Overview of Osteoarthritis
Osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time. It is the most common type of arthritis and is more common in older people.
People with osteoarthritis usually have joint pain and, after rest or inactivity, stiffness for a short period of time. The most commonly affected joints include the:
- Hands (ends of the fingers and at the base and ends of the thumbs).
- Lower back.
Osteoarthritis affects each person differently. For some people, osteoarthritis is relatively mild and does not affect day-to-day activities. For others, it causes significant pain and disability. Joint damage usually develops gradually over years, although it could worsen quickly in some people.
What happens in osteoarthritis?
Researchers do not know what triggers or starts the breakdown of the tissues in the joint. However, as osteoarthritis begins to develop, it can damage all the areas of the joint, including:
- Cartilage, the tissue that covers the ends where two bones meet to form a joint.
- Tendons and ligaments.
- Synovium, the lining of the joint.
- Meniscus in the knee.
As the damage of soft tissues in the joint progresses, pain, swelling, and loss of joint motion develops. If you have joint pain, you may be less active, and this can lead to muscle weakness, which may cause more stress on the joint. Over time, the joint may lose its normal shape. Also, small bone growths, called osteophytes or bone spurs, may grow on the edges of the joint. The shape of the bone may also change. Bits of bone or cartilage can also break off and float inside the joint space. This causes more damage. Researchers continue to study the cause of pain in people who have osteoarthritis.
Who Gets Osteoarthritis?
Anyone can get osteoarthritis; however, it is more common as people age. Women are more likely than men to have osteoarthritis, especially after age 50. For many women, it develops after menopause.
Younger people can also develop osteoarthritis, usually as the result of:
- Joint injury.
- Abnormal joint structure.
- Genetic defect in joint cartilage.
Symptoms of Osteoarthritis
The symptoms of osteoarthritis often begin slowly and usually begin with one or a few joints. The common symptoms of osteoarthritis include:
- Pain when using the joint, which may improve with rest. For some people, in the later stages of the disease, the pain may be worse at night. Pain can be localized or widespread.
- Joint stiffness, usually lasting less than 30 minutes, in the morning or after resting for a period of time.
- Joint changes that can limit joint movement.
- Swelling in and around the joint, especially after a lot of activity or use of that area.
- Changes in the ability to move the joint.
- Feeling that the joint is loose or unstable.
Osteoarthritis symptoms can affect joints differently. For example:
- Hands. Bony enlargements and shape changes in the finger joints can happen over time.
- Knees. When walking or moving, you may hear a grinding or scaping noise. Over time, muscle and ligament weakness can cause the knee to buckle.
- Hips. You might feel pain and stiffness in the hip joint or in the groin, inner thigh, or buttocks. Sometimes, the pain from arthritis in the hip can radiate (spread) to the knees. Over time, you may not be able to move your hip as far as you did in the past.
- Spine. You may feel stiffness and pain in the neck or lower back. As changes in the spine happen, some people develop spinal stenosis, which can lead to other symptoms.
As your symptoms worsen over time, activities that you could participate in become difficult to do, such as stepping up, getting on or off the toilet or in and out of a chair, gripping a pan, or walking across a parking lot.
Pain and other symptoms of osteoarthritis may lead you to feel tired, have problems sleeping, and feel depressed.
Cause of Osteoarthritis
Osteoarthritis happens when the cartilage and other tissues within the joint break down or have a change in their structure. This does not happen because of simple wear and tear on the joints. Instead, changes in the tissue can trigger the breakdown, which usually happens gradually over time.
Certain factors may make it more likely for you to develop the disease, including:
- Being overweight or obese.
- History of injury or surgery to a joint.
- Overuse from repetitive movements of the joint.
- Joints that do not form correctly.
- Family history of osteoarthritis.
Diagnosis of Osteoarthritis
There is no single test for osteoarthritis. Diagnosing the condition may include the following:
- Providing to a doctor a medical history that includes your symptoms, any other medical problems you and your close family members have, and any medications you are taking.
- Having a physical exam to check your general health, reflexes, and problem joints.
- Having images taken of your joint using:
- X-rays, which can show loss of joint space, bone damage, bone remodeling, and bone spurs. Early joint damage does not usually appear on x-rays.
- Magnetic resonance imaging (MRI), which can show damage to soft tissues in and around the joint. Generally, MRI helps to evaluate a joint that is locking or giving out.
- Having blood tests to rule out other causes for symptoms.
- Taking joint fluid samples to look for other causes of joint pain, such as infection or gout.
Treatment of Osteoarthritis
The goals of your treatment for osteoarthritis include:
- Reducing pain and other symptoms.
- Improving joint function.
- Stopping the disease from progressing.
- Maintaining a health-related quality of life to help prevent disability.
Treating osteoarthritis usually begins with:
- Learning about osteoarthritis. Your doctor may recommend classes that you can attend or online programs you can join.
