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Osteoarthritis

Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis

Osteoarthritis (OA) is the most common joint disorder. It is due to aging and wear and tear on a joint.

Causes

Cartilage is the firm, rubbery tissue that cushions your bones at the joints. It allows bones to glide over one another. When the cartilage breaks down and wears away, the bones rub together. This often causes the pain, swelling, and stiffness of OA.

As OA worsens, bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint may become weaker and stiffer.

Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.

Other factors can also lead to OA.

  • OA tends to run in families.
  • Being overweight increases the risk for OA in the hip, knee, ankle, and foot joints. This is because extra weight causes more wear and tear.
  • Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints.
  • Jobs that involve kneeling or squatting for more than an hour a day, or involve lifting, climbing stairs, or walking increase the risk for OA.
  • Playing sports that involve direct impact on the joint (football), twisting (basketball or soccer), or throwing also increase the risk for OA.

Medical conditions that can lead to OA include:

  • Bleeding disorders that cause bleeding in the joint, such as hemophilia
  • Disorders that block the blood supply near a joint and lead to bone death (avascular necrosis)
  • Other types of arthritis, such as long-term (chronic) gout, pseudogout, or rheumatoid arthritis

Symptoms

Symptoms of OA often appear in middle age. Almost everyone has some symptoms by age 70.

Pain and stiffness in the joints are the most common symptoms. The pain is often worse:

  • After exercise
  • When you put weight or pressure on the joint

With OA, your joints may become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.

"Morning stiffness" refers to the pain and stiffness you feel when you first wake up in the morning. Stiffness due to OA often lasts for 30 minutes or less. It can last more than 30 minutes if there is inflammation in the joint. It often improves after activity, allowing the joint to "warm up."

During the day, the pain may get worse when you are active and feel better when you are resting. As OA gets worse, you may have pain even when you are resting. And it may wake you up at night.

Some people might not have symptoms, even though x-rays show the changes of OA.

Exams and Tests

A health care provider will examine you and ask about your symptoms. The exam may show:

  • Joint movement that causes a crackling (grating) sound, called crepitation
  • Joint swelling (bones around the joints may feel larger than normal)
  • Limited range of motion
  • Tenderness when the joint is pressed
  • Normal movement is often painful

Blood tests are not helpful in diagnosing OA.

An x-ray will likely show:

  • Loss of the joint space
  • Wearing down of the ends of the bone
  • Bone spurs

Treatment

OA cannot be cured. It will most likely get worse over time. However, your OA symptoms can be controlled.

You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.

MEDICINES

Over-the-counter (OTC) pain relievers, such as acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID)can help with OA symptoms. You can buy these medicines without a prescription.

 It is recommended that you DO NOT take more than 3 grams (3,000 mg) of acetaminophen a day. If you have liver disease, talk with your provider before taking acetaminophen. OTC NSAIDs include aspirin, ibuprofen, and naproxen. Several other NSAIDs are available by prescription. Talk with your provider before taking an NSAID on a regular basis.

Duloxetine (Cymbalta) is a prescription antidepressant that can also help treat long-term (chronic) pain related to OA.

Supplements that you may use include:

  • Pills, such as glucosamine and chondroitin sulfate
  • Capsaicin skin cream to relieve pain

LIFESTYLE CHANGES

Staying active and getting exercise can maintain joint and overall movement. Ask your provider to recommend an exercise routine. Water exercises, such as swimming, are helpful.

Other lifestyle tips include:

  • Applying heat and cold to the joint
  • Eating healthy foods
  • Getting enough rest
  • Losing weight if you are overweight
  • Protecting your joints from injury

If the pain from OA gets worse, keeping up with activities may become more difficult or painful. Making changes around the home can help take stress off your joints to relieve some of the pain. If your work is causing stress in certain joints, you may need to adjust your work area or change work tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion of stiff joints as well as your balance. If therapy does not make you feel better after 6 to 8 weeks, then it likely will not work at all.

Massage therapy may provide short-term pain relief. Make sure you work with a licensed massage therapist who is experienced in working on sensitive joints.

BRACES

Splints and braces may help support weakened joints. Some types limit or prevent the joint from moving. Others may shift pressure off one portion of a joint. Use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

ALTERNATIVE TREATMENTS

Acupuncture is a traditional Chinese treatment. It is thought that when acupuncture needles stimulate certain points on the body, chemicals that block pain are released. Acupuncture may provide short-term pain relief for OA.

Yoga and tai chi have also shown some benefit in treating the pain from OA.

S-adenosylmethionine (SAMe, pronounced "Sammy") is a manmade form of a natural chemical in the body. It may help reduce joint inflammation and pain.

SURGERY

Severe cases of OA might need surgery to replace or repair damaged joints. Options include:

Which Osteoarthritis Treatment Is Right for You?

  • Which of these medicines can help relieve osteoarthritis (OA) pain?

