What is osteoarthritis and what does it do?
Osteoarthritis - known among physicians as OA - is a disease in which cartilage breaks down. Cartilage is the spongy tissue that coats the ends of bones in joints and acts as a shock absorber. Normally, damaged cartilage is constantly being repaired as old cartilage is degraded. When the balance between degradation and repair is thrown off, cartilage breakdown occurs. As a result of cartilage breakdown, damage to bone occurs. The result can be painful, tender, creaky joints and limitations on joint movement. For more information on osteoarthritis, see our
Osteoarthritis Overview.
What puts me at greater risk of osteoarthritis?
We don't know all the answers, but some of the risks may include:
- Age, because the prevalence of osteoarthritis increases in older age groups;
- Genetics, because some sub-types of osteoarthritis seem to be inherited;
- Hormones, because post-menopausal estrogen replacement therapy helps protect women from developing osteoarthritis;
- Trauma, especially injuries of the knee;
- Possibly occupational injuries, because studies report an increased incidence of osteoarthritis among workers who use certain joints repetitively, such as jackhammer operators (wrists, hands, and elbows), coal miners (knees), cotton pickers (fingers), and farmers (hips);
- Being overweight, because obesity in women has definitely been shown to be a risk factor for development of knee osteoarthritis;
- Nutrition, because lack of vitamin D may predispose patients with established osteoarthritis of the knee to further progression.
What are the most common symptoms of osteoarthritis?
Pain is the most common symptom, and it occurs primarily when the joint is moved, rarely at rest. Pain is often accompanied by crepitus (a crackling sound). Some patients experience a "gelling phenomenon" -- the perception of stiffness, usually lasting less than 20 minutes in the affected joint. Why some people have pain with osteoarthritis and others do not remains unknown. The perception of pain depends not only on the disease process and the brain's processing of pain messages, but also on cultural, gender, and psychological factors. The joints most commonly involved are: the last and middle joint in the fingers; the joint that joins the thumb to the wrist; the hip; the knee; the neck; and the lower back.
Osteoarthritis is not associated with the presence of fever, weight loss, anorexia, severe muscle atrophy, or symmetrical joint involvement. That is, when the left knee is affected, the right may not be -- in contrast to other forms of arthritis where both are apt to be affected, called symmetrical involvement. For more information, read our full In-Depth Disease Overview on osteoarthritis.
How is osteoarthritis treated?
Treatment will depend on the severity of your osteoarthritis, any other diseases you have, and what medications you are taking, all of which will be determined by the physician during a complete examination. Treatment is aimed at control of pain by decreasing inflammation in the joint and with analgesics; oral medications may be prescribed, or injections into the joint. With the help of the physician and literature from the Arthritis Foundation, patients should first educate themselves about the disease and the various therapy modalities, such as
physical and occupational therapy, especially the importance of exercise. It is also wise to maintain good nutrition and, if you are overweight, to reduce your weight.
What are some of the pharmacological treatments for osteoarthritis pain?
AnalgesicsIf you are suffering from mild to moderate osteoarthritis pain, simple analgesics such as acetaminophen (Tylenol, others) can provide some relief. It’s important to understand, however, that while acetaminophen can alleviate pain, it doesn't address inflammation. Be sure to inform your doctor if you are taking acetaminophen, because it can affect other medications that you may be taking. Also, ask your doctor about guidance for alcohol use, as consuming three or more alcoholic drinks a day while taking acetaminophen may cause liver damage.
NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. Oral NSAIDs can cause stomach upset, so some prescription NSAIDs come in a patch that you affix to your skin or in a gel form that you can rub on the painful joint. Other NSAID side effects include ringing in your ears, ulcers, stomach or intestinal bleeding, cardiovascular problems, liver and kidney damage, heart failure, fluid retention, and kidney failure. The risk of major side effects is greatest if you use NSAIDs at high dosages for long-term treatment.
Topical Pain RelieversOver-the-counter gels, ointments, creams, and sprays can temporarily ease OA pain and reduce swelling in joints close to the surface of the skin, such as fingers, knees, and elbows. Topical pain relievers include trolamine salicylate (found in Aspercreme and Sportscreme); methyl salicylate, menthol, and camphor (found in Double Ice ArthriCare, Eucalyptamint, Icy Hot, and Ben-Gay); or capsaicin from the seeds of hot chili peppers (found in Zostrix and Capzasin-P).