- Exercising, which can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Remember to start any exercise program slowly and take the time to adjust to the new level of activity. You should speak to your doctor or physical therapist about a safe, well-rounded exercise program, which may include:
- Range-of-motion and stretching activities to keep your joints limber.
- Strengthening exercises performed with weights or exercise bands to strengthen muscles that support joints affected by arthritis.
- Exercises in the water to help lower the stress on the joints while exercising.
- Balance and agility exercises to help you maintain daily living skills.
- Low-impact activities that give you a moderate level of activity without putting stress on the joints. These may include walking, cycling, swimming, tai chi, water aerobics, or a low-impact aerobics class.
- Managing your weight can help reduce the stress on joints. In addition, if you are overweight or obese, losing weight can help to reduce pain, prevent more injury, and increase mobility in the joints. This can be especially helpful for weight-bearing joints such as your knees or hips.
- Using braces or orthotics that your doctor prescribes and that are fitted by a health care professional may be helpful to stabilize a joint affected by osteoarthritis.
Some people may need medications to help manage the symptoms of osteoarthritis, including:
- Oral pain relievers.
- Oral anti-inflammatory medications to treat pain and inflammation.
- Topical creams, rubs, or sprays that you apply to the skin over sore joints to relieve pain.
- Corticosteroids, strong inflammation-fighting drugs that are usually injected into the joint to temporarily relieve pain. Because they are potent drugs, your doctor will determine how many injections you should receive and how often to achieve the desired benefit.
- Hyaluronic acid substitutes (viscosupplements), which are injected into the knee to replace a normal component of the joint involved in lubrication and nutrition are sometimes recommended for knee osteoarthritis.
- Selective serotonin and norepinephrine reuptake inhibitors that you take orally to help control chronic (long-term) pain.
If other treatments are not helping and if the joint damage is extensive, some people may have surgery. When considering surgery, many factors may determine if it is the right option, including your age, pain intensity, the degree to which arthritis interferes with your lifestyle, level of disability, and occupation. Surgeries may include one or more of the following:
- Osteotomy: Surgical removal of a piece of bone.
- Partial or total joint replacement surgery: Removal of part of all of the damaged joint and replacing it with a new joint made of plastic, metal, or ceramic.
Other therapies such as massage can increase blood flow and bring warmth to the area. Some research shows that acupuncture may help relieve osteoarthritis pain. Doctors believe that the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system. Before using other therapies, talk to your doctor about the best options for your treatment.
Who Treats Osteoarthritis?
Treating osteoarthritis requires a team effort involving you and several types of health care professionals. These may include:
- Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
- Primary care doctors, such as a family physician or internal medicine specialist, who coordinates care between the different health providers and treats other problems as they arise.
- Orthopaedic surgeons, who specialize in treatment and surgery for bone and joint diseases.
- Physical therapists, who help improve joint function.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Dietitians, who teach about nutrition and maintaining a healthy weight.
- Nurse educators, who help you understand your condition and help start treatment plans.
- Physiatrists (physical, medicine, and rehabilitation specialists), who supervise exercise programs.
- Psychologists or social workers, who help with psychosocial challenges caused by medical conditions.
- Chiropractors, who focus treatment on the relationship between the body's structure, mainly the spine, and its functioning.
Living With Osteoarthritis
There are many things you can do to help you live with osteoarthritis, including:
- Heat and cold therapies can reduce joint pain. Heat therapy increases blood flow, tolerance for pain, and flexibility. Cold therapy numbs the nerves around the joint to reduce pain and may relieve inflammation.
- Support or assistive devices such as a cane or walker can help you move around safely, provide stability, and lower pain. If you have arthritis in your hands, you may find it helpful to use devices to help you grip, such as jar openers.
- Try to avoid repetitive motions, such as frequent bending.
- Shoe inserts or braces can help support your joint and help lower pain and pressure on the area. This can be helpful when you stand or walk.
- Make appointments to see your health care provider. This allows you to participate in your treatment and talk about your symptoms. Some people find it helpful to join a class that provides information on osteoarthritis and how to manage the symptoms to allow you to live an active lifestyle.
- Support groups, both online and in your community, can help you cope and offer tips on how to emotionally manage having the disease and live a healthy lifestyle.
Research Progress Related to Osteoarthritis
NIAMS-funded research helps find new discoveries allowing people to live longer, healthier lives. NIAMS and the National Institutes of Health support research on osteoarthritis and are studying:
- Epidemiology and pathogenesis of osteoarthritis.
- Different risk factors for osteoarthritis.
- Treatment options, prevention, and diagnosis of the disease.
- Imaging methods for cartilage and joints.
In addition, studies continue to:
- Evaluate human genetics of bone and cartilage and their interactions with the environment.
- Examine biomarkers for osteoarthritis as potential surrogate endpoints for disease onset and progression.
- Evaluate the effectiveness of weight loss and exercise in managing the symptoms and outcomes in people with osteoarthritis of the knee.
- Compare how different biologic factors may influence pain relief in people with osteoarthritis.
Read more about NIAMS-Supported Research Programs.