     

    A. Acetaminophen (such as Tylenol)

     

    B. Aspirin

     

    C. Ibuprofen (such as Advil or Motrin)

     

    D. Naproxen (such as Aleve or Naprosyn)

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. Your doctor may recommend acetaminophen first, because it has fewer long-term side effects than the others.  If your pain continues, your doctor may recommend other pain relievers. Always ask your doctor which medicine is safest for you and how much to take.
  • Exercise is one of the best treatments for arthritis pain.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Staying active not only helps reduce pain, but also relieves stiffness, boosts your energy, and improves bone and muscle strength. But some sports or exercises may make your pain worse. Work with your doctor or physical therapist to develop an exercise routine for you.
  • You can help treat OA at home by doing the following:

     

    A. Losing extra pounds

     

    B. Getting enough sleep

     

    C. Eating a balanced, healthy diet

     

    D. All of the above

    Correct Answer
    The correct answer is all of the above. Losing extra pounds can take pressure off joints in the legs and feet. Getting enough sleep helps you recover more quickly after a flare-up. And eating a balanced diet helps keep your whole body healthy.
  • Physical therapy can benefit many people with OA.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Physical therapy can help improve muscle strength and the motion of stiff joints, as well as your sense of balance. Therapists have many techniques for treating OA. If you don't get relief, ask your doctor about other treatment options.
  • Over-the-counter remedies that can help relieve OA symptoms include:

     

    A. Glucosamine

     

    B. Chondroitin sulfate

     

    C. Capsaicin skin cream

     

    D. A and B

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. Glucosamine, chondroitin sulfate, and capsaicin cream have all been shown to help relieve OA pain in some people. Talk to your doctor about which over-the-counter remedies may work best for you.
  • Which of the following treatments is better for OA pain?

     

    A. Heat

     

    B. Cold

     

    C. Both heat and cold

    Correct Answer
    The correct answer is both heat and cold. Hot packs, warm towels, or taking a warm bath can help increase blood flow and make your joints more flexible. Cold packs can help numb the painful area and reduce joint pain. Work with your doctor to see what works best for you.
  • You should only use a brace if your doctor recommends it.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one and ask how to use it. Using a brace the wrong way can cause joint damage, stiffness, and pain.
  • How often can you receive corticosteroid injections to treat pain?

     

    A. Once a week

     

    B. Once a month

     

    C. Two to four times a year

     

    D. Once a year

    Correct Answer
    The correct answer is two to four times a year. Corticosteroids are hormones that help reduce swelling in the joint. They are effective as a short-term treatment to relieve joint pain. However, experts recommend that you have no more than four injections a year.
  • If you have OA, you’ll need to have surgery sooner or later.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Although you may need to have surgery if your symptoms are severe, many people can treat their symptoms without ever having surgery. Talk to your doctor about what treatments may help relieve your OA pain.
  • The only type of surgery for OA involves replacing the joint.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Although joint replacement surgery is common, other surgeries can repair a damaged joint. If you are thinking about surgery, talk with your doctor about all of your options.

Support Groups

Organizations that specialize in arthritis are good resources for more information on OA.

Outlook (Prognosis)

Your movement may become limited over time. Doing everyday activities, such as personal hygiene, household chores, or cooking may become a challenge. Treatment usually improves function.

When to Contact a Medical Professional

Call your provider if you have symptoms of OA that get worse.

Prevention

Try not to overuse a painful joint at work or during activities. Maintain a normal body weight. Keep the muscles around your joints strong, especially the weight-bearing joints (knee, hip, or ankle).

References

Block JA, Scanzello C. Osteoarthritis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 262.

Felson DT. Treatment of osteoarthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR, eds. Kelly and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 100.

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465-474. PMID: 22563589 www.ncbi.nlm.nih.gov/pubmed/22563589.

Zhang W, Ouyang H, Dass CR, Xu J. Current research on pharmacologic and regenerative therapies for osteoarthritis. Bone Res. 2016;4:15040. PMID: PMC4772471 www.ncbi.nlm.nih.gov/pmc/articles/PMC4772471.

  • Osteoarthritis

    Osteoarthritis

    Animation

  •  

    Osteoarthritis - Animation

    This animation compares a normal adult knee joint and a knee joint affected by osteoarthritis.

