules in the joint, changing the metabolism of joint structures, or they may change the shape of a joint during growth, leaving slight defects in the way bones that come together in joints fit together. This may cause cartilage to wear away more quickly than normal. Double-jointedness, an inherited trait where the joints bend farther than usual, may also increase risk for osteoarthritis.

Signs and Symptoms

Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms develop slowly and may be stable for many years. Researchers do not yet know what causes the disease, but they suspect a combination of factors in the body and in the environment. Genetics, weight and stresses on the joints from certain jobs, hobbies or other activities may affect the disease and how a person reacts to it.

Usually, osteoarthritis develops slowly. Early on, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint but most often occurs at the joints in the hands, hips and knees.

Hands: Osteoarthritis of the fingers is the one type of the disease that seems to be predominantly hereditary. More women than men have it, and risk increases after menopause. Small, bony knobs appear on the end joints of the fingers. They are called Heberden's nodes. Similar knobs (called Bouchard's nodes) can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled and may ache or be stiff and numb. The base of the thumb joint is also commonly affected by osteoarthritis. This kind of osteoarthritis can be helped by medications, splints or heat treatment.
Knees: The knees are among the body's main weight-bearing joints. They are also among the joints most commonly affected by osteoarthritis. An afflicted knee may be stiff, swollen and painful, making it hard to walk, climb or get in and out of chairs and bathtubs. If not treated, osteoarthritis in the knee can lead to disability. However, even with treatment, osteoarthritis may progress. Medications, losing weight, exercise and walking aids can reduce pain and disability. In severe cases, knee replacement surgery may be required. Research studies show that being overweight increases the risk of developing osteoarthritis of the knees and show that injuries to the knee are a major cause of disease.
Hips: Osteoarthritis in the hip can cause pain, stiffness and severe disability. People most often feel the pain in their groin, front of thighs or knees. Walking aids, such as canes or walkers, can reduce stress on the hip. Osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care a challenge. Walking aids, medication and exercise can help relieve pain and improve motion. A health care professional may recommend hip replacement if the pain is severe and not helped by other treatments.

Diagnosis

The warning signs of osteoarthritis include steady joint pain or intermittent pain that usually worsens with activity, brief stiffness after getting out of bed, joint swelling or tenderness in one or more joints and a crunching feeling or sound of bone rubbing on bone.

No single test can diagnose osteoarthritis. Most health care professionals use a combination of the following methods to diagnose the disease and rule out other conditions:

Clinical history. The health care professional will begin by asking you to describe your symptoms, and when and how the condition started. Be sure to provide an accurate description of pain, such as what makes it worse or better, stiffness and joint function and how they have changed over time. You should also share information on other medical conditions and any medicines you are taking.
Physical examination. The health care professional will check your general health and examine joints that bother you, as well as your reflexes and muscle strength. He or she will observe your ability to walk, bend and carry out activities of daily living.
X-rays and other imaging techniques. X-rays can show how much joint damage has been done; they may show such things as cartilage loss, bone damage and bone spurs. But there is often a big difference between the severity of osteoarthritis that the X-ray shows and the degree of pain and disability the patient has. In addition, X-rays may not show early osteoarthritis damage (before much cartilage loss has taken place). Other types of imaging tests may also be used to look for damage that cannot be seen on X-ray, such as magnetic resonance imaging (MRI) or ultrasound.
Other tests. A health care professional may order blood tests to rule out other possible causes of your arthritis. Another common test includes "joint aspiration," or "arthrocentesis," during which fluid is drawn from the joint for examination. The fluid can be examined to see if it contains the crystals that cause gout or pseudogout or if it is moderately or severely inflamed, which suggests you have rheumatoid arthritis.

It is usually not difficult to tell if a patient has osteoarthritis. It is more difficult to tell if the disease is causing the patient's symptoms. Osteoarthritis is so common, especially in older people, that it may mask other conditions that are actually responsible for symptoms. A health care professional will try to find out what is causing the symptoms, ruling out other disorders and identifying conditions that may make the symptoms worse.

