Osteoarthritis

Definition

Cartilage is smooth tissue that covers the bone in a joint. Osteoarthritis (OA) is the wearing down of cartilage over time. OA can cause pain and limit movement.

Joints Affected by Osteoarthritis

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Causes

Cartilage acts as a cushion for the bones. It also helps bones move smoothly over each other. High impact, stress, and pressure on the joint can wear down the cartilage. The damage worsens over time. For some, the cartilage may completely wear away. This leaves the bone surfaces bare which causes pain and trouble moving.

Wear and tear of the joint is a part of aging. Injuries to the joint, weak muscles, or other health problems can speed up and worsen the damage.

Risk Factors

OA is more common in older adults. Other factors that may increase your chance of OA include:

• Excess body weight
• Family history of OA
• Having an injury or surgery to the cartilage
• Having a job or doing physical activities that put stress on the joints
• Certain endocrine, metabolic, or neuropathic disorders
• Avascular necrosis—death of bone from lack of blood flow

Symptoms

OA is most common in larger joints that support weight such as the spine, hips, and knees. It is also common in active joints like the hand and feet. Common symptoms include:

• Mild to severe pain in a joint, especially after overuse or long periods of rest
• Creaking or grating sound in the joint
• Swelling, stiffness, and problems moving the joint, especially in the morning
• Decreased stiffness after starting activity

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. The doctor can often diagnose OA based on your symptoms.

Other tests are not always needed. The doctor may do more tests if your symptoms are not typical. They can help to rule out other issues like a new injury. Test options may include:

• X-ray—damage from OA can be seen on x-ray
• Blood tests—to look for signs of infection or markers of joint disease
• MRI scan—to rule out injuries
• Ultrasound

Treatment

OA cannot be cured. Treatment is focused on:

• Reducing joint pain and inflammation
• Improving joint function
• Slowing future damage

Treatment may change over time. Options may include:

Weight Loss

Extra weight can increase pressure on the joints. This may speed up wear and tear. The closer you are to your ideal weight, the better it will be. If you are overweight, losing any weight can lessen the stress on your joints. A dietitian can help you make meal plans.

Exercise and Therapy

Muscles affect how the joints line up and how they move. It can also affect how much stress is placed on your joints. Strong muscles can decrease the wear and tear with each movement. They can help to slow the progress of OA.

Strong muscles related to the joint may also decrease OA pain and make movement easier. Low impact may be a good way to start. For example, swimming and water aerobics improve muscle health with less impact on the joints. Ask a doctor or an exercise specialist for help to create a program that works for you.

OA can make everyday tasks difficult. Physical or occupational therapy can provide new steps or devices to help you such as:

• Shoes with shock-absorbing insoles
• Splints or braces to align joints and distribute weight
• Elastic supports
• Canes, crutches, walkers, and orthopedic shoes
• Home tools, such as handrails and grips or raised seats, including toilet seats

Other therapy options include:

• Transcutaneous electrical nerve stimulation (TENS)—electrical pulses that can reduce pain signals
• Manual therapy—such as massage therapy to improve muscle balance and joint alignment

Medications

Medicines may help to manage pain or swelling. Options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical pain medicines that are applied to the skin—capsacian is a common choice
• Prescription pain medicines
• Corticosteroid—may be by mouth or by injection
• Viscosupplementation injection (hyaluronic acid)—to replace low levels and help cushion the joint

Heat and Ice

Heat may help loosen stiff joints and help you move easier. Heat may be given through hot water bottles, warm soaks, paraffin, or heating pads.

Ice may help to decrease swelling and pain. It may be most useful after activity.

Alternative Treatments

These therapies may be able to give you some relief. They work best when used in combo with treatments above. Let your doctor know about any treatment you may try to make sure all your efforts work together. Options that have shown some promise with OA include:

• Acupuncture
• Balneotherapy (hot water therapy)
• Relaxation therapy
• Yoga
• Tai chi

Surgery

OA can sometimes cause severe limits. If it is making daily life hard, your doctor may recommend a surgery. Surgery may be done to:

• Remove loose pieces of bone or cartilage from joints
• Reposition bones to balance stress on the joint
• Replace a damaged joint with an artificial one

Prevention

To reduce your chance of OA:

• Maintain a healthy weight.
• Do regular exercise, such as walking, stretching, swimming, or yoga.
• Limit repetitive motions. Avoid risky activities that may lead to joint injury. This is even more important after age 40.