Osteoarthritis

What is osteoarthritis?

Osteoarthritis is a type of arthritis that affects the cartilage (connective tissue) around the joints. While there are many forms of arthritis, osteoarthritis is the most common. Some people call it wear-and-tear arthritis. It can affect any joint but most commonly affects the hips, knees, shoulders, and hands.

Osteoarthritis occurs when the smooth cartilage that lines the ends of bones and allows for joint motion wears away, eventually exposing the bone underneath. While arthritis is not reversible, there are steps you can take to reduce the pain and inflammation.

Most common symptoms

Arthritis involves inflammation. Typical symptoms include pain, swelling, mild warmth and redness, and stiffness in the joints. Arthritis pain is dull and achy. Although there can be flare-ups where the pain is sharper. It can sometimes be difficult to put weight on the affected joint.

Arthritis pain often worsens during activity. Still, you may feel it when you’re not doing anything. And it may be even more noticeable when in bed. It is not uncommon for arthritic joints to stiffen with inactivity and gradually loosen as you start moving.

The muscles around an arthritic joint tend to weaken, which can lead to legs giving way (collapsing). Or it can make it difficult to lift arms up or grip an object when the shoulder and hands are involved.

Main symptoms

• Dull, aching pain in the affected joint:
  • Hip: Usually groin or thigh pain.
  • Knee: Can be on the inside, outside, front, or back of the knee, depending on part of the joint involved.
  • Shoulder: Usually deep over the front or side of the arm.
  • Hand: Typically affects the base of the thumb and finger joints.
• Stiffness in a joint reduces its range of motion.
• Joint swelling. Typically most noticeable in the knee joint—called “water on the knee.”
• Pain is worse with activity but can also hurt when at rest.
• Night pain, which can interfere with sleep.
• Mild redness or warmth of the joint. (Not to be confused with infection, which usually causes intense redness and warmth.)

Other symptoms

• Weakness or giving way of the legs—hip/knee arthritis.
• Loss of grip strength—hand or thumb arthritis.
• Difficulty with overhead movements—shoulder arthritis.
• Occasional sharp pain or difficulty with weight-bearing activities.

Risk factors for osteoarthritis

Osteoarthritis is the most common joint disease. It can be caused by many factors including:

• Genetics (having a parent or sibling with arthritis).
• Obesity.
• Having a physical or heavy labor job.
• Having a previous joint injury, such as broken bones or ligament tears.
• Anatomical abnormalities that alter the joint mechanics.
• Having a prior surgery, especially removal of cartilage or ligament surgery.

Next steps

Most arthritis pain responds to the well-known combination of therapies called “RICE,” for Rest, Ice, Compression, and Elevation.

While you don’t necessarily need to see a doctor or seek emergency treatment for arthritis, flare-ups can be very painful. Excessive swelling in the joint can also cause stiffness and limit your movement. Contact your doctor if your pain is intolerable, fails to respond to RICE, or it is severely limiting your ability to function.

• Rest means avoiding activities that aggravate the joint. Depending on the level of pain, you may want to use a cane or crutch to take pressure off of the limb.
• Icing protocols vary but usually include leaving the ice on for 20 minutes, 3 to 4 times a day.
• Compression includes the use of an ACE wrap or compression sleeve to help reduce swelling and provide support and stability to the joint.
• Elevation can help reduce swelling. Elevate the arm or leg—keep it above the level of the heart.

Causes of osteoarthritis

While many factors play a role in arthritis, the exact cause is often not clear. There are microscopic changes that happen to the cartilage lining the joint that eventually cause it to wear away.

People who have had injuries to the joint in the past including ligament tears, fractures, or cartilage damage, are at higher risk of arthritis. There is increasing evidence that obesity plays a role as well.

What is the best treatment for osteoarthritis?

The goal of treating osteoarthritis is to reduce pain and swelling and to help maintain the movement in your joints. Although arthritis cannot be cured, non-surgical measures can be effective early in the disease. More invasive treatments may be necessary as the arthritis worsens and symptoms progress. The range of treatments includes:

• Avoid activities that trigger pain—and try to rest. For arthritis in the lower part of the body, avoid impact loading exercises (running and jumping) as well as repetitive motions like kneeling, crouching, or squatting. For shoulder, wrist, elbow, or hand arthritis, avoid repetitive overhead activity (shoulder) or gripping small objects (hand).
• Bracing. Braces provide external support to the joint and can take pressure off or provide stability to otherwise weakened muscles.
• Losing weight. This is an important and often overlooked method of relieving arthritis pain, particularly in the lower part of the body. Every pound of weight lost equates to 3 or 4 pounds of pressure off of the joint. Even a modest weight loss of 10 to 15 pounds can take 40 to 60 pounds of stress off of an arthritic hip or knee.
• Physical therapy or occupational therapy. Therapy for arthritis involves gentle motion exercises to relieve stiffness. It includes stretching and strengthening of the muscles around a joint. And treatments like electrical stimulation and ultrasound, which can lessen pain. Aquatic (water) therapy can be particularly helpful for people who find other exercises too uncomfortable.
• Ice/Heat. Icing joints can reduce swelling and numb pain, especially after activities that inflame the joint. Heat can loosen stiff or sore muscles and joints.
• Anti-inflammatories (NSAIDs). Over-the-counter NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can relieve pain. If these are not effective, prescription NSAIDs can be used. The key to success is to take them on a schedule for at least 2 to 3 weeks. Many patients give up too quickly. It is important to talk to your doctor about your medical history and whether or not it is safe to take NSAIDs, as long-term use can come with certain risks.
• Injections. Corticosteroid (“cortisone”) injections can be given to almost any arthritic joint. Cortisone relieves inflammation inside the joint. It reduces pain and swelling. Another type of injection, viscosupplementation, is approved for knee arthritis. It involves a gel material that cushions and lubricates the joint where cartilage has worn away.
• Surgery. Surgical treatment for arthritis typically involves joint replacement surgery. The joint is replaced with metal and plastic parts. A replaced joint can never again become arthritic. For people who may be too young for replacement surgery, an osteotomy (cutting and re-aligning the bone) may be performed to shift pressure in the joint from arthritic to non-arthritic areas. Some people may consider a less invasive surgery like arthroscopy (“scope” or “clean-out” procedure), but there is little evidence that this works and it can aggravate symptoms.

Follow up

Symptoms of arthritis may come and go, from mild to severe without warning. Arthritis flare-ups can last several days or even several weeks. If your symptoms don’t improve with at-home measures in 2 to 4 weeks or you are severely limited by pain, swelling, or stiffness, contact your doctor. Keep in mind that anti-inflammatory medications can take 2 to 4 weeks of regular use to be effective. Cortisone shots usually take effect within 2 to 4 days.

Prevention

While most arthritis is not truly preventable, there are steps you can take to maintain the health of your joints. Staying a healthy weight can help prevent the development of arthritis, stop arthritic symptoms from worsening, and relieve arthritis pain.

Following a regular exercise regimen can help maintain a healthy weight and keep muscles toned and conditioned. There is no evidence that activity causes arthritis to worsen or damages joints. Focus on low-impact exercise and gentle stretching and strengthening of the joints and muscles around the joint.