Not everyone with osteoarthritis feels pain. In fact, about one-third of people for whom X-rays show evidence of osteoarthritis report pain or other symptoms.

The most common way to measure pain is for a health care professional to ask you about it. For example, you may be asked to describe the level of pain you feel on a scale of one to 10. Use specific words to describe your pain-like aching, burning, stinging or throbbing to better convey what is happening. It's also important to describe if and where the pain travels (for example, from the groin down to the knee).

Since health care professionals rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. On a daily basis, describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain and your reactions to the pain. For example: "On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees." The diary will give your health care professional some insight into your pain and may play a critical role in the management of your disease.

Treatment

A successful treatment program for osteoarthritis may involve a combination of therapies tailored to your needs, lifestyle and health. Work closely with your health care provider to help create the most effective treatment for you.

In general, osteoarthritis treatment has three general goals:

Control pain through drugs and other measures.
Improve joint care through rest and exercise.
Maintain an appropriate body weight and achieve a healthy lifestyle.

In addition to the guidance of your primary health care professional, you may need care from a physical therapist, a rheumatologist (a physician who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and bones) or a physiatrist (a physician who specializes in the diagnosis and management of injuries and diseases causing pain, loss of function and disability). Treatment plans often include the use of exercise, massage, heat, relaxation techniques, splints and braces and local injections to relieve pain.

Osteoarthritis treatment plans also often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery and nontraditional treatments.

If you are diagnosed with osteoarthritis, you may be prescribed a variety of medicines to eliminate or reduce pain and to improve functioning. Health care professionals consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and a drug's potential side effects. You must use medicines carefully, and tell your health care professional about any changes that occur.

The following types of medicines are commonly used in treating osteoarthritis:

Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some NSAIDs over the counter (for example, aspirin, ibuprofen and naproxen). Other NSAIDs are available by prescription only. These drugs all reduce inflammation or swelling and relieve pain. However, each NSAID is a different chemical and can have slightly different effects in the body.

NSAIDs can cause stomach irritation or affect kidney function and blood pressure. Plus, there is the potential for cardiovascular events associated with the use of NSAIDS. The longer you use NSAIDs, the more likely you are to have side effects. Many other drugs cannot be taken with NSAIDs. NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency and hypertension. It's important to ask your health care professional for safety information associated with pain relievers with your personal health history in mind.

A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2), which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. Celecoxib (Celebrex) is currently the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart attack and stroke; discuss these risks with your health care professional. For more information on the risks associated with Celebrex, visit www.fda.gov.

Recently, NSAIDs have become available in topical form in the United States. Such preparations are much safer to use because lower levels of medication reach the bloodstream, and they don't pass through the stomach. They are less effective than oral NSAIDs, however.

Acetaminophen (Tylenol). This analgesic and fever-reducer (antipyretic) is not an NSAID and does not reduce inflammation. It is less likely to irritate the stomach than NSAIDs. Its availability over the counter, low cost and mild side effects make it a good choice for treating mild arthritis pain, but NSAIDS are usually more effective for patients with moderate to severe pain. Long-term use of acetaminophen taken multiple times daily may be associated with liver damage or inflammation of the kidneys (nephritis). Patients with liver disease and heavy alcohol drinkers should not use acetaminophen without first talking to a health care professional.

Health care professionals may prescribe several other medications for osteoarthritis. They include:

Tramadol hydrochloride (Ultram). Ultram is a prescription narcotic analgesic that provides pain relief for short-term acute flare-ups of osteoarthritis with fewer side effects than NSAIDs. Your health care professional may recommend tramadol in combination with acetaminophen for maximum pain relief.
Rubs and sprays (for example, capsaicin cream) applied directly to the skin.
Mild narcotic medications (opioids), which, while moderately effective, are potentially addictive and may have multiple side effects.
Corticosteroids. These powerful anti-inflammatory hormones are made naturally in the body or produced synthetically. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a short-term measure.
Colchicine. This drug is often prescribed to treat crystal arthritis, which sometimes coexists with osteoarthritis. Colchicine may help people who have crystal arthritis (either pseudogout or gout), in addition to their osteoarthritis. People who have kidney or liver disease may be unable to use colchicines. Discuss benefits and risks with your health care professional.

