Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, and it affects millions of people worldwide.

OA breaks down the cartilage in your joints. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage absorbs the shock of movement. When cartilage is damaged, bones rub together. Over time, this rubbing can permanently damage the joint.

OA causes pain, swelling, and reduced motion in your joints. It can occur in any joint, but it usually affects the hands, knees, hips, or spine. OA symptoms gradually worsen over time, but staying active and maintaining a healthy weight can improve symptoms. Medicines and other treatments can slow the progression of OA. Risk factors for OA include being overweight, getting older, and injuring a joint.

Symptoms of OA vary, depending on which joints are affected and how severely they are affected. However, the most common symptoms are pain and stiffness, especially first thing in the morning or after resting. Affected joints may get swollen, especially after extended activity.

Common signs and symptoms of OA include:

• pain. Your joint may hurt during or after movement.
• tenderness. Your joint may feel tender when you apply light pressure to it.
• stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
• loss of flexibility. You may not be able to move your joint through its full range of motion.
• grating sensation. You may hear or feel a grating sensation when you use the joint.
• bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

OA occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In OA, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

OA usually happens gradually over time. Some risk factors that might lead to OA include:

• being overweight
• getting older
• joint injury
• joints that are not properly formed
• a genetic defect in joint cartilage
• stresses on the joints from certain jobs and playing sports

No single test can diagnose OA. Most doctors use several methods, including medical history, a physical exam, imaging tests, or lab tests.

Medical history. Your doctor will start by asking you to describe your symptoms, when and how those symptoms began, and how they have changed over time. The doctor will also review any other health problems, any medications you are taking, and your family history of related medical conditions.

Physical examination. Your doctor will examine your reflexes, muscle strength, and general health, as well as evaluate any bothersome joints and assess your ability to walk, bend, and do day-to-day activities.

X-rays. X-ray images can help doctors figure out which type of arthritis you have and how much the joints have been damaged. X-rays of arthritic joints reveal cartilage loss, bone damage, and bone spurs.

Magnetic resonance imaging (MRI). MRIs provide high-resolution computerized views of the tissues inside the body. A doctor may use MRI to better diagnose OA if you have pain, especially if X-ray findings do not reveal OA.

Your doctor may use other blood or laboratory tests to rule out other conditions that might be causing symptoms. The doctor also may order a joint aspiration, a test in which fluid is drawn from the joint. The fluid sample might show bacteria, which would suggest that joint pain is the result of infection, or it might show uric acid crystals, which would suggest gout is to blame for joint pain.

The pain, reduced mobility, side effects from medication, and other factors associated with OA can lead to negative health effects not directly related to the joint disease. For example, knee or hip pain may lead to a sedentary lifestyle that promotes weight gain and possible obesity. Being overweight or obese can lead to the development of diabetes, heart disease, and high blood pressure.

Also, people with OA experience more falls and have greater risk of facture than people without OA due to decreased function, muscle weakness, and impaired balance that make them more likely to fall. Side effects from medications used for pain relief can also contribute to falls, such as narcotic pain relievers that can make people feel dizzy and unbalanced.

Lifestyle changes and home treatments also can help reduce OA symptoms. People with OA should exercise regularly, manage stress and engage in relaxing activities and maintain good communication with their doctor or other health care providers.

Exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. If you feel new joint pain while exercising, stop.

Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.

Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.

Use assistive devices. Assistive devices, such as scooters, canes, walkers, or special tools or grips, can make it easier to go about your day without stressing your painful joint. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you.

Patient education programs and support groups can help people learn about OA and self-care. It is important people that people maintain good overall health and a positive attitude after a diagnosis of OA.

With education and self-care, people with OA can:

• understand the disease
• reduce pain
• stay active
• cope with their body, mind, and emotions
• have more control over the disease
• live an active, independent life

A positive attitude helps people with OA:

• focus on what they can do, not what they cannot do
• focus on their strengths, not their weaknesses
• break down activities into small tasks that are easy to manage
• build fitness and healthy eating into their daily routines
• develop ways to lower and manage stress
• balance rest with activity
• develop a support system of family, friends, and health care providers

Doctors often combine treatments to fit a patient's needs, lifestyle, and health. The goals of OA treatment are to improve joint function, maintain a healthy body weight, control pain, and achieve a healthy lifestyle.

Many OA treatment plans involve combinations of:

• exercise
• weight control
• rest and joint care
• nondrug pain relief techniques to control pain
• medicines
• complementary and alternative therapies
• surgery

OA symptoms may be helped by certain medications, including:

Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it does not reduce inflammation. It is effective for people with OA who have mild to moderate pain. Do not take more than the recommended dosage of acetaminophen.

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain associated with OA. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others). Topical NSAIDS have fewer side effects and may relieve pain just as well. Prescription NSAIDS include celecoxib (Celebrex), meloxicam (Mobic), indomethacin (Indocin, Tivorbex), and diclofenac (Voltaren, Cataflam, Pennsaid, others).

Corticosteroids. Corticosteroids reduce inflammation associated with OA, but these should not be taken for a long time.

Many people with OA use natural or alternative therapies to address symptoms and improve their overall well-being. Therapies may include nutritional supplements, acupuncture or acupressure, massage, relaxation techniques, or hydrotherapy.

Joint surgery can repair or replace severely damaged joints, especially hips or knees.