Osteoarthritis

What is osteoarthritis?

Inside a joint, a tissue called cartilage cushions the joint and prevents the bones from rubbing against each other. Osteoarthritis develops when the cartilage of a joint erodes (breaks down). Bones begin to rub against each other, causing pain and difficulty moving the joint. Osteoarthritis also can affect nearby bones, which can become enlarged in places. These enlargements are called bone spurs or osteophytes.

In the past, osteoarthritis was considered a non-inflammatory condition. In fact, because the word “arthritis” means joint inflammation, many health care professionals preferred the term “degenerative joint disease” rather than osteoarthritis. However, it is now well established that inflammation is present in the joints of people with osteoarthritis, though typically it is less obvious and less prominent than the inflammation observed in other types of arthritis, such as rheumatoid arthritis or gout.

Osteoarthritis can range from mild to severe. The pain associated with osteoarthritis can be significant, and it usually is made worse by movement. Osteoarthritis can be limited to one joint or start in one joint (usually the knee, hip, hand, foot, or spine), or it can involve a number of joints. If the hand is affected, usually many joints of the fingers become arthritic.

Osteoarthritis probably does not have a single cause, and for most people there are likely many causes or contributors. Age is a leading risk factor, because osteoarthritis tends to become more common as people get older. However, joints do not always deteriorate with age.

Other major risk factors for osteoarthritis include joint injury, obesity, certain genes, and abnormalities in joint shape or alignment. One theory is that some people are born with defective cartilage or slight defects in the way joints fit, and as these people age, they are more likely to have cartilage in the joint break down.

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Other conditions that increase the risk of osteoarthritis include:

repeated episodes of bleeding into the joint, as may occur in hemophilia or other bleeding disorders
repeated episodes of gout or pseudogout, in which uric acid or calcium crystals in the joint cause episodes of inflammation
avascular necrosis, a condition in which the blood supply to the bone near the joint is interrupted, leading to bone death and eventually joint damage; the hip is affected most often
chronic (long-lasting) inflammation caused by previous rheumatic illness, such as rheumatoid arthritis
metabolic disorders, such as hemochromatosis, in which a genetic abnormality leads to too much iron in the joints and other parts of the body
joint infection.

Women are affected by osteoarthritis more often than are men.

Osteoarthritis is one of the most common medical conditions, affecting an estimated 33 million people in the United States. In many people, it goes unrecognized. It is estimated that as many as half of all those who have osteoarthritis do not know that the pain and stiffness they are experiencing are symptoms of osteoarthritis. Conversely, many people whose x-rays show evidence of osteoarthritis have no symptoms.

Symptoms of osteoarthritis

Symptoms of osteoarthritis include:

joint pain with or without swelling, often worse after activity
limited flexibility, especially after not moving for a while
bony lumps at the end of fingers, called Heberden's nodes, or on the middle joints of fingers, called Bouchard's nodes
a grinding sensation when the joint is moved
numbness or tingling in an arm or leg, which can happen if the arthritis has caused bone changes that are putting pressure on a nerve; for example, in the neck or lower back.

People who have osteoarthritis often complain of a deep ache, centered in the joint. Typically, the pain is aggravated by using the joint and relieved by rest. However, as the disease worsens, the pain becomes more constant. Often, when the pain is significant during the night, it interferes with sleep.

Diagnosing osteoarthritis

Your doctor may ask about osteoarthritis in your parents, because osteoarthritis appears to have a genetic component.

He or she will examine you, looking for loss of joint motion, tenderness, warmth, and swelling around the joints. Your doctor may order x-rays, but osteoarthritis may not be apparent in its earliest stages and many people have osteoarthritis by x-ray in joints despite having no symptoms. Your health care professional also may order blood tests to look for evidence of another arthritic condition.

Expected duration of osteoarthritis

Osteoarthritis is a long-lasting condition that tends to get worse slowly over time.

Preventing osteoarthritis

There is no reliable way to prevent most cases of osteoarthritis. However, you may be able to control some factors that increase the risk of developing the disease, such as

maintaining an ideal body weight
preventing joint injury.

It may also help to prevent or treating any conditions that might contribute to joint damage, such as hemochromatosis, gout, or infection.

Treating osteoarthritis

Treatment focuses on managing pain and maintaining the ability to use the joint. A combination of treatments, including medications and non-drug options, are commonly recommended.

Your doctor likely will suggest that you perform certain exercises to reduce stiffness and improve your ability to move the joints. Because extra pounds put pressure on sensitive joints, it is important that you lose excess weight. In addition, if you have osteoarthritis of the spine, it is important to maintain good posture to distribute weight and pressure evenly throughout the body. Physical and occupational therapists can be helpful in recommending an exercise program and measures to reduce joint stress, such as braces, canes, or other assistive devices.

Applying heat or cold can relieve pain temporarily. Your doctor also can advise you on the use of heating pads, hot baths, and ice packs to ease the discomfort.

People with symptoms of osteoarthritis often experience significant benefit from one or more medications. Oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as topical diclofenac (Voltaren, Flector, others), oral ibuprofen (Advil, Motrin and others), or oral naproxen (Aleve, Naprosyn and others) are generally the first medications recommended for osteoarthritis. However, NSAIDs may be unsafe for people at high risk of developing ulcers, including people who have had ulcers in the past and the elderly. For these people, medications called cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex), may be less irritating to the stomach and intestines but have similar effectiveness as older medicines. Stomach problems, including ulcers, are the most common side effects of these medications, but there are others, including an increased risk of cardiovascular problems.

Other medications that may reduce symptoms of osteoarthritis include topical capsaicin and oral duloxetine (Cymbalta).

In some instances, your health care professional may remove fluid from the joint and inject the joint with a corticosteroid drug. However, the benefit of these injections tends to be temporary and should not be administered frequently (for example, no more than three or four times per year).

Other treatments of uncertain (and possibly limited) benefit include glucosamine, chondroitin, fish oil, and injections of hyaluronate. In the past, acetaminophen (Tylenol, others) and opiates were common treatments for osteoarthritis, but are less favored now due to limited benefit, significant risks, or both.

There is currently no compelling evidence that the joint deterioration of osteoarthritis can be slowed or stopped by any particular medication.

In severe cases, your doctor may recommend surgery, such as joint replacement.

When to call a professional

Call your doctor if you have joint pain, a grinding sensation in joints, or limited joint motion.

Prognosis

When treated properly, symptoms of osteoarthritis can usually be well controlled. However, it is a long-lasting disease that may require ongoing care over time.