Medicines used to treat osteoarthritis may have side effects, so it is important to learn about the drugs you are taking. Even nonprescription drugs should be reviewed. Certain patients may be at greater risk for side effects, such as those with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke and those who consume alcohol. The risk of certain side effects in some osteoarthritis medications may be reduced by taking the drug with food. Some patients should avoid stomach irritants such as alcohol, tobacco and caffeine. Other medicines may be taken to protect the stomach lining by coating the stomach or blocking stomach acids. These measures help but are not always completely effective.

Other options for relieving the pain and damage caused by osteoarthritis include:

Viscosupplements. These medications use hyaluronic acid (or hyaluronate) to replace the synovial fluid that helps lubricate the joints, which is lost in patients with osteoarthritis. (Hyaluronic acid is one of the two natural lubricants in synovial fluid.) It is approved by the U.S. Food and Drug Administration for the treatment of knee pain in osteoarthritis patients who are unresponsive to nonpharmacologic measures and analgesic medications and who have significantly increased flares of inflammation or extensive inflammation. Even though FDA approved, controversy remains over the effectiveness of hyaluronic acid injections. The drugs, which include hyaluronan (Hyalgan) and hylan-GF-20 (Synvisc), are injected directly into the joint. These drugs are usually injected into the knee, but their use in other joints is being studied. Injections are typically given weekly over several weeks, and the pain relief may last for a few months. Because it is made from rooster combs, people with sensitivity to birds, feathers or eggs should not receive viscosupplements. Since the data on its effectiveness is mixed, hyaluronic acid is not recommended in most treatment guidelines.
Physical or occupational therapy. The goals of occupational and physical therapy are to preserve the use of your joints, restore lost abilities, maintain your fitness, help you adapt to new levels of activity and help you maintain the ability to partake in the activities you enjoy. Occupational therapy can teach you how to reduce the strain on your joints during daily activity, and physical therapy can teach you exercises designed to preserve and strengthen your joints. Some of the therapeutic methods available include rest during flare-ups; applying heat or cold; exercise, including water exercises, strength exercises and recreational exercise; specific exercise to help you prepare for or recover from surgery if surgery is prescribed; joint protection activities and exercises; and assistive devices, such as a bath stool in your shower or a shoe horn.
Surgery. A variety of surgical procedures are used to treat osteoarthritis including joint realignment, joint fusion, cartilage grafting and joint replacement. Surgeons may replace affected joints with artificial joints called prostheses, which can last about 20 years. These joints can be made from metal alloys, high-density plastic and ceramic material and can be joined to bone surfaces by special cements. A small percentage of these artificial joints may need revision, especially after years of use. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level and other medical conditions.

The decision to perform surgery depends on several factors: level of disability, intensity of pain, weight, interference with lifestyle, age, occupation and other medical conditions. Currently, the majority of osteoarthritis surgery cases involve replacing the hip or knee joint, but other joints can be replaced, including thumb joints, shoulder joints and elbow joints. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.

When joint replacement isn't an option, other types of surgery for osteoarthritis may involve realigning or fusing bones to increase stability and help decrease pain.

Discuss the benefits and drawbacks of surgery with your health care professional before you make a decision about whether it's best for you.
Weight loss: Weight loss can reduce stress on weight-bearing joints, limit further injury and result in less pain and better function. A dietitian can help you develop healthy eating habits and a nutritional plan to promote weight loss.
Exercise. Exercise is frequently used to treat osteoarthritis, whether or not a patient is overweight. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise you can do will depend on which joints are involved, how stable the joints are and whether a joint replacement has already been done.

