Osteoarthritis is by far the most common type of arthritis, and the percentage of people who have it grows higher with age. An estimated 27 million Americans age 25 and older have osteoarthritis.
As people get older or overuse their joints, the cartilage in those joints, which provides a smooth surface for the ends of the bones to glide over each other, begins to break down and get degraded. The body’s ability to make new cartilage can also be compromised with advancing age. This can also cause inflammation, which results in pain. As the body tries to compensate for this lost cartilage, the bones will start to grow osteophytes, also known as ‘bone spurs’, which can also be painful.
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 doctor-diagnosed arthritis.
Osteoarthritis usually happens gradually over time. Some risk factors that might lead to it include:
- Being overweight
- Getting older
- Joint injury
- Joints that are not properly formed
- A genetic defect in joint cartilage
- Stresses on the joints from certain jobs and playing sports.
Most successful treatment programs involve a combination of treatments tailored to the patient’s needs, lifestyle, and health. Most programs 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.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases lists four goals of osteoarthritis treatment:
- control pain
- improve joint function
- maintain normal body weight
- achieve a healthy lifestyle.
Achieving these goals is through six primary treatment approaches:
- exercise
- weight control
- rest and relief from stress on joints
- nondrug pain relief techniques and alternative therapies
- medications to control pain
- surgery
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, and water aerobics are a few popular types of exercise for people with osteoarthritis. Your doctor and/or physical therapist can recommend specific types of exercise depending on your particular situation.
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, and increase mobility. A dietitian can help you 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. If you have trouble sleeping, you may find that relaxation techniques, stress reduction, and biofeedback can help, as can timing medications to provide maximum pain relief through the night. If joint pain interferes with your ability to sleep or rest, consult your doctor.
Some people find relief from special footwear and insoles that can reduce pain and improve walking or from using canes 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. If you need a splint, an occupational therapist or a doctor can help you get a properly fitted one.
Nondrug pain relief and alternative therapies
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. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.)
Transcutaneous electrical nerve stimulation (TENS). TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.
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 doesn’t 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. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) revealed that acupuncture relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard care.
Folk remedies. These can include the wearing of copper bracelets, following special diets, and rubbing WD-40 on joints to “lubricate” them. 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. It is unknown whether they might change the course of disease.
Medications to control pain
Doctors prescribe medicines to eliminate or reduce pain and to improve functioning. Doctors 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, your medical history (other health problems you have or are at risk for), and other medications you are taking.
Because some medications can interact with one another and certain health conditions put you at increased risk of drug side effects, it’s important to discuss your medication and health history with your doctor before you start taking any new medication, and to see your doctor regularly while you are taking medication. By working together, you and your doctor can find the medication that best relieves your pain with the least risk of side effects.
The following types of medicines are commonly used in treating osteoarthritis:
Acetaminophen: A medication commonly used to relieve pain, acetaminophen, is available without a prescription. It is often the first medication doctors recommend for osteoarthritis patients because of its safety relative to some other drugs and its effectiveness against pain.
NSAIDs (nonsteroidal anti-inflammatory drugs): A large class of medications useful against both pain and inflammation, (NSAIDs) are staples in arthritis treatment. Aspirin, ibuprofen, naproxen, and naproxen sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body.
Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, 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 doctor.
Narcotic or central acting agents. Tramadol is a prescription pain reliever and synthetic opioid that is sometimes prescribed when over-the-counter medications don’t provide sufficient relief. It works through the central nervous system to achieve its effects. Tramadol carries risks that don’t exist with acetaminophen and NSAIDs, including the potential for addiction.
Mild narcotic painkillers containing analgesics such as codeine or hydrocodone are often effective against osteoarthritis pain. But because of concerns about the potential for physical and psychological dependence on these drugs, doctors generally reserve them for short-term use.
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. They are occasionally used for inflammatory flares.
Hyaluronic acid substitutes. 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 your doctor prescribes, it will be given in a series of three to five injections. These products are approved only for osteoarthritis of the knee.
Other medications. Doctors may prescribe several other medicines for osteoarthritis. They include topical pain-relieving creams, rubs, and sprays, which are applied directly to the skin over painful joints. They contain ingredients that work in one of three different ways: (1) by stimulating the nerve endings to distract the brain’s attention from the joint pain, (2) by depleting the amount of a neurotransmitter called substance P that sends pain messages to the brain, or (3) by blocking chemicals called prostaglandins that cause pain and inflammation.
Because most medicines used to treat osteoarthritis have side effects, it’s important to learn as much as possible about the medications you take, even the ones available without a prescription. 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 you 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. In some cases, it may help to take another medication along with an NSAID to coat the stomach or block stomach acids. Although these measures may help, they are not always completely effective.
Surgery
For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following:
- removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopy)
- repositioning of bones (osteotomy)
- resurfacing (smoothing out) bones (joint resurfacing).
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 (a process called biologic fixation) to hold them in place. Artificial joints can last 10 to 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 hip replacement 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 or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.
