What to know about osteoarthritis

According to the Arthritis Foundation, symptoms of this condition typically appear in people over 50.

Some people may experience pain and issues with mobility due to a small amount of damage, while others can have a lot of damage to the joint but few or no symptoms.

When symptoms develop, they can include:

• pain and stiffness that worsen after not moving the joint for a while
• swelling
• difficulty moving the affected joint
• warmth and tenderness in the joints
• a loss of muscle bulk

At the later stages, there may also be inflammation and hypertrophy to synovial tissue surrounding the joints. In end-stage OA, calcium phosphate and calcium pyrophosphate dihydrate crystals can be present in the joints.

Cartilage is a protective substance that cushions the ends of the bones in the joints and allows the joints to move smoothly and easily.

In people with OA, the smooth surface of the cartilage becomes rough and starts to wear away. As a result, the unprotected bones start to rub together, causing damage and pain.

Eventually, bony lumps form on the joint. The medical names are “bone spurs” or “osteophytes,” which can lead to a knobbly joint appearance.

As the bones change shape, the joints become stiffer, less mobile, and more painful. Fluid may also accumulate in the joint, resulting in swelling.

While OA can develop in any joint, it commonly affects the:

• knees
• hips
• hands
• lower back
• neck

The knees

The more common presentation of OA is in one knee due to injury, but it can occur in both knees.

People with the condition may notice pain when walking, especially uphill or upstairs, and a soft, grating sound when they bend or flex the knee.

Learn more about OA of the knee here.

The hips

OA in the hips can also cause pain in the:

• groin area
• buttocks
• the inside of the knee or thigh

A person with OA in the hips may find that any movement of the hip joint, such as walking or standing up, can cause difficulty or discomfort. Hips may “lock” in a position.

Find more ways to treat OA in the hips here.

The hands

OA commonly affects three parts of the hand:

• the base of the thumb
• the top joint of the fingers, closest to the nail
• the middle joint of the fingers

A person with the condition may notice:

• pain that may come and go and become more constant as OA progresses
• stiffness and difficulty opening and closing fingers completely
• a grating or crackling sound in the joint, known as crepitus
• swelling in the fingers
• nodules that develop on the finger joints, either the middle joint or joint near the fingertip
• joint deformity
• weakness

Learn more about arthritis in the fingers here.

Lower back

The first signs of osteoarthritis in the lower back or spine are pain and stiffness in the back or neck.

Symptoms will vary from person to person. The most common are stiffness, especially in the morning or after resting, and crunching or grinding noises when moving the back or neck.

Read more about spinal OA here.

Neck

Osteoarthritis in the neck results from the degeneration of joints, vertebrae, and spinal discs. Doctors also refer to this condition as:

• arthritis of the neck
• cervical osteoarthritis
• cervical spondylosis

Symptoms of neck OA range from few to no symptoms to pain, stiffness, and inflammation. Neck pain from OA tends to worsen after activity. A person may also develop bone spurs.

Complications such as losing coordination can occur if the spinal cord becomes pinched.

Doctors do not know the exact cause of OA, but the following risk factors increase the chances of developing it:

• Gender: OA is more common in females than males.
• Age: Symptoms are more likely to appear at a later age.
• Obesity: Excess weight can add stress to weight-bearing joints, increasing the risk of damage.
• Genetic and hereditary factors: People with family members with OA are more likely to develop the condition.
• Joint injury or overuse: Trauma or repetitive joint use can cause stress and damage, increasing the risk of OA in that joint.

Additional causes that may contribute to its development include environmental factors, such as:

• a person’s occupation
• level of physical activity and quadriceps strength
• diet
• sex hormones
• bone density

A doctor will usually ask about symptoms and perform a physical examination.

No definitive test can diagnose OA, but tests can show whether damage has occurred and help rule out other causes.

Tests include:

• X-rays and MRI scan: These can reveal bone spurs around a joint or a narrowing within a joint, suggesting that cartilage is breaking down. Doctors do not routinely use MRI scans, but they can detect OA at the earlier stages.
• Joint fluid analysis: A doctor will use a sterile needle to withdraw fluid from an inflamed joint for analysis. This can rule out gout or an infection.
• Blood tests: These can help rule out other conditions, such as inflammatory arthritis.
• Ultrasound: This scan can assess if there is inflammation.

While no treatment can reverse the damage of OA, some can help relieve symptoms and maintain mobility in the affected joints.

Interventions include:

• medication
• physical therapy
• assistive devices
• surgery
• lifestyle modifications

Medication

Medication can help reduce pain; some examples include:

Acetaminophen (Tylenol)

This can relieve pain in people with mild to moderate symptoms. A person should follow their doctor’s instructions as overuse can cause side effects and interactions with other medications.

