Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Osteoarthritis

(Degenerative Joint Disease; Arthritis, Osteo-)
by Editorial Staff and Contributors
Definition

Osteoarthritis is the breakdown of cartilage in the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.

Causes

Osteoarthritis is associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity.

Risk Factors

These factors increase your chance of developing osteoarthritis. Tell your doctor if you have any of these risk factors:

  • Neuromuscular disorders, like diabetes
  • Obesity
  • Genetic factors
  • Injury to the joint surface
  • Occupations and physical activities that put stress on joints
Symptoms

Symptoms include:

  • Creaking or grating sound in the joint
  • Deformity of the joint
  • Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time
  • Swelling, stiffness, limited movement of the joint, especially in the morning
  • Weakness in muscles around the sore joint
Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

  • Arthrocentesis —a procedure that involves withdrawing fluid from a joint
  • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
  • Blood tests
Treatment

There is no treatment that stops cartilage loss or repairs cartilage that is damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.

Treatments may include:

Medications
  • Over-the-counter pain medicine
    • Acetaminophen (eg, Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg, Advil) and naproxen (eg, Aleve)
  • Pain relief creams— capsaicin , methyl salicylate, and menthol
  • Prescription pain medicine
    • Arthrotec —nonsteroidal anti-inflammatory drug; may reduce the risk for gastrointestinal bleeding
    • Opiates and opiate-like medications
  • Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps lubricate the joint
Dietary Supplements

There is some evidence that glucosamine and chondroitin may relieve pain and/or decrease osteoarthritis progression. Talk with your doctor before taking any herbs and supplements.

Alternative Treatments

Some doctors report that acupuncture has been successful in reducing the pain of osteoarthritis, although the evidence is not consistent.

While more studies are needed, balneotherapy (hot water therapy), relaxation therapy , exercise , yoga , and tai chi may be helpful.

Mechanical Aids

Shoes with shock-absorbing soles may provide some relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain . Also, a firm mattress may help chronic back pain. Canes , crutches , walkers , and orthopedic shoes also can help those with advanced osteoarthritis in the lower body.

Weight Reduction

Losing weight can lessen the stress on joints affected by osteoarthritis. Losing five pounds can eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the greater the benefit.

Exercise and Physical Therapy

Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis in the knee, exercise, including strength training , can also help improve knee function.

Swimming and water aerobics are good options because they do not put stress on the joint.

Another option is transcutaneous electrical nerve stimulation (TENS). With TENS, you are connected to a machine that sends electrical signals through the skin to nerves. This type of therapy may decrease pain in some people.

Assist Devices

If you are having difficulty getting around due to arthritis pain, your doctor might recommend that you install handrails and grips throughout your home. These are useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you're having difficulty rising after sitting.

Heat and Ice

Applying heat (with hot water bottles or heating pads) helps joints and muscles move more easily. It can also lessen pain. Using ice packs after activity can also help.

Steroids

Corticosteroid injections to the inflamed joint may be given if other pain medicines do not work. Because repeated cortisone injections can be harmful to the cartilage, they are reserved for those with severe symptoms.

Surgery

Surgery can:

  • Remove loose pieces of bone or cartilage from joints
  • Replace joints
  • Reposition bones to redistribute stress on the joint
Prevention

To reduce your chance of getting osteoarthritis:

  • Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.
  • Do regular, gentle exercise (eg, walking, stretching, swimming, yoga).
  • Maintain a healthy weight.
  • With advancing age, certain activities may have to be dropped or modified. But, continue to be active.

Last reviewed: August 2010 by Marcin Chwistek, MD .

RESOURCES:
CANADIAN RESOURCES:
References:
  • American College of Rheumatology Subcommittee on Osteoarthritis. Recommendations for the medical management of osteoarthritis of the hip and knee. 2000 update. Arthritis Rheum . 2000;43:1905-1915.
  • Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp . Published July 2002. Updated May 2006. Accessed June 9, 2008.
  • Jordan K, Arden N, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis . 2003;62:1145-1155.
  • Osteoarthritis. EBSCO Natural and Alternative Treatment website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114 . Accessed March 4, 2008.
  • van den Berg WB. Pathophysiology of osteoarthritis. Joint Bone Spine . 2000;67:555-556.
  • 10/21/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;CD004376.
  • 12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Rutjes WJ, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.