Osteoarthritis (OA) is the most common type of arthritis and is caused by the breakdown of cartilage in the joints. When the cartilage in a joint begins to break down it results in the swelling and pain in the joint. As the cartilage continues to wear away the bones begin to rub against each other; this bone on bone contact causes stiffness, swelling, and pain in the joint.
OA is a degenerative form of arthritis and is a chronic (long-term) disease. As it is caused by wearing away of the cartilage, more people develop OA as they age. It usually occurs when people are aged 50 years or older. OA is more common in women than in men.
OA can sometimes run in families, especially when it affects the small joints in the hands. Other risk factors for OA include age, being overweight, excessive use of a joint, and suffering a serious injury to a joint. People who are overweight are at higher risk of getting OA in their weight-bearing joints such as the knees, hips, and the joints in their feet.
The most common symptom of osteoarthritis (OA) is joint pain and stiffness. It usually starts slowly and gets worse with time. Many patients don’t notice it at first.
Different people tend to show different symptoms. They can experience varying levels of discomfort and reduced joint mobility. In some people, joint pain and stiffness caused by OA can reduce the quality of sleep and lead to fatigue.
Joints that are commonly affected by osteoarthritis include the knees and the hips. Other joints can also be affected. These frequently include the:
- End joints or middle joints of fingers
- Base of the thumb
- Base of the big toe (this can form a bunion)
- Low back (this is also known as degenerative disc disease)
In people with OA, affected joints can feel stiff after a period of rest or when they wake up in the morning. The morning stiffness usually lasts only 20 to 30 minutes, until the joints get “worked out”.
Joint pain is usually worse after people with OA use their affected joints, and it gets better after the joints are rested for a period of time. When OA is more severe, the pain can continue throughout the day, even after periods of rest.
Osteoarthritis can also cause swelling of the joints. This can reduce the joints’ flexibility, and can cause a loss of strength.
Osteoarthritis is diagnosed by a thorough assessment and physical examination by a physician familiar with the disease. Many family physicians are very comfortable making this diagnosis.
Following an initial assessment, patients may also be sent for x-rays and blood tests to confirm the diagnosis.
Common Tests to Diagnose OA
X-Rays are one of the best tests to diagnose osteoarthritis because the changes in joints caused by OA can often be easily identified in x-ray images. OA’s tell-tale signs are very well described, and are easily recognizable by trained physicians.
Blood tests to rule out other conditions: It is sometimes difficult to distinguish OA from other forms of arthritis because there are about 100 different types of the disease. Blood tests help rule out other diagnoses.
Osteoarthritis occurs when the cartilage at the ends of the bones wear down. Cartilage helps protect the ends of the bones by working as a shock absorber for joints. It also helps them move smoothly. The reason that cartilage wears down is not well understood.
When cartilage starts to wear away, the ends of the bones in a joint may come into contact with one another (“bone on bone”). This can cause inflammation of the affected joints. The word inflammation comes from the Latin word inflammare which means to light on fire. In people with OA, inflammation causes the joints to become warm, swollen, and painful. Affected joints can feel like they’re on fire.
When joints are inflamed, the body tries to repair itself by growing new bone. It is thought that this is the body’s attempt to strengthen the damaged joint. Unfortunately, this part of the body’s healing process doesn’t work well for OA. It can result in the formation of nodes, or bumps of new bone growth around the joint. This occurs most commonly when joints in the hands are affected by OA. The inflammation and nodes can cause joint stiffness and pain.
Age is a significant risk factor in OA. Although it can occur at any age, people aged 50 and over have experienced more wear and tear on the cartilage in their joints and are more likely to get the disease. Women are more likely to get OA than men, but it is not understood why.
People who are overweight also have a higher chance of developing OA, especially in weight-bearing joints like the knees, hips, and feet. Even a little bit of weight loss (as few as 10 lbs or 4.5 kg) can make a big difference for people with OA in these joints.
People who have had a serious injury to a joint have a higher chance of eventually getting OA in that joint. This is thought to be the result of damage to the cartilage itself or to the way the joint moves. This explains why OA is common among former professional athletes and people who may have injured their joints in their line of work.
OA can sometimes run in families, especially when it affects joints in the hands. The reason for this is not well understood. Experts think it may have something to do with the shape of bones and how they fit together, or it may be related to the body’s ability to repair damage to joints.
Most medications for OA are geared towards pain control. They can help make living with OA much more comfortable and help to improve function and mobility. A mixed or multimodal approach that combines different treatments is common for patients with OA.
Possible medications include analgesics and opioids (pain killers), NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) to reduce inflammation, and corticosteroid injections for pain and swelling. Unfortunately, no medications exist that have been shown to alter the progression of osteoarthritis. Once a joint is damaged, there is nothing patients can take to undo or repair it.
The goal of these treatments is to keep the joints as healthy as possible for as long as possible. It is important to help keep the joints moving smoothly to help decrease joint pain and reduce limitations in mobility and functioning.
Medications for OA
Non-prescription analgesic medications such as acetaminophen (Tylenol) can be effective in controlling pain in some people with OA. It has been shown to be safe when used for long periods of time. This medications can only control pain. It does nothing to control OA or to prevent further joint damage.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation in joints caused by OA. They also help to reduce symptoms such as pain. There are about 20 different anti-inflammatory medications available. If one doesn’t work for a particular patient, there are lots of other options for them to try.
