What is Osteoarthritis?

Osteoarthritis is a condition of joints that causes pain, swelling, and loss of motion. Osteoarthritis mostly affects cartilage, the hard but slippery tissue that covers the ends of bones where they meet to form a joint.  Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks and wears away, allowing bones under the cartilage to rub together. Over time, the joint may lose its normal shape. Also, small deposits of bone—called osteophytes or bone spurs—may grow on the edges of the joint.  Bits of bone or cartilage can break off and float inside the joint space causing more pain and damage. The most commonly affected joints are those at the ends of the fingers (closest to the nail), basal thumbs, neck, lower back, knees, and hips.

Although osteoarthritis becomes more common with age, younger people can develop it, usually as the result of a joint injury, a joint malformation, or a genetic defect in joint cartilage. Both men and women have the disease. Before age 45, more men than women have osteoarthritis; after age 45, it is more common in women. It is also more likely to occur in people who are overweight and in those with jobs that stress particular joints. As the population ages, the number of people with osteoarthritis will only grow. By 2030, a projected 67 million people will have a diagnosis of arthritis.

Osteoarthritis affects people differently. It may progress quickly, but for most people, joint damage develops gradually over years. In some people, osteoarthritis is relatively mild and interferes little with day-to-day life; in others, it causes significant pain and disability.

Although osteoarthritis is a disease of the joints, its effects are not just physical. In many people with osteoarthritis, lifestyle and finances also decline.  Fortunately, most people with osteoarthritis live active, productive lives despite these limitations. They do so by using treatment strategies such as rest and exercise, weight management, pain relief modalities, education and support programs, learning self-care, and having a positive attitude.

How do you know if you have Osteoarthritis?

Usually, osteoarthritis comes on slowly. Early in the disease, joints may ache after physical work or exercise. Later on, joint pain may become more persistent. Patients may also experience joint stiffness, particularly when first waking up in the morning or after having been in one position for a long time.

Although osteoarthritis can occur in any joint, most often it affects the hands, knees, hips, and spine (either at the neck or lower back). Different characteristics of the disease can depend on the specific joint(s) affected.  For information on the joints most often affected by osteoarthritis, see the following descriptions:

Hands:  Osteoarthritis of the hands seems to have some hereditary characteristics; that is, it runs in families. If your mother or grandmother has or had osteoarthritis in their hands, you are at greater-than-average risk of having it too. Women are more likely than men to have hand involvement and, for most, it develops after menopause.

When osteoarthritis involves the hands, small, bony knobs may appear on the end joints (those closest to the nails) of the fingers. They are called Heberden’s (HEBerr-denz) nodes. Similar knobs, called Bouchard’s (boo-SHARDZ) nodes, can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees:  The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk, climb, and get in and out of chairs and bathtubs. Osteoarthritis in the knees can lead to disability.

Hips:  The hips are also common sites of osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness of the joint itself. The pain is typically felt in the groin, inner thigh, buttocks, and even the knees. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge.

Spine:  Osteoarthritis of the spine may show up as stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in pain, weakness, tingling, or numbness of the arms and legs. In severe cases, this can even affect bladder and bowel function.

How is Osteoarthritis diagnosed?

No single test can diagnose osteoarthritis; however, sometimes providers use tests to help confirm a diagnosis or rule out other conditions that could be causing a patient’s symptoms. The provider begins by asking the patient to describe the symptoms, when and how the condition started, as well as how the symptoms have changed over time. The provider will review medical problems the patient and close family members have and any medications the patient is taking.  X-rays can help providers determine the form of arthritis a person has and how much joint damage has been done.

X rays of the affected joint can show such things as cartilage loss, bone damage, and bone spurs. There often is a big difference between the severity of osteoarthritis as shown by the x-ray and the degree of pain and disability felt by the patient. X-rays may not show early osteoarthritis damage until much cartilage loss has taken place.

Magnetic Resonance Imaging

Magnetic resonance imaging, also known as MRI, provides high-resolution computerized images of internal body tissues. This procedure uses a strong magnet that passes a force through the body to create these images. Providers often use MRI tests if there is pain; if x-ray findings are minimal; and if the findings suggest damage to other joint tissues such as a ligament or the pad of connective tissue in the knee known as the meniscus.

Other tests

The provider may order blood tests to rule out other causes of symptoms. Joint aspiration, which involves drawing fluid from the joint through a needle and examining the fluid under a microscope, may also be performed. Joint fluid samples could reveal bacteria, indicating joint pain caused by an infection or uric acid crystals, indicating gout.

How is Osteoarthritis treated?

The four goals of Osteoarthritis treatment are:

• to control pain
• to improve joint function
• to maintain normal body weight
• to achieve a healthy lifestyle.