COX-2 InhibitorsCOX-2 Inhibitors are as effective for managing pain and inflammation as NSAIDs, but they have fewer stomach-injuring side effects. Examples include celecoxib (Celebrex). They are more expensive than NSAIDs and do have side effects of their own, including fluid retention (which may worsen heart failure) and stomach ulcers, especially if you have experienced gastrointestinal bleeding in the past. They may also be associated with an increased risk of heart attack, transient ischemic attack, or stroke. The risk is greater if you have heart disease or use NSAIDs for a long time. It's important to discuss the risks and benefits of using these medications with your physician.
TramadolTramadol (Ultram) is a prescription medication that serves as a centrally-acting analgesic. Although it has no anti-inflammatory effect, it helps to alleviate pain with fewer side effects (such as stomach ulcers and bleeding) than those of NSAIDs. Tramadol has been known to cause nausea and constipation. Generally, this drug is used for short-term treatment of acute flare-ups, or it is used in combination with acetaminophen to increase pain relief.
Stronger PainkillersPrescription pain medication, such as codeine and propoxyphene (Darvon), may provide relief from more severe osteoarthritis pain but also carry a risk of dependence. Side effects may include nausea, constipation, and sleepiness.
AntidepressantsAntidepressants can help alleviate the depression associated with chronic pain while helping to reduce pain. Those used for arthritis treatment are amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane), imipramine (Tofranil, Norfranil) and nortriptyline (Pamelor, Aventyl).
I’ve tried a variety of drugs to help me cope with the pain, and they aren’t providing enough relief. I don’t feel ready for surgery; are there any other treatments available to me?
Intra-articular injections of cortisone made directly into the arthritic joint can also provide pain relief. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into an area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further discussion with your physician may be needed to identify other treatment options.
Viscosupplementation is a newer therapy, proven useful in animals, that has been developed to treat patients with long-standing, painful osteoarthritis who might not be appropriate for more traditional therapy. In normal joint function, synovial fluid has the ability to change from viscous properties to elastic properties as load is increased. This is important to provide a frictionless surface. Hyaluronic acid is an important high molecular weight component of synovial fluid. Enzymes and free radicals, generated during inflammation in osteoarthritis, degrade hyaluronic acid such that it loses its viscous and elastic properties. In addition to contributing to loss of joint function, some research has postulated that the degraded hyaluronic acid in itself contributes further to joint damage. Viscosupplementation with hyaluronic acid may delay and possibly halt progression of osteoarthritis.
"Nutraceuticals", such as glucosamine and chondroitin sulfate, are also available. The purported effect of these supplements is to enhance cartilage metabolism, minimize progressive degeneration and possibly promote cartilage regeneration. However, because these substances are not regulated by the FDA, and because there is insufficient clinical data to demonstrate their efficacy, it is difficult to assess their true value at this time.
Are there exercises that I can do to improve my joint flexibility, strength, and fitness, and to relieve my pain?
A regular exercise program is crucial to managing your osteoarthritis and staying well. The proven physical benefits of exercise – improved joint flexibility, strength, fitness, as well as more energy, and better pain relief – will help you optimize your physical mobility now and in the future.
Consult with your physician and seek the guidance of an experienced physical therapist; performing the wrong exercises can place undue stress on the joint and exacerbate the condition.
View more information on exercise and OA.
What activity modifications can be done to help alleviate osteoarthritis pain?
When should I consider surgery?
When conservative measures for treating osteoarthritis fail and pain in a specific joint disables an active individual, surgery may restore a patient’s comfort and ability to pursue normal activities. Since such a surgery will relieve pain more than it will restore range of motion. the best candidate for surgery is the patient whose arthritic pain has interrupted the activity of daily living (i.e. can't walk more than a block or awakens from sleep with pain in the affected joint) and who has not been helped sufficiently by activity modification, physical therapy and drug therapy. For such patients, surgery relieves joint pain and improves their quality of life. The type of surgery recommended will depend on a patient’s age, activity level, and the joint involved. When appropriate, total joint replacements are available for almost every joint in the body. Learn more about Total Joint Arthroplasty of the
knee or
hip.