Treating arthritis often requires a multidisciplinary or team approach. Many types of health professionals care for people with arthritis. You may choose a few or more of the following professionals to be part of your health care team:
Primary care physicians. Doctors who treat patients before they are referred to other specialists in the health care system. Often a primary care physician will be the main doctor to treat your arthritis. Primary care physicians also handle other medical problems and coordinate the care you receive from other physicians and health care providers.
Rheumatologists. Doctors who specialize in treating arthritis and related conditions that affect joints, muscles, and bones.
Orthopaedists. Surgeons who specialize in the treatment of, and surgery for, bone and joint diseases.
Physical therapists. Health professionals who work with patients to improve joint function.
Occupational therapists. Health professionals who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
Dietitians. Health professionals who teach ways to use a good diet to improve health and maintain a healthy weight.
Nurse educators. Nurses who specialize in helping patients understand their overall condition and implement their treatment plans.
Physiatrists (rehabilitation specialists). Medical doctors who help patients make the most of their physical potential.
Licensed acupuncture therapists. Health professionals who reduce pain and improve physical functioning by inserting fine needles into the skin at specific points on the body.
Psychologists. Health professionals who seek to help patients cope with difficulties in the home and workplace resulting from their medical conditions.
Social workers. Professionals who assist patients with social challenges caused by disability, unemployment, financial hardships, home health care, and other needs resulting from their medical conditions.
Chiropractors. Health professionals who focus treatment on the relationship between the body’s structure—mainly the spine—and its functioning.
Massage therapists. Health professionals who press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet.
It is estimated that over 27 million people in the United States suffer from some form of osteoarthritis or degenerative disease of the joints. It occurs when the cartilage between moving joints (articular cartilage) degrades or wears away, causing bones to grind together and cause pain, swelling, and stiffness. Bone spurs (extra bone that forms to correct the problem) can also form, causing additional pain and inflammation.
Although it can affect any joints, the ‘weight-bearing’ joints are most often affected, such as the feet, knees, hips, and spine. There is no single known cause, but many factors can predispose a patient to developing osteoarthritis. Old age is a primary risk factor, as is obesity, and previous injury to a joint. Diabetes, other arthritides, ligamentous damage, and inflammatory diseases can also play a role.
Diagnosis is made from patient history and a simple X-ray will reliably show damage. Osteoarthritis cannot be reversed, but treatment options are available. Primary treatments are physical therapy, weight loss (if needed), exercise, and over the counter pain relief (ibuprofen, naproxen). In advanced cases with extreme pain or disability, surgery is a viable option, such as joint replacement (knee, hip, shoulder, feet), spinal fusion, arthroscopy to fix cartilage, and osteotomy to change bone structure.
Exercise and weight reduction
Exercise plays a key part in a comprehensive treatment plan. Researchers are studying exercise in greater detail and finding out just how to use it in treating or preventing osteoarthritis. For example, several scientists have studied knee osteoarthritis and exercise. Their results included the following:
- Walking can result in better functioning, and the more you walk, the farther you will be able to walk.
- People with knee osteoarthritis who are active in an exercise program feel less pain. They also function better.
Research has shown that losing extra weight can help people who already have osteoarthritis. Moreover, overweight or obese people who do not have osteoarthritis may reduce their risk of developing the disease by losing weight.
Patient education and self-management
When patients understand and feel that they have some control over their chronic disease, the course of their disease is often improved. One recent NIAMS-supported study found that improvement can be made in the self-management of osteoarthritis when spouses provide help. The intervention that was tested used spouse-assisted coping skills training and exercise training to improve physical fitness, pain coping, and self-efficacy in patients with osteoarthritis of the knee. The results from the study suggest that a combination of both spouse-assisted pain coping skills training and exercise training leads to more improvements than could be achieved with either intervention alone.
Other research shows that patient education and social support is a low-cost, effective way to decrease pain and reduce the amount of medicine patients use. One NIAMS-funded project involves developing and testing an interactive Web site by which health professionals and patients could communicate concerning appointments and treatment instructions, thus giving patients a greater role in and control of their care.
Complementary and alternative therapies
In recent years, the nutritional supplement pair glucosamine and chondroitin has shown some potential for reducing the pain of osteoarthritis, though no conclusive proof has emerged to date. Both of these nutrients are found in shark cartilage, the shells of shellfish, and pig ears and noses, and are components of normal cartilage.
The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which was cosponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and NIAMS, assessed the effectiveness and safety of these supplements when taken together or separately. The trial found that the combination of glucosamine and chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements.
The 4-year trial was conducted at 16 sites across the United States. The results were published in the Feb. 23, 2006 edition of the New England Journal of Medicine.
There are other complementary and alternative therapies under investigation. The longest and largest randomized, controlled phase 3 clinical trial of acupuncture ever conducted revealed that the therapy relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard care. The trial, supported by NIAMS and NCCAM, was the first with sufficient rigor, size, and duration to show that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee. These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for people who suffer from knee osteoarthritis.
The progression of osteoarthritis may be slower in people who take higher levels of vitamins D, C, or E, or beta carotene. NIAMS is sponsoring a clinical trial to see if vitamin D slows the progression of knee osteoarthritis. More studies are needed to confirm a possible role of this vitamin in osteoarthritis treatment.
