Gerald Hurowitz, M.D.·Published 20 August 2004·6 min read
Key points
Osteoarthritis is one of the most common medical conditions, afflicting an estimated 15.8 million people in the United States.
A health care professional may ask about osteoarthritis in your parents, because osteoarthritis appears to have a genetic component.
Osteoarthritis is a long-lasting condition that usually gets worse slowly over time.
There is no reliable way to prevent most cases of osteoarthritis.
What Is It?
Osteoarthritis is one of the most common medical conditions, afflicting an estimated 15.8 million people in the United States. In many people, it goes unrecognized. It is estimated that as many as half of all those who have osteoarthritis do not know that the pain and stiffness they are experiencing are symptoms of osteoarthritis.
Although the term "arthritis" means joint inflammation, there is relatively little inflammation in the joints of most people with osteoarthritis. For this reason, many experts and health care professionals refer to call it degenerative joint disease because it seems to be caused by age-related "wear and tear" of the joints.
Osteoarthritis occurs when the cartilage of a joint (which normally cushions the joint and protects it from impact) erodes. As bone rubs against bone, a person will feel pain and have difficulty moving the joint. Osteoarthritis also can affect nearby bones, which can become enlarged in places. These enlargements are called bone spurs or osteophytes.
Osteoarthritis can range from mild to severe. The pain associated with osteoarthritis can be significant and it usually is made worse by movement. Osteoarthritis can be limited to one joint or start in one joint — usually the knee, hip, hands, feet or spine — or it can involve a number of joints. If the hand is affected, usually many joints of the fingers become arthritic.
There probably is no single cause of osteoarthritis, and, for most people, no cause can be identified. Age is a leading risk factor, because osteoarthritis usually occurs as people get older. However, research suggests that joint deterioration is not an inevitable part of aging. Other factors seem to contribute to osteoarthritis. Sports-related injuries or repeated small injuries caused by repeated movements on the job may increase the risk of developing osteoarthritis. Genetics also plays a role. Obesity seems to increase the risk of developing osteoarthritis of the knees.
Other factors that increase the risk of osteoarthritis include:
Repeated episodes of bleeding into the joint, as may occur in hemophilia or related bleeding disorders
Repeated episodes of gout or pseudogout, in which uric acid or calcium crystals deposited into the joint cause episodes of inflammation
Avascular necrosis, a condition in which the blood supply to the bone near the joint is interrupted, leading to bone death and eventually joint damage — The hip is affected most often.
Chronic (long-lasting) inflammation caused by previous rheumatic illness, such as rheumatoid arthritis
Osteoporosis, which can increase the risk of bone fractures, sometimes leading to osteoarthritis if they occur near a joint
Metabolic disorders, such as hemochromatosis, in which a genetic abnormality leads to too much iron in the joints and other parts of the body
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
One theory is that some people are born with defective cartilage or slight defects in the way joints fit, and as these people age, they are more likely to have cartilage in the joint break down.
Women are affected by osteoarthritis slightly more often than men.
People who have osteoarthritis often complain of a deep ache, centered in the joint. Typically, the pain is aggravated by using the joint and relieved by rest. However, as the disease progresses, the pain becomes more constant. Often, when the pain is significant during the night, it interferes with sleep.
Symptoms
Symptoms of osteoarthritis include:
Joint pain and swelling after activity or in response to a change of weather
Limited flexibility, especially after not moving for a while
Bony lumps at the end of fingers, called Heberden's nodes, or on the middle joints of fingers, called Bouchard's nodes
A grinding sensation when the joint is moved
Numbness or tingling in an arm or leg, which can happen if the arthritis has caused bone changes that are putting pressure on a nerve, for example in the neck or lower back
Diagnosis
A health care professional may ask about osteoarthritis in your parents, because osteoarthritis appears to have a genetic component.
He or she will examine you, looking for tenderness, warmth and swelling around the joint or joints. There is no test that confirms the diagnosis. Your health-care provider may order X-rays, but osteoarthritis only shows up on X-rays in the later stages of the disease. Your health care professional also may order blood tests to look for evidence of another arthritic condition.
Expected Duration
Osteoarthritis is a long-lasting condition that usually gets worse slowly over time.
Prevention
There is no reliable way to prevent most cases of osteoarthritis. However, you may be able to control some factors that increase the risk of developing the disease. You can:
Maintain an ideal body weight.
Prevent osteoporosis by getting enough exercise, vitamin D and calcium and possibly by taking medication
Prevent major accidents and injuries.
Treating or preventing any associated conditions that might contribute to joint damage (for example, gout or infection) also may prove beneficial.
Treatment
Treatment focuses on managing pain and maintaining the ability to use the joint.
An over-the-counter painkiller, such as acetaminophen (Tylenol), can help to ease stiffness and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others) also may help. However, NSAIDs may be unsafe for people at high risk of developing ulcers, including people who have had ulcers in the past and the elderly. For these people, newer medications called cyclooxygenase-2 (COX-2) inhibitors, including celecoxib (Celebrex), rofecoxib (Vioxx) and valdecoxib (Bextra), may be safer. All of these medications should only be taken under the supervision of a physician. Do not combine them with other drugs without consulting your physician. Stomach problems, including ulcers, are the most common side effects of these medications. Other pain medications, such as tramadol (Ultram) or codeine-type medicines, may be prescribed if the other medicines don't work.
In rare instances, when inflammation is significant, your health care professional may remove fluid from the joint and inject the joint with a corticosteroid drug. This is recommended for acute problems with weight-bearing joints, usually the knee. However, these drugs can damage the joint if they are used too much, so your health-care provider will use them only when absolutely necessary.
A newer treatment that may help is a series of injections of a substance called hyaluronate (brand names Synvisc and Hyalgan). Hyaluronate is a chemical that provides lubrication and nutrition to the joint. Synvisc and Hyalgan are synthesized forms that can be injected weekly for three to five weeks into an osteoarthritic knee. Some studies suggest that these injections help, although others have found no benefit.
Studies also suggest that an over-the-counter supplement called glucosamine sulfate is safe and may help people with osteoarthritis in the knees. A study published in 2001 described improvement over three years for patients taking 1,500 milligrams of glucosamine a day compared with a placebo (an inactive pill). Whether joint deterioration can be slowed or stopped by treatment with glucosamine is a matter of debate. A more definitive study sponsored by the U.S. National Institutes of Health is ongoing and should help sort out many unknowns about glucosamine therapy.
Over-the-counter creams containing capsaicin applied to the skin over painful joints also may help.
Applying heat or cold can relieve pain temporarily. Your health care professional also can advise you on the use of heating pads, hot baths and ice packs to ease the discomfort.
Your health care professional likely will suggest that you engage in certain exercises to reduce stiffness and improve your ability to move the joints. Because extra pounds put pressure on sensitive joints, it is important that you control your weight. In addition, if you have osteoarthritis of the spine, it is important to maintain good posture to distribute weight and pressure evenly throughout the body.
In severe cases where deterioration is significant, your health care professional may recommend surgery to correct deformity in a joint or to reconstruct or replace a hip or knee joint.
When To Call A Professional
You should contact a health care professional if you have joint pain, a grinding sensation in joints or limited joint motion.
Prognosis
When treated properly, osteoarthritis is rarely crippling. However, it is a long-lasting disease that may require ongoing care and possible changes in treatment over time.
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