Osteoarthritis

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What is osteoarthritis?

Osteoarthritis is an ongoing, progressive disease that causes inflammation, pain, stiffness and swelling of joints. The joints of the body are the areas where two or more bones meet. The ends of the bones are protected by a durable tissue called cartilage, which helps bones to move easily without damaging bone tissue. In osteoarthritis, the cartilage breaks down, or becomes torn or thin, resulting in friction on the ends of the bones as they make contact. With time, this causes the classic symptoms of osteoarthritis, such as joint pain, stiffness, and swelling.

Osteoarthritis can also cause inflammation of the synovial membranes. Healthy synovial membranes line and protect the joints and allow smooth and free movement. When synovial membranes are inflamed, they become swollen, tender and warm, and are unable to move freely.

Osteoarthritis is also known as degenerative joint disease, because it can get worse with time and cause deterioration of joint function, difficulty moving, and even disability. Osteoarthritis cannot be cured, but early diagnosis and treatment can help to reduce symptoms and minimize complications.

Complications of osteoarthritis can be serious and include joint damage, deformity, and disability. Seek prompt medical care if you have symptoms of osteoarthritis, such as inflammation, pain, stiffness, and swelling of joints. Early diagnosis and treatment can minimize discomfort and reduce the risk of serious complications.

What are the symptoms of osteoarthritis?

The symptoms of osteoarthritis vary between individuals. At the onset of the disease, symptoms can be vague and develop slowly. Many people have no symptoms in the early stages of osteoarthritis.

Joint pain occurs as osteoarthritis progresses. Joint pain becomes more severe with time and can lead to difficulty moving, immobility, and disability. Certain types of activities may increase or aggravate joint pain. Joint pain is often worse after excessive exercise or periods of inactivity.

Symptoms of osteoarthritis include:

  • Altered joint alignment

  • Crunching, crackling, or grating sound or sensation in the affected joint

  • Difficulty moving and immobility due to joint pain and inflammation

  • Joint deformity in later stages of the disease

  • Joint inflammation and warmth

  • Joint pain, which may be aggravated by certain types of activities including excessive exercise or excessive inactivity

  • Joint stiffness

  • Joint swelling

  • Muscle weakness in the area of affected joints

What are the stages of osteoarthritis?

Osteoarthritis is a progressive condition, meaning it changes and worsens with time. In general, the progression from a normal joint to an arthritic joint takes 10 to 20 years, but the process varies widely between people.

There does not appear to be a widely accepted clinical classification of osteoarthritis. The following grades for osteoarthritis were defined by Kellgren and Lawrence in the 1950s based on X-ray imaging:

  • Grade 0: no visible changes in the joint 

  • Grade 1: small bony growths (osteophytes) may be visible

  • Grade 2: osteophytes are present and there is evidence of joint space narrowing

  • Grade 3: multiple osteophytes, narrowed joint space, and possible deformity at the ends of bones

  • Grade 4: large osteophytes, bone deformity, and marked narrowing

Doctors may also describe osteoarthritis in stages, combining both symptoms and imaging results:

  • Stage 1: minor osteoarthritis with slight wear and tear and tiny bony growths, which may not be visible on X-ray, and no pain 

  • Stage 2: mild osteoarthritis, with possible knee pain and visible changes in joint cartilage and bony growths, although the joint space will likely appear normal on X-rays

  • Stage 3: moderate osteoarthritis, with knee pain and visible loss of cartilage, joint space narrowing, and bony growths visible by X-ray

  • Stage 4: severe, late-stage, or end-stage osteoarthritis, with significant narrowing, cartilage breakdown, chronic inflammation, and greater pain requiring joint replacement

What causes osteoarthritis?

Osteoarthritis is the breakdown of cartilage that normally cushions the ends of bones. Primary osteoarthritis is linked to age-related wear and tear on the joint with time, but the exact cause of the loss of cartilage is not completely understood. Osteoarthritis is not a normal part of aging. Certain risk factors affect the likelihood of an older person developing the condition.

In some cases, osteoarthritis is caused by a specific injury or exacerbated by obesity. Osteoarthritis is also related to genetics, since you are more likely to develop the condition if you have a family member with osteoarthritis.

What are the risk factors for osteoarthritis?

A number of factors may increase your chances of developing osteoarthritis. Not all people with risk factors will develop osteoarthritis, and not all people with osteoarthritis have risk factors. Risk factors include:

  • Acromegaly (disorder in which there is excessive growth hormone, which can affect the bones and joints)
  • Age older than 45 years
  • Certain blood and circulation disorders, such as hemophilia and avascular necrosis
  • Family history of osteoarthritis or bone deformities
  • Female biological sex
  • Gout
  • Hemochromatosis (disorder in which there is too much iron, which can damage cartilage)
  • Joint injury including fractures, joint dislocations, ligament tears, and overuse injuries
  • Obesity, which can put excessive pressure on the knees, hips, ankles and foot joints
  • Prolonged occupational or sports-related stress on joints
  • Rheumatoid arthritis
  • Weak muscles, particularly around the knees

How do you prevent osteoarthritis?

