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Osteoarthritis
Definition
Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint.
Alternative Names
Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis
Causes
Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' on a joint.
- Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
- If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness.
- Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.
Often, the cause of OA is unknown. It is mainly related to aging.
The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.
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 of OA in the hip, knee, ankle, and foot joints 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 put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
- Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis.
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 avascular necrosis
- Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis
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Symptoms
Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint.
If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.
The phrase "morning stiffness" refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint.
During the day, the pain may get worse when you're active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night.
Some people might not have symptoms, even though x-rays show the changes of OA.
Exams and Tests
A physical exam can show:
- Joint movement may cause a cracking (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
No blood tests are helpful in diagnosing OA.
An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and 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.
MEDICATIONS
Over-the-counter pain relievers, which you can buy without a prescription, can help with OA symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs. If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.
Other medications or supplements that you may use include:
- Corticosteroids injected right into the joint to reduce swelling and pain
- Over-the-counter remedies such as glucosamine and chondroitin sulfate
- Capsaicin (Zostrix) skin cream to relieve pain
- Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 - 6 months
LIFESTYLE CHANGES
Staying active and getting exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Other lifestyle recommendations include:
- Applying heat and cold
- Eating a healthy, balanced diet
- Getting rest
- Losing weight if you are overweight
- Protecting the joints
As the pain from your OA becomes worse, keeping up with everyday activities may become more difficult or painful.
- Sometimes making changes around the home will take some stress off your joints, and 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 sense of balance. Therapists have many techniques for treating OA. If therapy does not make you feel better after 6 - 8 weeks, then it likely will not work at all.
Massage therapy may also help provide short-term pain relief. Make sure you work with an experienced massage therapist who understands how to work with sensitive joint areas.
BRACES
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. Using a brace the wrong way can cause joint damage, stiffness, and pain.
ALTERNATIVE TREATMENTS
Acupuncture is a treatment based on Chinese medicine. How it works is not entirely clear. Some studies have found that acupuncture may provide short-term pain relief for people with OA.
S-adenosylmethionine (SAMe, pronounced "Sammy") is a man-made form of a natural byproduct of the amino acid methionine. It has been marketed as a remedy for arthritis, but scientific evidence to support these claims is lacking.
SURGERY
Severe cases of OA might need surgery to replace or repair damaged joints. Surgical options include:
- Arthroscopic surgery to trim torn and damaged cartilage
- Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
- Surgical fusion of bones, usually in the spine (arthrodesis)
- Total or partial replacement of the damaged joint with an artificial joint (knee replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)
Support Groups
For more information and support, see arthritis resources.
Outlook (Prognosis)
Every person with OA is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities.
Your movement may become very limited over time. Doing everyday activities, such as personal hygiene, household chores, or cooking may become a challenge. Treatment usually improves function.
Possible Complications
- Reactions to drugs used for treatment
- Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
- Decreased ability to walk
When to Contact a Medical Professional
Call your health care provider if you have symptoms of OA that get worse.
Prevention
Try not to overuse a painful joint at work or during activities.
References
Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77:177-184.
Hunter DJ. In the clinic: Osteoarthritis. Ann Intern Med. 2007;147(3):ITC8-1-ITC8-16.
Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi.
Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009;17:591-6000.
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377:2115-2126.
Reviewed By: Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
