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Definition

Cartilage is smooth tissue that covers the bone in a joint. Osteoarthritis (OA) is a gradual wearing down of cartilage. It can cause pain and limit movement.

Joints Affected by Osteoarthritis

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Causes  ^

Cartilage is smooth tissue that covers the areas of bone that make up a joint. It provides a cushion for the bones and helps the joint work smoothly. Over time the impact, stress, and pressure on the joint can wear down the cartilage. The damage worsens over time. The cartilage may completely wear away and the bare bones rub together. Bone on bone friction causes pain and inflammation.

The wear and tear of the joint is a part of aging. However, it can be made worse. Injuries to the joint, weak muscles, or other medical conditions all add to and speed up the damage.

Risk Factors  ^

OA is more common in older adults. Other factors that may increase your chance of OA include:

  • Excess body weight
  • Family history of OA
  • Having an injury or surgery to the joint surface, especially the cartilage
  • Having a job or doing physical activities that put stress on the joints
  • Certain endocrine, metabolic, or neuropathic disorders
  • Avascular necrosis—death of bone from lack of blood flow

Symptoms  ^

OA is most common in larger joints that support weight such as the spine, hips, and knees. It is also common in active joints like the hand and feet. Common symptoms include:

  • Mild to severe pain in a joint, especially after overuse or long periods of rest
  • Creaking or grating sound in the joint
  • Swelling, stiffness, and problems moving the joint, especially in the morning
  • Decreased stiffness after starting activity

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done. The doctor can often diagnose OA based on your symptoms.

Other tests are not always needed. The doctor may do more tests if your symptoms are not typical. The tests can help to rule out other issues like new injury. Test options may include:

  • X-ray—damage from OA can be seen on x-ray
  • Blood tests—to look for signs of infection or markers of joint disease
  • MRI scan—to rule out injuries
  • Ultrasound

Treatment  ^

OA cannot be cured. Treatment is focused on:

  • Reducing joint pain and inflammation
  • Improving joint function
  • Slowing future damage

Options may include:

Weight Loss

Losing weight can lessen the stress on joints. The closer you are to your ideal weight, the greater the benefit. A dietitian can help with meal planning.

Exercise and Therapy

Muscles affect the alignment of the joint, how they move, and how much stress is placed on them. The stronger the muscles the less wear and tear happens with each movement. This can help slow progression of OA.

Strengthening the muscles that support the joint may also decrease OA pain and improve movement. Low impact options may help. For example, swimming and water aerobics improve muscle health with less impact on the joints. The doctor or an exercise specialist can help to create a program.

OA can make everyday tasks difficult. Physical or occupational therapy can provide new steps or devices to help you such as:

  • Shoes with shock-absorbing insoles
  • Splints or braces to align joints and distribute weight
  • Elastic supports
  • Canes, crutches, walkers, and orthopedic shoes
  • Home tools, such as handrails and grips or raised seats, including toilet seats

Other therapy options include:

  • Transcutaneous electrical nerve stimulation (TENS)—electrical pulses that can reduce pain signals
  • Manual therapy—therapies such as massage therapy can improve muscle balance and joint alignment

Medications

Medications may help to manage pain or swelling. Options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Topical pain medicines that are applied to the skin—capsacian is a common choice
  • Prescription pain medicines
  • Corticosteroid—may be by mouth or by injection
  • Viscosupplementation injection (hyaluronic acid)—to replace low levels and help cushion the joint

Heat and Ice

Heat may help loosen stiff joints and improve movement. Hot water bottles, warm soaks, paraffin, or heating pads may help.

Ice may help decrease swelling and pain. It may be most useful after activity.

Alternative Treatments

Alternative therapies may give some relief. It is best when used in combination with treatments above. It is important to work with your doctor to make sure all your efforts work together. Alternative options that have shown some promise with OA include:

Surgery

Surgery may be needed for joints that are causing severe limits. It may be done to:

  • Remove loose pieces of bone or cartilage from joints
  • Reposition bones to balance stress on the joint
  • Replace a damaged joint with an artificial one

Prevention  ^

To reduce your chance of OA:

  • Maintain a healthy weight.
  • Do regular exercise, such as walking, stretching, swimming, or yoga.
  • Avoid repetitive motions and risky activities that may lead to joint injury. This is even more important after age 40.
RESOURCES:

American College of Rheumatology
http://www.rheumatology.org

The Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca

Seniors Canada
http://www.seniors.gc.ca

REFERENCES:

Degenerative arthritis (list of topics). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 21, 2014. Accessed May 11, 2016.

Hochberg MC, Altman RD, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-474.

Fernandes L, Hagen KB, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125-1135.

Living with arthritis. Arthritis Foundation website. Available at: http://www.arthritistoday.org/about-arthritis/types-of-arthritis/osteoarthritis. Accessed May 11, 2016.

Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp. Updated April 2015. Accessed May 11, 2016.

Sinusas, K. Osteoarthritis: Diagnosis and treatment. Am Fam Physician. 2012;85(1):49-56.

van den Berg WB. Pathophysiology of osteoarthritis. Joint Bone Spine. 2000;67:555-556.

10/21/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;CD004376.

12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Rutjes WJ, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.

10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.

10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

11/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm. Updated November 4, 2010. Accessed May 11, 2016.

11/29/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Man Ther. 2011;16(2):109-117.

7/15/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dilek B, Gözüm M, Sahin E, et al. Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2013 Apr;94(4):642-9.

6/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: MQIC guideline on medical management of adults with osteoarthritis. Available at: http://www.guideline.gov/content.aspx?id=47806. Updated August 1, 2013. Accessed June 29, 2015.

9/3/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Zhou ZY, Liu YK, et al. Body mass index and knee osteoarthritis risk: A dose-response meta-analysis. Obesity (Silver Spring). 2014 Jul [Epub ahead of print].

1/5/2018 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T916957/Injection-therapy-for-osteoarthritis-OA-of-the-knee: Krsticevic M, Jeric M, et al. Proliferative injection therapy for osteoarthritis: a systemic review. Int Orthop. 2017 Apr;41(4):671-679.

Last reviewed September 2017 by Warren A. Bodine, DO, CAQSM  Last Updated: 12/29/2017

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