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Osteoarthritis

Alternative names: Degenerative Joint Disease, Arthritis

What is osteoarthritis?

Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.

Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also softens the shock of physical movement. 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 stiffening of the joint. Over time, the joint may lose its normal shape. Also, bone spurs – small growths called osteophytes – may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain, catching, and damage.

What are the signs of osteoarthritis?

  • Steady or intermittent pain in a joint
  • Stiffness in a joint after getting out of bed or sitting for a long time
  • Swelling or tenderness in one or more joints
  • A crunching feeling or the sound of bone rubbing on bone

If you pain is hot, red, or tender, it is probably not osteoarthritis. Check with your doctor about other causes, such as rheumatoid arthritis. In fact, only a third of people whose X-rays show evidence of osteoarthritis report pain or other symptoms. Osteoarthritis most often occurs at the ends of the fingers, the base of the thumbs, and in the neck, lower back, knees, and hips.

What causes osteoarthritis?

Osteoarthritis is a degenerative disease, meaning that the cartilage of the joint slowly breaks down, either because of age or wear and tear. Therefore, osteoarthritis is most common before the age of 45 (in men), most often due to sports or other physical activities, and is most common after 45 (in women) because of aging.

How does my doctor tell if I have osteoarthritis?

No single test can diagnose osteoarthritis. Most doctors use a combination of the following things to diagnose the disease and rule out other conditions:

Clinical history: The doctor begins by asking the patient to describe the symptoms, and when and how the condition started. Good doctor-patient communication is important. The doctor can understand the patient's problem better if the patient gives a good description of pain, stiffness, and joint function, and how they have changed over time. It also is important for the doctor to know how the problem affects the patient's work and daily life. Finally, the doctor also needs to know about other medical problems and whether the patient is taking any medicines.

Physical examination: The doctor will check the patient's general health, including checking reflexes and muscle strength. Joints bothering the patient will be examined. The doctor will also observe the patient's ability to walk, bend, and carry out activities of daily living.

X-rays: Doctors take X-rays to see how much the joint has changed. X-rays of the affected joint can show such things as thin cartilage, bone damage, and bone spurs. But there often is a big difference between the severity of osteoarthritis on the X-ray and the pain and disability felt by the patient. Also, X-rays may not show early osteoarthritis damage, before much cartilage loss has taken place.

Other tests: The doctor may order blood tests to rule out other causes of symptoms. Another common test is called joint aspiration, which means drawing fluid from the joint with a needle for examination.

It usually is 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 symptoms actually may be due to other medical conditions. The doctor will try to find out what is causing the symptoms by looking for other disorders and identifying things that may make the symptoms worse. The severity of symptoms in osteoarthritis is influenced greatly by the patient's attitude, anxiety, depression, and daily activity level.

How is osteoarthritis treated?

Most effective treatment programs involve a combination of things tailored to the patient's needs, lifestyle, and health. Osteoarthritis treatment has four general goals:

  • Improve joint use through rest and exercise.
  • Maintain an acceptable body weight.
  • Control pain with medicine and other measures.
  • Promote a healthy lifestyle.

Non-surgical treatments

Exercise: Research shows that exercise is one of the best treatments for osteoarthritis. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and 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 will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done.

Rest and joint care: Treatment plans include regularly scheduled rest. Patients must learn to recognize the body's signals, and know when to stop or slow down, which prevents pain caused by overexertion. Some patients find that relaxation techniques, stress reduction, and biofeedback help. Some use canes, trekking poles, or splints to protect joints and take pressure off them. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints should be used only for limited periods because joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help the patient get a properly fitting splint.

Non-drug pain relief: People with osteoarthritis may find ways to relieve pain without drugs or medicines. Warm towels, hot packs, or a warm bath or shower to apply moist heat to the joint can relieve pain and stiffness. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel) 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.) Water therapy in a heated pool or whirlpool also may relieve pain and stiffness. For osteoarthritis in the knee, patients may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

Weight control: Osteoarthritis patients who are overweight or obese need to lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injury. A dietitian can help patients develop healthy eating habits. A healthy diet and regular exercise help reduce weight.

Medicines: Doctors prescribe medicines to eliminate or reduce pain and to improve functioning. A number of factors are considered when choosing medicines for patients with osteoarthritis. Two important factors are how bad the pain is and the possible side effects of the medicine. Patients must use medicines carefully and tell their doctors about any changes that occur.

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

  • Acetaminophen, a pain reliever, such a Tylenol*
  • NSAIDs (nonsteroidal anti-inflammatory drugs), some over-the-counter medications such as aspirin, Advil*, Motrin IB*, Aleve*, ketoprofen, and other prescription medicines
  • COX-2 inhibitors, new NSAIDs such as celecoxi and Celebrex* reduce inflammation
  • Other medications: topical pain-relieving creams, rubs, and sprays; mild narcotic painkillers (may be addictive and are not commonly used); corticosteroids (short-term use), powerful anti-inflammatory hormones made naturally in the body or manmade may be injected into the affected joints to temporarily relieve pain—oral corticosteroids should not be used to treat osteoarthritis; hyaluronic acid, a medicine for joint injection and a normal component of the knee.

* Brand names included here are provided as examples only. Their inclusion does not mean they are endorsed by Dartmouth-Hitchcock. Also, if a certain brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. Even nonprescription drugs should be checked.

Surgical treatments

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to

  • Remove loose pieces of bone and cartilage from the joint if they are causing mechanical symptoms of buckling or locking
  • Resurface (smooth out) bones
  • Reposition bones
  • Replace joints

The surgeries are called:

The decision to use surgery depends on several things. Both the surgeon and the patient consider the patient's level of disability, the intensity of pain, the interference with the patient's lifestyle, the patient's age, and occupation. Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.

Nontraditional Approaches

Among the alternative therapies used to treat osteoarthritis are the following:

  • Acupuncture: Some people have found pain relief using acupuncture (the use of fine needles inserted at specific points on the skin). Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some patients.
  • Alternative remedies: Some patients seek alternative therapies for their pain and disability. Some of these alternative therapies have included wearing copper bracelets, drinking herbal teas, and taking mud baths. While these practices are not normally harmful, some can be expensive. They can also cause delays in seeking medical treatment.
  • Nutritional supplements: Nutrients such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies are being carried out to further evaluate these claims.

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