Osteoarthritis
all information

Osteoarthritis

(Degenerative Joint Disease; Arthritis, Osteo-)

En Español (Spanish Version)More InDepth Information on This Condition

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

© 2008 Nucleus Medical Art, Inc.

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

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

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

Symptoms

Symptoms include:

  • 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
  • Weakness in muscles around the sore joint
  • Deformity of the joint

Diagnosis

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

Tests may include:

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 medication
    • Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen (Advil, Aleve)
      • A study looked at topical vs. oral ibuprofen to relieve chronic knee pain. Comparing the two groups, there were no significant differences in pain, stiffness, or difficulty. Those in the oral group, however, experienced more side effects. *
  • Prescription Pain Relief Medication
    • Arthrotec—NSAID that may reduce the risk for gastrointestinal bleeding
    • Opiates, and opiate-like medications

    ***Please Note: On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx (rofecoxib) from the US and worldwide market due to safety concerns. A study showed a small but significant increased risk of cardiovascular events (such as heart attack) in patients taking the prescription medication. Vioxx is a so-called "selective" nonsteroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation, and other conditions. Since Merck's withdrawal of Vioxx, evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex (celecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class.

  • Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps lubricate the joint
  • Pain relief creams—capsaicin, methyl salicylate, and menthol

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 can 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, and 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. Swimming and water aerobics are good because they don't put stress on the joint.

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, heating pads, hot paraffin) 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:

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

Prevention

To reduce your chance of getting osteoarthritis:

  • Maintain a healthy weight.
  • Do regular, gentle exercise, including walking, stretching, swimming, and 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 dropped or modified. But, you should continue to be active.

RESOURCES:

American College of Rheumatology
http://www.rheumatology.org/

The Arthritis Foundation
http://www.arthritis.org/

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca/

Seniors Canada On-line
http://www.seniors.gc.ca/

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 Publishing Health Library, Natural and Alternative Treatment website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?token=da29d243-e573-4601-8b42-77cd0ccb14b2chunkiid=21505. Accessed March 4, 2008.

van den Berg WB. Pathophysiology of osteoarthritis. Joint Bone Spine. 2000;67(6):555-6.

*2/7/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Underwood M, Ashby D, Cross P, et al. Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study. BMJ. 2008;336:138-142. Epub 2007 Dec 4.



Last reviewed February 2008 by Jill Landis, MD

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.


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