Most successful treatment regimens involve a combination of treatments tailored to the patient’s needs, lifestyle, and health. Most include ways to manage pain and improve function. These can involve exercise, weight control, rest and relief from stress on joints, pain relief techniques, medications, surgery, and complementary and alternative therapies. These approaches are described below.

Exercise

Research shows that exercise is one of the best treatments for osteoarthritis.  Exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Exercise is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise prescribed will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. Walking, swimming, cycling, and water aerobics are a few popular types of exercise for people with osteoarthritis. Providers and/or physical therapists can recommend specific types of exercise depending on particular patient situations.  These exercises usually include:

• Strengthening exercises. These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.
• Aerobic activities. These are exercises, such as brisk walking or low-impact aerobics that get the heart pumping and can keep the lungs and circulatory system in shape.
• Range-of-motion activities. These keep joints limber.
• Balance and agility exercises. These help maintain daily living skills.

Weight Control

Osteoarthritis patients who are overweight or obese should try to lose weight.  Weight loss can reduce stress on weight-bearing joints, limit further injury, extend the life of joints, and increase mobility. A dietitian can help develop healthy eating habits. A healthy diet and regular exercise help reduce weight.

Rest and Relief from Stress on Joints

Treatment plans include regularly scheduled rest. Patients must learn to recognize the body’s signals and know when to stop or slow down. This will prevent the pain caused by overexertion. Although pain can make it difficult to sleep, getting proper sleep is important for managing arthritis pain. Patients who have trouble sleeping may find that relaxation techniques, stress reduction, and biofeedback can help, as can timing medications to provide maximum pain relief through the night.

Some people find relief from special footwear and insoles that can reduce pain and improve walking or from using canes or walkers to take pressure off painful joints. They may use splints or braces to provide extra support for joints and/or keep them in proper position during sleep or activity. Splints should be used only for limited periods of time because joints and muscles need to be exercised to prevent stiffness and weakness.

Nondrug Pain Relief and Alternative Therapies

People with osteoarthritis may find many nondrug ways to relieve pain. Below are some examples:

Heat and Cold. Heat or cold (or a combination of the two) can be useful for joint pain. Heat can be applied in a number of different ways—with warm towels, hot packs, or a warm bath or shower—to increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area.

Massage. In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

Complementary and Alternative Therapies. When conventional medical treatment does not provide sufficient pain relief, people are more likely to try complementary and alternative therapies to treat osteoarthritis. Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.

Folk Remedies include the wearing of copper bracelets and following special diets.  Although these practices may or may not be harmful, no scientific research to date shows that they are helpful in treating osteoarthritis. They can also be expensive and using them may cause people to delay or even abandon useful medical treatment.

Nutritional Supplements such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis as have certain vitamins. Additional studies have been carried out to further evaluate these claims.  It is unknown whether they might change the course of disease.

Medications to Control Pain

Providers prescribe medicines to eliminate or reduce pain and to improve function. They consider a number of factors when choosing medicines for their patients with osteoarthritis. These include the intensity of pain, potential side effects of the medication, medical history, and other medications patients may be taking.  Because some medications can interact with one another and certain health conditions put patients at increased risk of drug side effects, it is important to discuss medication and health history with the provider before starting any new medication, and to see the provider regularly while taking medication.  By working together, patients and their providers can find the medication that best relieves pain with the least risk of side effects. The following types of medicines are commonly used in treating osteoarthritis:

Acetaminophen (Tylenol): A medication commonly used to relieve pain, acetaminophen is available without a prescription. It is often the first medication recommended for osteoarthritis patients because of its safety relative to some other drugs and its effectiveness against pain. It should be used with caution in patients who have a history of liver disease.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) (Advil/Ibuprofen/Aleve/Naproxen/Aspirin): A large class of medications useful against both pain and inflammation, (NSAIDs) are staples in arthritis treatment. They are often the first type of medication used. All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors (Celebrex/Meloxicam), are available only with a prescription.  All NSAIDs can have significant side effects, and for unknown reasons, some people seem to respond better to one NSAID than another. Any person taking NSAIDs regularly should be monitored by a provider.

Certain health problems and lifestyle habits can increase the risk of side effects from NSAIDs. These include a history of peptic ulcers or digestive tract bleeding, use of oral corticosteroids or anticoagulants (blood thinners), smoking, and alcohol use. There are measures one can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants such as alcohol, tobacco, and caffeine.  Although these measures may help, they are not always completely effective. NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he/she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs, because NSAIDs alter the way the body uses or eliminates these other drugs. Patients should check with their health care providers or pharmacist before taking NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People over age 65 and those with any history of ulcers or gastrointestinal bleeding, or kidney disease should use NSAIDs with caution.