Some patients benefit from cortisone injections directly into a joint. This type of treatment can reduce the pain and swelling in joints affected by OA. It can take up to 24 or 48 hours to feel the effects of a corticosteroid injection. Once the effects set in, they can last for a few days up to a few months; it depends on the individual person and the joint. Corticosteroid injections are usually limited to 3 or 4 in a single joint per year.
When non-prescription analgesics and NSAIDs are not enough to control joint pain caused by OA, stronger medicines called opioids may be used. While opioids can be very effective at controlling pain, they should be used with caution because they can cause dependence and have been associated with drug abuse. Examples of opioids include codeine, morphine, and oxycodone.
A trained arthritis physiotherapist can design a program of exercise and stretching that can help improve joint pain and stiffness. They can also provide education about joint protection to prevent further damage.
Weight Loss Therapy
Losing weight, even as few as 10 pounds (4.5kg), is another treatment option that can improve OA in weight-bearing joints.
Surgery (Joint Replacement)
Surgery is an option in severe, advanced cases where a patient’s joints lose their ability to function and it is necessary to improve mobility, restore functioning, and enhance quality of life.
It is arguably the most effective form of treatment for OA. Surgery usually involves replacing a damaged joint with an artificial joint, most commonly the hip or knee.
While surgery has revolutionized the treatment of OA, it is also associated with potential risks. Patients should talk to their doctor to find out if surgery is right for them.
Living with OA
The pain and stiffness caused by OA can sometimes limit people’s normal activities, including work. There are many things people can do to lessen the impact of OA on their work and daily routine.
We recommend adjusting features of the workplace to help make working with OA easier. For example, people that sit for much of the day can adjust the position of chairs and desks for proper posture. Vehicle seats can be adjusted to make driving more comfortable and reduce stress on joints and affected tissues.
Those who find out they have OA while they’re still young can consider choosing work that isn’t physically demanding on their joints and back.
Exercise is important to overall health. It also helps keep the joints moving properly, and helps protect them by strengthening the muscles around them.
The level and amount of exercise people with OA can do depends on the activity of their disease.
A trained arthritis physiotherapist is the best person to help design an exercise program tailored to the needs of patients with OA.
The following are some useful articles on exercising with arthritis:
Exercise and Arthritis: An article by arthritis physiotherapist Marlene Thompson
Exercising in a Flare: Another excellent article by Marlene Thompson on how to cope with flares through your exercise routine.
Alcoholic beverages are not an effective treatment for OA, and they can interact with many medications.
People with OA that plan on drinking should ask their doctor about possible negative interactions with the medications they take.
Some examples of medication that mixes poorly with alcohol includes, and is not limited to: the DMARDs methotrexate, Arava (leflunomide), and Imuran (azathioprine).
Smoking is not healthy for people with OA. It can make symptoms worse and harder to treat.
Research has shown that some arthritis medications do not work as well in people who smoke.
We recommend that smokers quit immediately to reduce the impact of their symptoms, improve the effectiveness of their medications, and improve their overall health.
Smoking significantly increases the risk of cardiovascular disease. The chronic (long-term) inflammation caused by rheumatic diseases like OA already increases this risk without a big extra boost from smoking.
Travel is still possible when you have OA.
It is best for people with this disease to get organized well in advance of a trip to ensure a smooth, comfortable, and enjoyable time.
Check out our Travel Checklist page.
Though OA does not particularly cause a loss of sex drive, it can cause pain, fatigue and emotional hardships. These hardships risk creating barriers to sexual needs, ability, and satisfaction.
People with OA can take comfort knowing that sex and intimacy can be maintained. In many cases, it can help draw partners closer together, especially through improved communication.
For more information on intimacy and arthritis, a great book is: Rheumatoid Arthritis: Plan to Win by Cheryl Koehn, Taysha Palmer and John Esdaile.
Osteoarthritis (OA) has no effect on fertility. The chances of getting pregnant for people with OA are the same as with people that don’t have it. OA also has no known effects on the developing fetus or the newborn.
The two main issues doctors worry about with OA and pregnancy are:
Patients with OA might be treated with a number of medications that can affect pregancies including NSAIDs, anti-TNF biologics, and occasionally DMARDs. It is important for people with OA who want to become pregnant to discuss their medications with their doctor and create a pre-pregnancy plan. A plan is important for a number of reasons. For example, discontinuing a particular medication for safety of the newborn might cause OA to flare, so its wise to have a plan in place to handle these possibilities.
Any type of arthritis that affects the pelvis or the hips can make vaginal delivery difficult. It is important for those planning pregnancy to discuss delivery options with an obstetrician.
Following the basics of healthy eating can help improve health and well-being in everyone, including those with OA. Keeping a healthy weight helps reduce the load on weight-bearing joints including the spine, hips, and knees, making it easier to live with the disease.
Unfortuantely, no special diet has ever been proven to significantly alter the course of OA or any other types of arthritis.
In addition, no known natural remedies or complementary therapies have been proven to help OA in any significant way.
People with OA should consult with their doctor to make sure that any supplements or alternative therapies they consume will not negatively interact with their medications.
Its very important for people with OA to attend regularly scheduled appointments with their rheumatologist, and promptly get any tests that are ordered by their doctors.
It is often very important that medications are taken exactly as prescribed. Patients should always talk to their doctor about any issues they experience, or if they would like to change anything.
Osteoarthritis is a chronic disease and a rheumatologist is the best partner in helping patients achieve the best quality of life possible.