Osteoarthritis (OA), also called degenerative joint disease, is the most common chronic disease of the joints and affects more than 30 million Americans. In normal joints, the cartilage that covers the end of each bone serves as a cushion and lubricant. In people with osteoarthritis, the cartilage wears down, causing pain, inflammation, and problems moving the joint. Although OA can affect any joint, it appears more frequently in the hips, knees, lower back, and neck. It can also affect the fingers and feet. Osteoarthritis can occur at any age, but it is most common in people older than 65. 

What are the typical symptoms?

 The symptoms of osteoarthritis can vary. The most common symptoms are pain and stiffness in the joints that are most pronounced first thing in the morning or after periods of inactivity (like getting up from a chair). People with OA may also experience aching in the joint after extended activity, decrease in range of motion or flexibility, mild swelling around the joint, or a grating sensation when bending a joint. OA pain, swelling, or stiffness may make it difficult to perform ordinary daily tasks. When the lower body joints are affected, activities such as walking or climbing stairs may become difficult. When finger and hand joints are affected, osteoarthritis can make it challenging to grasp and hold objects. OA symptoms can hinder work, social life, and family life if steps are not taken to prevent joint damage, manage pain, and increase flexibility.

How is osteoarthritis diagnosed?

To diagnose osteoarthritis, your doctor will collect information on your personal and family medical history, perform a physical examination, and order diagnostic tests. During the physical exam, the doctor will examine your joints and test the range of motion (how well each joint moves). They will look for areas that are tender, painful, or swollen, as well as signs of joint damage. The following tests may help confirm a diagnosis of OA; however, they are not always necessary as a medical history review and physical examination can diagnose OA:

• Joint aspiration - The doctor will numb the joint and insert a needle into the joint to withdraw fluid. The fluid will be examined for evidence of crystals and inflammation (white blood cells). This test can also help rule out other medical conditions or other forms of arthritis (such as gout or rheumatoid arthritis).
• X-ray can show bone spurs and the space between your joints to determine if there is any narrowing.
• Magnetic resonance imaging (MRI) can provide a better image of cartilage and other structures such as tendons. However, an MRI is not necessary to diagnose OA.

What are the risk factors?

• Age – Simply put, the risk of developing OA increases with age.
• Obesity – Being overweight puts additional pressure on the hips and knees. Many years of carrying extra pounds on your body can cause the cartilage that cushions joints to break down faster. Research has also shown that there is a link between being overweight and having an increased risk of osteoarthritis in the hands. These studies suggest that excess fat tissue produces inflammatory chemicals (adipokines) that can damage the joints. Our modern western diet, which consists of highly processed foods, has been linked to the acceleration of cartilage destruction compared to our diet 100 years ago.
• Injury and overuse - Repetitive movements or injuries to joints (such as a fracture, surgery, or ligament tears) can lead to osteoarthritis. Some athletes, for example, repeatedly damage joints, tendons, and ligaments, which can speed cartilage breakdown. Certain careers that require standing for long periods, repetitive bending, heavy lifting, or other movements can also make cartilage wear away more quickly. An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.
• Genetics - Various genetic traits can make a person more likely to develop OA. One possibility is a rare defect in the body’s production of collagen, the protein that makes up cartilage. This abnormality can cause osteoarthritis to occur as early as age 20. Other inherited traits may result in slight defects in the way the bones fit together so that cartilage wears away faster than usual. Researchers have found that a gene called FAAH, previously linked to increased pain sensitivity, is higher in people with knee OA than in people who don’t have the disease.

What types of treatment are available for osteoarthritis?

Osteoarthritis is a chronic (long-term) disease. There is no cure, but there are treatment options available to help you manage your symptoms. Long-term management of the disease will include several factors:

Exercise/Physical Activity One of the most beneficial ways to manage OA is to get moving. While it may be hard to think of exercise when a joint hurts, moving is considered an essential part of the treatment plan.

• Studies show that simple activities like walking around the neighborhood or taking a fun, easy exercise class can reduce pain and help maintain a healthy weight.
• Strengthening exercises build muscles around OA-affected joints, easing the burden on those joints and reducing pain.
• Range-of-motion exercises help improve joint flexibility and reduce stiffness.
• Aerobic exercise helps to improve stamina and energy levels and also helps to reduce excess weight. The U.S. Department of Health and Human Services recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week.
• Slow, gentle stretching of joints may improve flexibility, lessen stiffness, and reduce pain. Exercises such as yoga and tai chi are great ways to manage stiffness.

Physical and Occupational Therapy Physical and occupational therapists can provide a range of treatment options for pain management, including ways to properly use joints, heat and cold therapies, and range of motion and flexibility exercises. They can also suggest helpful assistive devices (scooters, canes, walkers, splints, shoe orthotics, or useful tools, such as jar openers, long-handled shoehorns, or steering wheel grips).

Maintaining a Healthy Weight Excess weight adds additional stress to weight-bearing joints, such as the hips, knees, feet, and back. Losing weight can help people with OA reduce pain and limit further joint damage. The basic rule for losing weight is to eat fewer calories, eat more fruits and vegetables, and less processed food, and increase physical activity.

Pain Management with Medication Medications for osteoarthritis are available as pills, syrups, creams, lotions, or they are injected into a joint. They include:

• Topical pain relievers such as Aspercreme®, Salonpas®, Capsaicin®, topical lidocaine, or a diclofenac gel such as Voltaren®.
• Oral pain relievers include over the counter acetaminophen, and an atypical prescription opioid called tramadol that we use with caution.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen, meloxicam, and celecoxib. They are available over-the-counter or by prescription, and we consider if the patient has any history of kidney disease, heart disease, or stomach ulcers.
• Corticosteroid injections can help reduce local inflammation and improve pain. They cannot be done more frequently than every three months because of possible structural damage.
• Many people with OA use natural or alternative therapies to address symptoms. Some of these include nutritional supplements such as glucosamine-chondroitin-collagen, turmeric with boswellic acid, and alternative treatment such as acupuncture, acupressure, massage, relaxation techniques, and hydrotherapy.

Surgery In cases where the pain cannot be controlled, surgery may be a consideration. Surgical options include a less invasive arthroscopy to repair the joint, or for joints that cannot be repaired, a joint replacement may be necessary.

Positive Attitude Many studies have demonstrated that a positive outlook can boost the immune system and increase a person's ability to handle pain.

If you suspect you may have osteoarthritis, an Atrius Health rheumatologist can assess your symptoms and help you find the best solution to manage your pain.