Nonsteroidal anti-inflammatory drugs

If acetaminophen does not help, the doctor may recommend a stronger pain reliever, including:

• ibuprofen
• aspirin
• diclofenac

A person can take these orally or topically, applying the medication to the skin.

Capsaicin cream

This is a topical medication that contains the active compound in chilies. It creates a heat sensation that can reduce substance P levels, a chemical that acts as a pain messenger.

People should not use the cream on broken or inflamed skin and avoid touching the eyes, face, and genitals after using it.

Intra-articular cortisone injections

Corticosteroid injections in the joint can help manage severe pain, swelling, and inflammation. Learn more about knee injections for OA here.

These are effective, but long-term use can lead to adverse effects, including joint damage and a higher risk of osteoporosis.

Duloxetine (Cymbalta) is an oral drug that can help treat chronic musculoskeletal pain.

Read more about the medications for OA here.

Physical therapy

Various types of physical therapy may help, including thermotherapy — heat and cold can help reduce joint pain and stiffness. A person can try wrapping a hot water bottle or an ice pack in a towel and placing it on the affected joint.

Another option is manual therapy. This involves a physical therapist using hands-on techniques to help keep the joints flexible and supple.

Assistive devices

Various tools can provide physical support for a person with OA:

• Special footwear or insoles: These can help if OA affects the knees, hips, or feet by distributing body weight more evenly. Some shock-absorbing insoles can also reduce the pressure on the joints. Find out more about shoes for knee OA here.
• A stick or cane: This can help take the weight off the affected joints and may reduce the risk of a fall. A person should use it on the side of the body opposite the areas with OA.
• Splints, leg braces, and supportive dressings: These can help with resting a painful joint. A splint is a rigid material providing joint or bone support. Learn more about knee braces here.

Surgery

Joint surgery can help improve pain and movement by replacing damaged joints. The joints that doctors most commonly replace are the hips and knees.

A surgeon can determine the best procedure for a person according to how badly damaged the joint is. Some helpful procedures include:

Arthroplasty

This involves a surgeon removing the damaged areas and inserting an artificial joint made of metal and plastic. Some doctors refer to this procedure as a total joint replacement.

The joints that most often need replacing are the hip and knee joints, but implants can also replace the joints in the:

• shoulders
• fingers
• ankles
• elbows

However, there is a risk that the implants will not fully replicate normal motion.

Learn more about knee replacement surgery here.

Arthrodesis

Arthrodesis involves a surgeon fusing the joint’s bones to promote the strengthening and stabilizing of the joint.

Osteotomy

This involves a surgeon removing a small section of bone, either above or below the knee joint. Medical professionals reshape the bone to relieve pressure on the part of the joint.

Possible complications of surgery

Septic arthritis is joint inflammation resulting from bacteria. Joint replacement surgery slightly increases the risk of infection.

This is a medical emergency, and hospitalization is necessary. Treatment involves antibiotic medication and drainage of the infected fluid from the joint. In severe cases, further surgery is necessary.

A range of strategies can help ease the symptoms of OA. People can consult a doctor for advice about suitable lifestyle adjustments. The doctor may recommend:

Exercise and maintaining a healthy weight

Excess weight may worsen OA, so doctors recommend people try to maintain a healthy weight through a balanced diet and exercise.

Current guidelines recommend that people should do at least 150 minutes of moderate-intensity exercise each week.

A doctor or physical therapist can help develop an exercise program, and it is important to follow their instructions carefully to prevent further damage.

Learn more about suitable exercises for knee arthritis here.

Managing blood sugar

High glucose levels, such as in people with diabetes, can make cartilage stiffer, inflamed, and more likely to break down.

A person can follow the treatment plan that their doctor recommends to manage their diabetes.

Learn more about diabetes and joints here.

Protecting joints

Gentle stretching, raising and lowering legs from a standing or seated position, daily walks, and hobbies such as gardening can also help with joint pain.

People should ensure they warm up and cool down before and after doing exercise.

Supplements

2017 research associates vitamin D deficiency with a higher risk of development or progression of OA because vitamin D impacts bone quality. Find out what the best vitamin D supplements are here.

Learn more about joint supplements here.

OA is a common disease that causes joints to deteriorate, leading to pain and stiffness. It tends to appear during middle age or later.

There is currently no cure, but researchers are looking for ways to slow or reverse the damage. Pain relief medications or surgeries are treatment options, but lifestyle remedies can also help manage it, including exercise, stretching, and dietary supplements.