Exercise can produce generalized improvement as well as specific effects. When it comes to osteoarthritis of the knee, the level of muscle strength in the thigh muscle (quadriceps) and perhaps in the muscles around the hips are important. Strengthening these muscles can relieve symptoms. Walking can result in better functioning and increased walking distance.

In addition, there is evidence that yoga and tai chi can help reduce osteoarthritis pain. These alternative forms of exercise combine gentle exercises, stretching and deep breathing.

Ask your health care professional or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should use drugs, such as analgesics or anti-inflammatories, to make exercising easier, or if you should use ice afterward. An exercise plan should also include regularly scheduled rest. Learn to recognize your body's signals, and know when to stop or slow down to prevent pain caused by over-exercising.
Supportive devices. Osteoarthritis pain can be so bad that you need a cane or splints to protect your joints and to take pressure off them. Splints or braces provide extra support for a weakened joint and keep the joint in proper position during sleep or activity. An occupational therapist or a health care professional can help fit you properly with a splint. Braces have been shown to be effective for knee osteoarthritis.

Alternative Therapies for Relieving Arthritis Pain

Relaxation techniques. Stress reduction and relaxation techniques, such as deep breathing, guided imagery and visualization (where you focus on "seeing" pleasant pain-free scenes or activities in your mind), may provide some pain relief.
Acupuncture. Acupuncture is an important component of traditional Chinese medicine. It involves the insertion of thin needles at specific points, which are mostly along the body's nerve pathways, to improve health. According to the Arthritis Foundation, acupuncture may be useful as an adjunct treatment or an acceptable alternative treatment option for arthritis pain, working to help release tightened muscles, regulate the body's nervous system to stimulate natural endorphins and alter the body's perception of pain. Indeed, a clinical trial showed that acupuncture, when used along with conventional therapy, improved function and reduced pain in osteoarthritis of the knee. Individuals who want to use acupuncture should discuss their interest with their health care team and should receive treatment only from a licensed acupuncturist.
Nutritional supplements. Many studies have carefully evaluated the role of nutritional supplements in osteoarthritis.

Two supplements that have received a lot of attention regarding their potential benefits in people with osteoarthritis are glucosamine and chondroitin sulfate. Both are substances naturally produced by the body. The supplements are derived from animal tissue, specifically from crab, lobster and shrimp shells (glucosamine), and from animal (shark) cartilage (chondroitin). So far, studies on these supplements—when used alone and together—have shown few, if any, benefits. Therefore, the American College of Rheumatology does not recommend chondroitin or glucosamine for initial treatment of osteoarthritis. However, the College recommends that patients who are currently taking these supplements and experiencing improvements should not stop taking them.

The FDA does not regulate glucosamine/chondroitin or other food supplements, as it does over-the-counter medications and prescription drugs. If you are considering trying one or both of these supplements, check with your health care professional first. Side effects associated with these supplements include increased intestinal gas and softened stools. If you experience these problems, you might want to try another supplement brand before you stop using them altogether.

Certain vitamins have been linked to joint health, particularly vitamins C, D and K. There is no good evidence that vitamin C slows the progress of osteoarthritis, but more research is needed on vitamins D and K.

In addition, some controversial studies show oils found in avocado and soybeans, called avocado-soybean unsaponifiables (ASUs), may slow cartilage loss and actually help repair cartilage in hip and knee joints when taken orally.

Products and reports about nutritional supplements claiming to provide pain relief should be viewed with caution until more studies can be conducted. Discuss your interest or questions about such products and reports with your health care professional.
Transcutaneous electrical nerve stimulation (TENS). TENS is the application of electrical stimulation from a small device to the nerve endings that lie below the skin for pain relief. The use of TENS in people with osteoarthritis is controversial. A 2015 Cochrane Review concluded that TENS can reduce pain "over and above that seen with a placebo." Other past studies have not shown a benefit.
Biofeedback. Biofeedback is a way to enhance a body signal so that you are aware of something that usually occurs at a level below consciousness. An electronic device provides information about a body function (such as heart rate) so that you can learn to control that function. If you have arthritis, biofeedback can help you learn to relax your muscles. In this case, an electronic device amplifies the sound of a muscle contracting, so the arthritis patient knows that the muscle is not relaxed. The therapy is typically learned with the help of a health care professional and then practiced at home, either with the use of a biofeedback machine once the patient has mastered the technique, or without one.