The risk of osteoarthritis increases with age, but it is not inevitable. Other risk factors include joint injury and repetitive stress on the joint(s), which you have some control over. You may be able to lower your risk of developing osteoarthritis by modifying known risk factors.

Strategies to lower your risk include:

  • Eating healthy, nutritious food

  • Maintaining a healthy weight

  • Participating in a regular exercise program

  • Strengthening the muscles supporting your joints, including the thigh, back and core muscles. Physical therapy or occupational therapy can teach you the key exercises and ways you can avoid unnecessary stress on your joints—at any age.

  • Treating joint injuries and such conditions as gout and rheumatoid arthritis. (You can have more than one type of arthritis.)

  • Wearing recommended gear that protects joints during contact sports and dangerous activities. For example, if you are an athlete, cross-train with different types of sports to avoid stressing a single joint(s).

What are the diet and nutrition tips for osteoarthritis?

A healthy diet is a first-line prevention tip for many conditions, including any form of arthritis. There is a link between type 2 diabetes and metabolic syndrome and increased risk of osteoarthritis progression. Metabolic syndrome is marked by increased belly fat along with high blood sugar, high cholesterol, and high blood pressure.

There is some evidence that statins for high cholesterol are beneficial for osteoarthritis as well, so people with arthritis would benefit from a diet that promotes low cholesterol, as well as physical activity, which also helps keep cholesterol levels down. Arthritis is also an inflammatory condition, and a healthy diet is naturally anti-inflammatory.

These diet and nutrition tips may reduce the risk of osteoarthritis progression:

  • Decrease animal fats, full-fat dairy products, and trans fats

  • Decrease salt (choose low-sodium grocery items and do not add extra salt to dishes that already contain it)

  • Decrease sugar

  • Include dark, leafy greens and other foods rich in vitamin K, which promotes healthy bones and cartilage

  • Increase fiber to help fight cholesterol

  • Increase omega-3 fatty acids, either naturally or by supplementation (such as fish oil)

  • Increase fruits and vegetables 

  • Limit processed and junk foods like chips, store-bought baked goods, and fast food

Ask your healthcare provider for guidance before making significant changes to your diet. If you have osteoarthritis and struggle with weight management, high cholesterol, or high blood pressure, or you have diabetes, you would likely benefit from meeting with a dietitian.

What are some conditions related to osteoarthritis?

Osteoarthritis is the most common of the more than 100 types of arthritis. Other common types of arthritis include:

  • Gout, a form of arthritis caused by uric acid crystals lodging in the joint space

  • Juvenile arthritis, any type of arthritis affecting the pediatric population 

  • Psoriatic arthritis, an autoimmune disease that affects the joints and possibly the skin (psoriasis

  • Rheumatoid arthritis, an autoimmune disease that affects the joints and other parts of the body

How do doctors diagnose osteoarthritis?

A doctor diagnoses osteoarthritis based on a physical examination of the joint (or joints) and the patient’s symptoms. Most people are first diagnosed with osteoarthritis when it has progressed to periodic or constant pain.

An X-ray or other imaging can confirm the diagnosis and classify the arthritis as mild, moderate or severe.

Your doctor may order specific types of blood tests to help rule out other types of arthritis, such as rheumatoid arthritis or septic arthritis.

To help diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions related to your symptoms including:

  • How long have you been experiencing symptoms of arthritis?

  • How have your symptoms changed?

  • Have you ever injured your joint(s)?

  • Is your pain on one side of your body or both sides?

  • On a scale of 1 to 10 with 10 being the worst pain ever, how would you rate your pain?

  • Do you adjust or modify activities because of your symptoms?

  • When do your symptoms occur?

  • What makes your symptoms better or worse? (Activity, ice packs, warm packs, etc.)

  • How often do you exercise?

  • What types of exercise do you do?

How is osteoarthritis treated?

Treatment plans for osteoarthritis use a multifaceted approach and are individualized to the stage and advancement of the disease, and your age, medical history, and coexisting diseases or conditions. There is no cure for osteoarthritis, but with early recognition and treatment, it is possible to minimize or delay joint damage and complications, such as chronic pain and disability.