Many studies have shown that green tea possesses anti-inflammatory properties. One study showed that mice predisposed to a condition similar to human osteoarthritis had mild arthritis and little evidence of cartilage damage and bone erosion when green tea polyphenols were added to their drinking water. Another study showed that when added to human cartilage cell cultures, the active ingredients in green tea inhibited chemicals and enzymes that lead to cartilage damage and breakdown. Further studies are needed to determine the effects of green tea compounds on human cartilage.
Although health care professionals can prescribe or recommend treatments to help you manage your arthritis, the real key to living well with the disease is 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 six habits are worth committing to:
1. Get educated. To live well with osteoarthritis, it pays to learn as much as you can about the disease. Three kinds of programs help people understand osteoarthritis, learn self-care, and improve their good-health attitude. They are:
- patient education programs
- arthritis self-management programs
- arthritis support groups.
These programs teach people about osteoarthritis, its treatments, exercise and relaxation, patient and health care provider communication, and problem solving. Research has shown that people who participate in these programs are more likely to have positive outcomes.
2. Stay active. Regular physical activity plays a key role in self-care and wellness. Four types of exercise are important in osteoarthritis management. The first type, strengthening exercises help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. The second type, aerobic conditioning exercises improve cardiovascular fitness, help control weight, and improve overall function. The third type, range-of-motion exercises, help reduce stiffness and maintain or increase proper joint movement and flexibility. The fourth type, balance and agility exercises, can help you 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.
Before beginning any type of exercise program, consult your doctor or physical therapist to learn which exercises are appropriate for you and how to do them correctly, because doing the wrong exercise or exercising improperly can cause problems. A health care professional can also advise you on how to warm up safely and when to avoid exercising a joint affected by arthritis.
3. 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 and the joints of the feet. It can also minimize your risk of developing other health problems.
4. 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. If arthritis pain makes it difficult to sleep at night, speak with your doctor and/or physical therapist about the best mattress or comfortable sleeping positions or the possibility of timing medications to provide more pain relief at night. You may also 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.
5. Have fun. Although having osteoarthritis certainly isn’t fun, it doesn’t mean you have to stop having fun. If arthritis makes it difficult to participate in favorite activities, ask an occupational therapist about new ways to do them. Activities such as sports, hobbies, and volunteer work can distract your mind from your own pain and make you a happier, more well-rounded person.
6. Keep a positive attitude. 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. This attitude—a good-health mindset—doesn’t just happen. It takes work, every day. And with the right attitude, you will achieve it.
The primary symptoms of osteoarthritis are:
- Stiffness in a joint after getting out of bed or sitting for a long time
- Swelling in one or more joints
- Crunching feeling or the sound of bone rubbing on bone
About a third of people whose x rays show evidence of osteoarthritis report pain or other symptoms. For those who experience steady or intermittent pain, it is typically aggravated by activity and relieved by rest.
If you feel hot or your skin turns red, or if your joint pain is accompanied by other symptoms such as a rash or fevers, you probably do not have osteoarthritis. Check with your doctor about other causes, such as rheumatoid arthritis.
Usually, osteoarthritis comes on slowly. Early in the disease, your joints may ache after physical work or exercise. Later on, joint pain may become more persistent. You may also experience joint stiffness, particularly when you first wake up in the morning or have 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:
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’re 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. But sometimes pain is felt in the groin, inner thigh, buttocks, or 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 weakness, tingling, or numbness of the arms and legs. In severe cases, this can even affect bladder and bowel function.
No single test can diagnose osteoarthritis; however, sometimes doctors use tests to help confirm a diagnosis or rule out other conditions that could be causing a patient’s symptoms. Most doctors use a combination of the following methods:
Clinical history
The doctor begins by asking the patient to describe the symptoms, and when and how the condition started, as well as how the symptoms have changed over time. The doctor will also ask about any other medical problems the patient and close family members have and about any medications the patient is taking. Accurate answers to these questions can help the doctor make a diagnosis and understand the impact the disease has on your life.
Physical examination
The doctor will check the patient’s reflexes and general health, including muscle strength. The doctor will also examine bothersome joints and observe the patient’s ability to walk, bend, and carry out activities of daily living.
X rays
X rays can help doctors 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. But 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. Also, x rays may not show early osteoarthritis damage until much cartilage loss has taken place.
Magnetic resonance imaging
Also known as MRI, magnetic resonance imaging 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. Doctors 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 doctor may order blood tests to rule out other causes of symptoms. He or she may also order a joint aspiration, which involves drawing fluid from the joint through a needle and examining the fluid under a microscope. Joint fluid samples could reveal bacteria, indicating joint pain is caused by an infection or uric acid crystals, indicating gout.
Osteoarthritis is so common, especially in older people, that symptoms seemingly caused by the disease actually may be caused by other medical conditions. The doctor will try to find out what is causing the symptoms by ruling out other disorders and identifying conditions that may make the symptoms worse. The severity of symptoms in osteoarthritis can be influenced greatly by the patient’s attitude, anxiety, depression, and daily activity level.