Injections: Corticosteroids are powerful anti-inflammatory hormones made naturally in the body or man-made for use as medicine. They may be injected into the affected joints to temporarily relieve pain. This is a short-term measure, generally not recommended for more than two to four treatments per year. Oral corticosteroids are not routinely used to treat osteoarthritis.

Hyaluronic Acid Substitutes (Euflexxa/Synvisc): Sometimes called viscosupplements, hyaluronic acid substitutes are designed to replace a normal component of the joint involved in joint lubrication and nutrition. Depending on the particular product the provider prescribes, it will be given in a series of up to three injections. These products are approved only for osteoarthritis of the knee.

Narcotics (Vicodin/Norco/Percocet/Oxycodone/Morphine/Codeine) orother central acting agents (Tramadol):  Tramadol is a prescription pain reliever and synthetic opioid that is sometimes prescribed when over-the-counter medications do not provide sufficient relief. It works through the central nervous system to achieve its effects. Tramadol carries risks that do not exist with acetaminophen and NSAIDs, including the potential for addiction.  Narcotic painkillers containing analgesics such as codeine or hydrocodone are often effective against osteoarthritis pain; however, because of concerns about the potential for physical and psychological dependence on these drugs, providers generally avoid them or reserve them for short-term use only.

Surgery

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. Some prostheses are joined to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone into that surface to hold them in place. Artificial joints can last 15 years or longer. Surgeons choose the design and components of prostheses according to their patient’s weight, sex, age, activity level, and other medical conditions.  Joint replacement advances in recent years have included the ability, in some cases, to replace only the damaged part of the knee joint, leaving undamaged parts of the joint intact, and the ability to perform these surgeries through much smaller incisions than previously possible. The decision to use surgery depends on several factors, including the patient’s age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his/her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.

What You Can Do: The Importance of Self-Care

Although health care professionals can prescribe or recommend treatments to help you manage your arthritis, the real key to living well is up to you. Research shows that people with osteoarthritis who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life. Living well and enjoying good health despite arthritis requires an everyday lifelong commitment.

The Following Habits Are Worth Committing To:

1. Stay active. Regular physical activity plays a key role in self-care and wellness. People with knee osteoarthritis who are active in an exercise program feel less pain. They also function better.
   Four types of exercise are important in osteoarthritis management.

• Strengthening Exercises: Help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
• Aerobic Conditioning Exercises: Improve cardiovascular fitness, help control weight, and improve overall function.
• Range-of-Motion Exercises: Help reduce stiffness and maintain or improve proper joint movement and flexibility.
• Balance and Agility Exercises: Can help maintain daily living skills.

You should start each exercise session with an adequate warm-up and begin exercising slowly. Resting frequently ensures a good workout and reduces the risk of injury.

2. Eat well. Though no specific diet will necessarily make your arthritis better, eating right and controlling your weight can help by minimizing stress on the weight-bearing joints such as the knees, hips, and the joints of the feet. It can also minimize your risk of developing other health problems.
3. Get plenty of sleep. Getting a good night’s sleep on a regular basis can minimize pain and help you cope better with the effects of your disease.  You may improve your sleep by getting enough exercise early in the day; avoiding caffeine or alcoholic beverages at night; keeping your bedroom dark, quiet, and cool; and taking a warm bath to relax and soothe sore muscles at bedtime.
4. Keep a positive attitude. Although having osteoarthritis certainly is not fun, it does not mean you have to stop having fun. Activities such as sports, hobbies, and volunteer work can distract your mind from your pain and make you a happier, more well-rounded person.  Perhaps the best thing you can do for your health is to keep a positive attitude. People must decide to make the most of things when faced with the challenges of osteoarthritis.

• Focus on your abilities instead of disabilities.
• Focus on your strengths instead of weaknesses.
• Break down activities into small tasks that you can manage.
• Incorporate fitness and nutrition into daily routines.
• Develop methods to minimize and manage stress.
• Balance rest with activity.
• Develop a support system of family, friends, and health professionals.

For more information about Osteoarthritis consider the following resources:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health

1 AMS Circle
Bethesda,  MD 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (877-226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: [email protected]
Website:www.niams.nih.gov

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

2 AMS Circle
Bethesda,  MD 20892-3676
Phone: 202-223-0344
Toll Free: 800-624-BONE (2663)
TTY: 202-466-4315
Fax: 202-293-2356

Arthritis Foundation
Email: [email protected]
Website: http://www.arthritis.org

National Institute on Aging (NIA)
Website: http://www.bones.nih.gov

American Physical Therapy Association Information Center
Website: http://www.apta.org

National Institutes of Health
Website: http://www.nia.nih.gov/

American College of Rheumatology
Toll free: 800-222-2225
Website: http://www.rheumatology.org

American Academy of Orthopaedic Surgeons (AAOS)
Website: http://www.aaos.org