Prevention

While many osteoarthritis risk factors—being female, older and having other diseases that affect the bones and joints—cannot be changed, you can work on several other risk factors to lower your risk of developing the condition:

Obesity. Losing extra weight and exercising can help people with osteoarthritis. Most importantly, weight loss may reduce the risk of developing osteoarthritis of the knee in overweight or obese people.
On-the-job injuries. Taking precautions to avoid repetitive joint use and resulting joint injury in the occupational setting can help prevent osteoarthritis.
Sports injuries. Using recommended prevention strategies (warm-ups, strengthening exercises and appropriate equipment) helps to avoid joint injuries and damage to ligaments and cartilage, all of which can increase your risk of osteoarthritis.

Facts to Know

There are more than 100 kinds of arthritis, which literally means joint inflammation. About 5.4 million Americans are afflicted, and 27 million adults have osteoarthritis, by far the most common form, especially among older people. As with most types of arthritis, women are at higher risk than men for the condition.
Osteoarthritis occurs when the surface layer of cartilage—the protective tissue between bones at joints—breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint.
Osteoarthritis affects each person differently. Its progression rate and symptom severity vary widely. Researchers do not yet know what causes the disease, but they suspect a combination of factors in the body and in the environment. Also, diet, weight and stresses on the joints from certain jobs affect the disease and how a person reacts to it.
Researchers suspect inheritance plays a role in some cases of osteoarthritis. Some genes may influence joint shape, with certain shapes being vulnerable to osteoarthritis. Other genes may change the way tissues regenerate in the joint, making turnover of tissues less healthy.
The warning warning signs of osteoarthritis include steady or intermittent pain in a joint, worsening of pain with activity, stiffness after getting out of bed, joint swelling or tenderness in one or more joints, a crunching feeling or sound of bone rubbing on bone.
By age 55, more than 80 percent of the population has X-ray evidence of osteoarthritis in at least one joint. However, not all people with evidence of osteoarthritis in their X-rays report pain or other symptoms.
You can lower your risk of developing osteoarthritis by losing weight and taking precautions to avoid on-the-job and sports injuries. Consult your health care professional before embarking on a weight-loss program.
If you have symptoms of arthritis, it is a good idea to see a health care professional. Early intervention has proven to be a key to slowing progress of the disease.
A variety of medical and nonmedical options are available to help you manage osteoarthritis, including pain relievers, surgery, hyaluronic acid injections and diet and exercise modifications. Acupuncture, transcutaneous electrical stimulation (TENS), biofeedback and relaxation techniques are examples of alternative therapies that may provide some relief from arthritis pain.
Education is also an effective means of managing arthritis. The Arthritis Foundation Self-Help Program, sponsored by the Arthritis Foundation, may help reduce your pain, reduce disability, improve your quality-of-life and reduce your utilization of medical services.

Questions to Ask

Review the following Questions to Ask about osteoarthritis so you're prepared to discuss this important health issue with your health care professional.

Why am I having pain? Do I have osteoarthritis?
Are you sure I don't have other disorders that might causemy pain?
What drugs are available to help me? What are their benefits and side effects? Will these drugs interact with any other medications that I am taking?
Are there ways I can prevent my osteoarthritis from getting worse?
Besides taking drugs, what can I do to reduce my pain and make it easier to live with?
What should I do if an X-ray shows I have osteoarthritis, but I don't feel any pain?
What precautions should I take when exercising to protect affected joints? What should I do if my joints start to hurt or hurt worse while I'm exercising?
Can I benefit from changing my diet or losing weight? Will it lessen my joint pain?
Are there any devices that can make it easier for me to stay active without damaging my joints or aggravating my pain?
What can I do to cope with pain so I don't have to give up the activities that are important to me?
Are there support groups or other programs for people with osteoarthritis in this area?
Should I try a hyaluronic acid injection? What are its risks and benefits?

