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Osteoarthritis

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.

Joints Affected by Osteoarthritis
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Causes

The exact cause is unclear.

Risk Factors

Factors that may increase your chance of developing osteoarthritis include:

Symptoms

Osteoarthritis may cause:

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

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • X-ray to see internal body structures
  • CT scan to look at the extent of the arthritis
  • Arthrocentesis to rule out other causes of arthritis
  • Blood tests to rule out other causes of arthritis

Treatment

There is no treatment that stops cartilage loss or repairs damaged cartilage or bones of the joint. When cartilage wears away, bone on bone friction causes pain and inflammation. The goal of treatment is to reduce joint pain and inflammation, and to improve joint function.

Options may include:

Weight Reduction

Losing weight can lessen the stress on joints affected by osteoarthritis. 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 and strength training can also help improve knee function. Swimming and water aerobics are good options. They do not put stress on the joint.

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

If you have knee osteoarthritis, manual therapy, including massage therapy and manipulation, may be helpful.

Medications

  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Cyclooxgenase-2 (COX-2) inhibitors
  • Topical pain medications that are applied to the skin
  • Antidepressants
  • Opiates and opiate-like medications
  • Viscosupplementation injection
  • Corticosteroid injection

Heat and Ice

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

Dietary Supplements

Glucosamine and chondroitin are two commonly used supplements. But, research has shown that these are not beneficial for most people with osteoarthritis. Talk with your doctor before taking any herbs or supplements.

Mechanical Aids and Assistive Devices

Shoes with shock-absorbing in 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. Canes , crutches , walkers , and orthopedic shoes can help with advanced osteoarthritis in the lower body.

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.

Alternative Treatments

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

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

Surgery

Surgery may be needed for joints with severe damage. It may be done to remove loose pieces of bone or cartilage from joints or reposition bones to redistribute stress on the joint. Some may need to have the joint replaced with artificial joint.

Prevention

To help reduce your chance of developing osteoarthritis, take these steps:

  • Maintain a healthy weight.
  • Do regular, gentle exercise, such as walking, stretching, swimming, or yoga.
  • Avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.
  • With advancing age, certain activities may have to be stopped or modified. It is important to continue to be active, so find an activity that suits you.

Revision Information

  • American College of Rheumatology

    http://www.rheumatology.org

  • The Arthritis Foundation

    http://www.arthritis.org

  • The Arthritis Society

    http://www.arthritis.ca

  • Seniors Canada

    http://www.seniors.gc.ca

  • 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.

  • Jordan K, Arden N, 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. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/osteoarthritis. Accessed September 3, 2013.

  • Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health%5FInfo/Osteoarthritis/default.asp. Updated July 2010. Accessed September 3, 2013.

  • Sinusas, K. Osteoarthritis: Diagnosis and treatment. Am Fam Physician. 2012;85(1):49-56.

  • 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: 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: Rutjes WJ, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.

  • 10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.

  • 10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

  • 11/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm. Updated April 19, 2013. Accessed July 23, 2013.

  • 11/29/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Man Ther. 2011;16(2):109-117.

  • 7/15/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dilek B, Gözüm M, Sahin E, et al. Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2013 Apr;94(4):642-9.

  • 6/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: MQIC guideline on medical management of adults with osteoarthritis. Available at: http://www.guideline.gov/content.aspx?id=47806. Updated August 1, 2013. Accessed June 18, 2014.