  • Osteoarthritis

    Osteoarthritis

    Animation

  •  

    Osteoarthritis - Animation

    You used to take for granted that you could play a whole game of tennis or basketball without pain. But years of wear and tear have left their mark on your joints, and now your knees and hips hurt so much you can barely bend them. The pain you're feeling may be due to osteoarthritis, a problem many of us face as we get older. We all start out life with a thick layer of cartilage that cushions our joints in the space where the bones meet. That cartilage allows us to twist our legs to kick a soccer ball, or jump to shoot a basket. But years of running, jumping, and climbing stairs can wear out that cushion, leaving the bones rubbing painfully against each other. By age 70, just about everyone feels some pain and stiffness from osteoarthritis, especially when they get up in the morning or after they've overused the joint. You're more likely to have osteoarthritis if you're overweight. It's similar to what happens when you put extra weight on your bed. Eventually, you'll push on the springs so hard that you'll wear them out. The same is true for your joints. People who've had joint injuries or who have played certain sports are also more likely to get osteoarthritis. When you see your doctor about joint pain and stiffness, he'll check how well the joint moves and look for swelling around it. You probably won't be able to move the joint all the way. And when you do move it, it's likely to hurt and may make a cracking sound. An x-ray can confirm that you've lost cartilage around the joint. Unfortunately, there's no cure for osteoarthritis. But there are treatments to relieve the pain, including physical therapy, knee taping, special low load exercise programs, such as swimming, cycling, walking or stretching, and Tai chi in particular can be great for flexibility and strength. Over-the-counter medicines like topical Capsaicin, oral acetaminophen, aspirin, ibuprofen, and naproxen may help. Mud pack therapy may increase the benefit of whatever else you're doing. Your doctor may recommend getting a steroid injection into the joint to both relieve pain and reduce swelling. Another method, which injects artificial joint fluid into the knee, can relieve pain longer term, for up to six months. If the joint damage is really bad, you may need surgery to trim off damaged cartilage or to replace the affected joint in the knee, hip, shoulder, or elbow with an artificial joint. This is called joint replacement surgery, and is quite common for the both damaged hip and knee joints. Although it may hurt to move, staying active can help keep your joints healthy. Exercising can also help you lose the weight that's putting pressure on your sore joints. Ask your doctor to recommend a physical therapist, who can teach you exercises that strengthen the muscles supporting your joints. Osteoarthritis is different in everyone. Some people can get around fine with it while others have trouble doing even the simplest tasks, like bending down to get the morning paper. Before your joints get so stiff and painful that they limit your lifestyle, talk to your doctor about treatment and prevention options that can help you get around more like you used to.

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from wear and tear on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.

    Osteoarthritis

    illustration

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is associated with the aging process and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing bone to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

    Osteoarthritis

    illustration

  • Osteoarthritis

    Animation

  •  

    Osteoarthritis - Animation

    This animation compares a normal adult knee joint and a knee joint affected by osteoarthritis.

  • Osteoarthritis

    Animation

  •  

    Osteoarthritis - Animation

    You used to take for granted that you could play a whole game of tennis or basketball without pain. But years of wear and tear have left their mark on your joints, and now your knees and hips hurt so much you can barely bend them. The pain you're feeling may be due to osteoarthritis, a problem many of us face as we get older. We all start out life with a thick layer of cartilage that cushions our joints in the space where the bones meet. That cartilage allows us to twist our legs to kick a soccer ball, or jump to shoot a basket. But years of running, jumping, and climbing stairs can wear out that cushion, leaving the bones rubbing painfully against each other. By age 70, just about everyone feels some pain and stiffness from osteoarthritis, especially when they get up in the morning or after they've overused the joint. You're more likely to have osteoarthritis if you're overweight. It's similar to what happens when you put extra weight on your bed. Eventually, you'll push on the springs so hard that you'll wear them out. The same is true for your joints. People who've had joint injuries or who have played certain sports are also more likely to get osteoarthritis. When you see your doctor about joint pain and stiffness, he'll check how well the joint moves and look for swelling around it. You probably won't be able to move the joint all the way. And when you do move it, it's likely to hurt and may make a cracking sound. An x-ray can confirm that you've lost cartilage around the joint. Unfortunately, there's no cure for osteoarthritis. But there are treatments to relieve the pain, including physical therapy, knee taping, special low load exercise programs, such as swimming, cycling, walking or stretching, and Tai chi in particular can be great for flexibility and strength. Over-the-counter medicines like topical Capsaicin, oral acetaminophen, aspirin, ibuprofen, and naproxen may help. Mud pack therapy may increase the benefit of whatever else you're doing. Your doctor may recommend getting a steroid injection into the joint to both relieve pain and reduce swelling. Another method, which injects artificial joint fluid into the knee, can relieve pain longer term, for up to six months. If the joint damage is really bad, you may need surgery to trim off damaged cartilage or to replace the affected joint in the knee, hip, shoulder, or elbow with an artificial joint. This is called joint replacement surgery, and is quite common for the both damaged hip and knee joints. Although it may hurt to move, staying active can help keep your joints healthy. Exercising can also help you lose the weight that's putting pressure on your sore joints. Ask your doctor to recommend a physical therapist, who can teach you exercises that strengthen the muscles supporting your joints. Osteoarthritis is different in everyone. Some people can get around fine with it while others have trouble doing even the simplest tasks, like bending down to get the morning paper. Before your joints get so stiff and painful that they limit your lifestyle, talk to your doctor about treatment and prevention options that can help you get around more like you used to.

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from wear and tear on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.

    Osteoarthritis

    illustration

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is associated with the aging process and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing bone to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

    Osteoarthritis

    illustration

A Closer Look

 

 

Review Date: 5/12/2018

Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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