Key Q&A

What causes osteoarthritis?

In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint. Major injuries to the joint, like tears of ligaments or of the meniscus in the knee, can also lead to osteoarthritis.

What's the difference between osteoarthritis and rheumatoid arthritis?

Osteoarthritis only affects joints, not internal organs. Rheumatoid arthritis—the second most common form of arthritis—affects other parts of the body besides the joints. It typically causes inflammation and may make people feel sick, tired and sometimes feverish, among other symptoms. Rheumatoid arthritis is an autoimmune disease, in which the immune system attacks healthy tissues.

Am I at risk for osteoarthritis?

Women are at somewhat higher risk than men, and risk increases as you age. If your job or a sport you enjoy carries a high risk of injury, your risk of osteoarthritis is also higher. Being overweight is another risk factor, since extra weight increases stress on weight-bearing joints such as the knees and hips.

Can I do anything to reduce my risk of developing osteoarthritis?

Losing weight and minimizing injury to your joints on the job and at play can cut your risk.

What are the symptoms of osteoarthritis?

The warning signs of osteoarthritis include steady or intermittent pain in a joint, stiffness after getting out of bed, swelling or tenderness in one or more joints, increased pain with activity, a crunching feeling or sound of bone rubbing on bone.

How is osteoarthritis diagnosed?

A health care professional will probably take a clinical history, conduct a physical examination and may order X-rays. Be prepared to describe pain and other symptoms in detail. Specific descriptive terms—such as throbbing, constant, sharp, intermittent, aching, burning or stinging—are helpful. X-rays and other imaging techniques (such as MRI or ultrasound) can help determine how much joint damage has been done and whether you have cartilage loss, bone damage or bone spurs. However, X-rays may not show early osteoarthritis damage and may not be necessary to make the diagnosis. Various blood tests may be done to make sure you do not have rheumatoid arthritis, lupus or other forms of inflammatory disease. Fluid may be removed from your affected joint to help with diagnosis.

What's the latest on medications used to treat arthritis pain?

NSAIDs and acetaminophen are still top choices for treating arthritis pain, NSAIDS for moderate to severe osteoarthritis, and acetaminophen for mild to moderate cases. However, keep in mind that there is the potential for increased risk of cardiovascular (CV) events and gastrointestinal (GI) bleeding associated with the use of NSAIDS. It's important to ask your health care professional for information about safety information associated with pain relievers with your personal health history in mind.

Are there ways of alleviating osteoarthritis pain without medications?

Yes. Weight loss, exercise, physical therapy, stress reduction and biofeedback often help, as do using canes or wearing splints to take the pressure off joints. Warm towels, hot packs or a warm bath can often relieve pain, as can cold packs used after exercise (check with your health care professional before using hot or cold therapies).

Can I exercise if I have osteoarthritis?

Yes. Research shows that one of the best treatments for osteoarthritis is exercise. This activity can decrease pain, improve mood and outlook, increase flexibility, improve the heart and blood flow, maintain weight and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise you can do will depend on which joints are involved, how stable the joints are and whether a joint replacement has already been done. Be sure to discuss any plan to start an exercise program with your health care professional.

Should I make changes in my diet if I have osteoarthritis?

If you are overweight, you should discuss a weight-loss plan with a health care professional. Losing weight takes excess stress off weight-bearing joints and can limit further injury. Progression of the disease may be less in patients with high levels of vitamin C and D, although more studies are needed to confirm these reports.

