Osteoarthritis

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KEY POINTS

• Osteoarthritis is a disease in which the cartilage in your joints breaks down causing joint irritation, swelling, and pain.
• Treatment helps control symptoms and may include exercise, medicines, or surgery.
• Try to keep a healthy weight. Losing some weight can reduce the stress on your joints. Eat a healthy diet, and ask your healthcare provider if there are any limits on your exercise. If you smoke, try to quit.

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What is osteoarthritis?

Osteoarthritis is a disease in which the cartilage in your joints breaks down. Cartilage is tissue that lines and cushions the surface of joints. It covers the ends of bones and allows free movement of joints. If joint cartilage gets rough or wears away, the roughened cartilage or bone surfaces grind against each other. The joint gets irritated and swollen (inflamed). Sometimes the irritation causes abnormal growths of bone, called spurs.

Osteoarthritis most often affects joints in the feet, knees, hips, lower back, or fingers. It usually affects only one or a few joints at a time. It is a lifelong problem that can get worse over time. However, you can relieve symptoms and prevent or slow down joint damage by following your healthcare provider’s treatment plan and taking care of yourself.

What is the cause?

The exact cause of osteoarthritis is not known. Things that may cause or contribute to osteoarthritis are:

• Aging. Osteoarthritis slowly gets worse as you get older. Symptoms are usually not noticed until middle age.
• Too much wear on joints. Obesity, bad posture, and overuse can cause extra wear on joints.
• Injuries to joints from sports or accidents
• Pressure. Heavy lifting or contact sports can put pressure on joints and damage the cartilage.
• Genes you have inherited. Genes are inside each cell of your body and are passed from parents to children. They contain the information that tells your body how to develop and work. A family history of osteoarthritis can increase your risk of having osteoarthritis.

What are the symptoms?

Symptoms may include:

• Mild to severe pain in a joint, which may be worse after long periods of bending, lifting or not moving
• Creaking or grating sound in the joint
• Swelling, stiffness, or limited movement of the joint, especially in the morning
• Weakness in muscles around the sore joint from lack of use
• Changes in the shape of the joint

The pain of osteoarthritis starts with activity and continues after you stop the activity. The stiffness of osteoarthritis wears off quickly (usually within 15 to 30 minutes) once you get moving in the morning.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. If there is a question about what type of arthritis you have or how severe your osteoarthritis is, other tests may include:

• X-rays
• Blood tests
• Joint aspiration, which uses a needle to take fluid from a joint for testing

You may have other tests or scans to check for other possible causes of your symptoms.

How is it treated?

There is no cure for osteoarthritis, but treatment can help:

• Relieve pain and stiffness
• Reduce swelling
• Keep the joints working properly
• Stop or slow down damage to the joints

There are many ways to treat osteoarthritis.

Medicine

• Nonprescription pain medicine, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may help relieve pain. NSAIDs are available in pills, creams, and patches. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
  • NSAIDs, such as ibuprofen, naproxen, ketoprofen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
• Steroid medicine may be prescribed to decrease pain and swelling. It can be given as a pill, cream or ointment, or shot. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
• Hyaluronic acid may be injected into your knee if you have arthritis in your knee. It helps your knee move more easily.

Exercise

Three types of exercise may help:

• Range-of-motion exercises are gentle stretching exercises that help you improve movement of a joint. Examples include low-speed bike riding, tai chi, and yoga. Range-of-motion exercises help you keep or improve your flexibility and relieve stiffness.
• Strengthening exercise, such as weight training, makes muscles and tendons stronger. Strong muscles and tendons support joints better. You will be able to move more easily and with less pain.
• Aerobic or endurance exercise at a moderate pace, such as walking or bicycle riding, improves your overall health and helps control your weight. Exercise in a warm swimming pool is a very helpful option. The water supports your weight while you move, and the warmth helps improve joint movement.

Talk with your healthcare provider before you start an exercise program. Too much exercise too soon or not warming up enough may make arthritis worse. Your provider may refer you to a physical therapist to design a program that is right for you.

Surgery

Your provider may advise arthroscopy, which is a type of surgery done with a small scope inserted into your joint. Your provider can look directly at your joint and sometimes make helpful repairs, such as removing bone spurs, without having to cut open the joint.

If you have a joint that is severely damaged, surgery may be done to replace your joint with an artificial joint.

Other treatments

• Your healthcare provider may recommend physical or occupational therapy to treat pain and help you have better use of your joints.
• Although the evidence is not conclusive, some people seem to benefit from the natural remedies glucosamine and chondroitin sulfate. Acupuncture may also help reduce pain and stiffness in the joints.
• Transcutaneous electrical nerve stimulation (TENS) may relieve some types of arthritis pain. TENS directs mild electric pulses through the skin to nerves in the painful area.
• Sometimes it may help to use a splint or brace for a short time to rest the joint and protect it from injury.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider.
• Rest your joints when they are hot, swollen, or painful.
• Try to keep a healthy weight. If you are overweight, lose weight. Losing some weight can reduce the stress on your joints.
• Learn how to move in ways that are easier on your joints. Be open to using devices to help you. Helpful devices may include canes and walkers; bath seats and grab bars for the bathtub; and larger grips on tools, eating utensils, pens, and pencils. Velcro fasteners on clothes and shoes can be very useful, too.
• Rubbing deep-heat creams on a painful joint can give short-term relief. Putting an ice pack on the joint once or twice a day can also help relieve pain. See which works best for you. Some people get relief by alternating heat and cold packs. Hot paraffin baths can help symptoms in the hands and feet.
• Eat a healthy diet. Ask your provider about the benefits of talking to a dietitian to learn what you need in a healthy diet.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• Try to get at least 7 to 9 hours of sleep each night.
• Join a support group or take classes on how to manage your arthritis.
• Ask your healthcare provider:
  • How and when you will get your test results
  • If there are activities you should avoid and when you can return to your normal activities
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.