Medications for osteoarthritis

Medications used to treat osteoarthritis include:

  • Acetaminophen (Tylenol), which relieves pain
  • Cortisone injection, which reduces inflammation
  • Diclofenac (Voltaren), a nonsteroidal anti-inflammatory that comes in gel form
  • Glucosamine and chondroitin, which help strengthen damaged joint cartilage
  • Injection of a synovial fluid substitute (such as hyaluronic acid), which helps lubricate joints, serves as a filler to help keep space in the joint, acts as an antioxidant that helps protect cells from the damage, and overall eases stiffness and movement
  • Oral NSAIDs, such as ibuprofen (Advil, Motrin) and aspirin, which reduce inflammation 

Therapeutic treatments for osteoarthritis

Other treatments used to treat osteoarthritis may include:

  • Heat and cold therapies to reduce inflammation and stiffness
  • Occupational therapy to help maximize function and lessen stress on the joints
  • Physical therapy, including joint taping and range-of-motion exercises to help strengthen joints and delay the loss of joint function
  • Surgery to help improve joint pain, correct deformities, and increase function in seriously affected joints. Surgery may include a synovectomy, the removal of the joint lining. Joint replacement may also be performed in advanced cases. Surgeons recommend joint replacement for patients with moderate to severe pain and signs of joint disease on X-ray.
  • Weight loss, although not a medical therapy, is proven to reduce pain in people with knee arthritis (a greater than 10% reduction in body weight is linked to reduced pain and better function during a three-year follow-up, while a greater than 10% increase in body weight is associated with worse pain and function)

     

Complementary treatments for osteoarthritis

Some complementary treatments may help some people to better deal with osteoarthritis. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care.

Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Alternative osteoarthritis treatments include:

  • Acupuncture
  • Exercise in general (low impact)
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products, although there is low evidence these products are beneficial for osteoarthritis
  • Tai chi
  • Yoga

How does osteoarthritis affect quality of life?

Like other forms of arthritis, osteoarthritis places a tremendous burden on affected individuals, causing significant disability and greater healthcare costs. In addition to pain, people with osteoarthritis may experience:

  • Fatigue

  • Depression

  • Difficulty sleeping

  • Financial problems

  • Social withdrawal

The pain of osteoarthritis has a negative effect on quality of life. In fact, some experts consider osteoarthritis-related pain a distinct condition that warrants specific treatment. People with osteoarthritis experience pain related to the structural damage, but also inflammatory pain, which is more difficult to treat, and spontaneous pain.

Tips for coping with osteoarthritis 

With many chronic conditions, the symptoms and effects on quality of life are interconnected. For example, pain can lead to reduced activity and social engagements, which can lead to social withdrawal and depression. It is easier to cope with a chronic condition by tackling one thing at a time.

Talk with your doctor about your goals, such as reduced pain and better sleep, and how best to treat them. The more control you have over your symptoms and living with arthritis, the better you will feel.

The following coping tips may help lessen the burden of osteoarthritis:

  • Acupuncture and yoga for pain and poor sleep (regular sessions are necessary to maintain effectiveness) 

  • Cognitive behavioral therapy with a licensed professional counselor or psychologist, which can help prevent and control depression

  • Educate yourself and your loved ones about osteoarthritis and its treatment. Ask your doctor about education programs for chronic diseases, or visit the Centers for Disease Control and Prevention Self-Management Education Workshops.

  • Engaging friends and family for emotional and physical support

  • Joining an arthritis support group, especially if you do not have a strong social support system

  • Physical activity that burns calories but does not increase pain, such as swimming

  • Using assistive devices, such as a cane

What are the potential complications of osteoarthritis?

In some cases, osteoarthritis can lead to serious complications. It is important to understand that osteoarthritis and its symptoms are not a normal part of the aging process and can be treated. You can minimize discomfort and reduce your risk of complications by following the treatment plan you and your healthcare provider develop specifically for you. Complications of osteoarthritis include:

  • Adverse effects of osteoarthritis treatment

  • Chronic pain

  • Difficulties with fine motor control of the hands

  • Immobility and disability

  • Increased risk for falls

  • Joint deterioration, deformity and destruction

  • Nerve compression in the spinal cord (pinched nerves)

  • Problems with posture, walking and balance

  • Weakness or abnormal sensations of the arms or legs

Does osteoarthritis shorten life expectancy?

Osteoarthritis prognosis varies widely between people. It depends on which joints are affected, the severity of osteoarthritis symptoms, treatment, and impacts on quality of life. Symptoms typically worsen with time, but there may be long periods (perhaps years) where symptoms are mild. Keep in mind that the degree of joint damage does not always correlate with the severity of symptoms patients experience. Some people have significant joint deterioration with mild symptoms; others experience worsening symptoms without changes in the joint.

The negative effect of osteoarthritis on quality of life might have a negative effect on life expectancy as well. However, an analysis (published in 2019 in the journal Scientific Reports) of several independent studies suggests the opposite may be true: Osteoarthritis is linked to decreased mortality, as well as a four-year delay in dementia onset (cognitive decline) compared to people without osteoarthritis, at least in Western societies. (Dementia in osteoarthritic patients was delayed by 8 to 16 years compared to rheumatoid arthritis.) The factors that contribute to the longer lifespan and delayed dementia for people with osteoarthritis are not known.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 2
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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