Lifestyle Tips

Heat and cold for painful joints
Moist heat can temporarily ease pain and stiffness and relax your muscles to give you a good start to the day or make it easier to sleep at night. Try taking a bath or shower both in the morning and evening, or apply warm towels or hot packs for about 15 minutes. Cold treatments may help joints that have been overstressed (but don't use if you have poor circulation). One easy way is to use a bag of loose, frozen peas, wrapped in a towel. Apply for no more than 10 to 15 minutes. Check with your health care professional or physical therapist to see if heat or cold is better for you.
Exercise to keep knee pain from slowing you down
To keep osteoarthritis of the knee from interfering with your daily activities, maintain a light exercise regimen—and stick to it faithfully. The amount and form of exercise you can do will depend on how stable your knee joint is and whether a joint replacement has already been done.When it comes to osteoarthritis of the knee, the level of muscle strength in the thigh muscle (quadriceps) and muscles around the hip is important. Strengthening these muscles can relieve symptoms and prevent more damage. Walking can result in better functioning and increased walking distance.Ask your health care professional or physical therapist what exercises are best for you. Ask for guidelines on exercising when your knee is sore or if swelling is present.
Don't let diet news confuse
Cover all bases by sticking to a healthy weight-loss or weight-maintenance diet with well-balanced, not excessive, vitamin and mineral supplements. Don't overdo even with "natural" nutrients. For example, vitamin E, a naturally occurring antioxidant found in grains, nuts and oils, probably does not help prevent development or worsening of knee osteoarthritis and does not appear to be much of a pain reliever, as previously thought. At the same time, too much of it could increase your risk of bleeding if you are taking anti-bleeding medications. Ask your health professional about the best diet and nutritional supplement regimen for you.
Smart strategies for fighting fatigue
If you're fed up with feeling tired, you're not alone. Arthritis tends to sap your energy. Fatigue is more often due to rheumatoid arthritis than osteoarthritis, so if you have prominent fatigue with your arthritis, see an arthritis specialist to make sure you don't have rheumatoid arthritis. Get extra rest by taking breaks or naps during the day and allowing time for a full night's sleep. See your health care professional if you have trouble sleeping. Prioritize your activities and do the most important ones first, when you have the most energy. Pace yourself and don't overdo. Set a time limit on shopping, and watch for places you can stop to get off your feet, for example.

Organizations and Support

For information and support on coping with Osteoarthritis, please see the recommended organizations and books listed below.

American Academy of Orthopaedic Surgeons (AAOS)
Website: https://www.aaos.org
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-823-7186

American Chronic Pain Association
Website: https://www.theacpa.org
Address: P.O. Box 850
Rocklin, CA 95677
Hotline: 1-800-533-3231
Email: acpa@pacbell.net

Arthritis Foundation
Website: https://www.arthritis.org
Address: P.O. Box 7669
Atlanta, GA 30357
Hotline: 1-800-283-7800

Bone and Joint Decade
Website: https://www.usbjd.org/index.cfm
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-384-4010
Email: usbjd@usbjd.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Website: https://www.niams.nih.gov
Address: National Institutes of Health
Bldg. 31, Room 4C02 31 Center Dr. - MSC 2350
Bethesda, MD 20892
Hotline: 1-877-22-NIAMS (1-877-226-4267)
Phone: 301-496-8190
Email: niamsinfo@mail.nih.gov

Osteoarthritis Research Society International (OARSI)
Website: https://www.oarsi.org
Address: 15000 Commerce Parkway, Suite C
Mt. Laurel, NJ 08054
Phone: 856-439-1385
Email: oarsi@oarsi.org

Books

250 Tips for Making Life With Arthritis Easier: Official Publication of the Arthritis Foundation
by Shelley Peterman Schwarz

Arthritis 101: Questions You Have. Answers You Need.
by The Arthritis Foundation

Arthritis Cure Fitness Solution
by Brenda Adderly

Arthritis Sourcebook
by Amy L. Sutton

Managing & Preventing Arthritis - The Natural Alternatives
by George L. Redmon

Pain-Free Arthritis: A 7-Step Plan for Feeling Better Again
by Harris H. McIlwain and Debra Fulghum Bruce

Strong Women and Men Beat Arthritis
by Miriam E. Nelson, Ph.D, Kristin Baker, Ph.D, Lawrence Lindner, M.A. and Ronenn Roubenoff, M.D., M.H.S.

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