Managing the Pain of Osteoarthritis Day by Day

Arthritis is a general term that means inflammation in joints. Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It most commonly occurs in the weight bearing joints of the hips, knees, and spine. It can also affect the fingers, thumb, neck, and large toe. It is not typically common in other joints unless prior injury or excessive stress is involved.

Who Gets Osteoarthritis?

Osteoarthritis affects nearly 27 million Americans. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20's and 30's can get osteoarthritis. In people over 50, more women than men get osteoarthritis.

What Are the Symptoms of Osteoarthritis?

• Joint aching and soreness, especially with movement
• Pain and/or stiffness after overuse or after long periods of inactivity
• Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)

Osteoarthritis is not associated with fever, weight loss, or anemia (low red-blood cell count). If these symptoms are present in someone with osteoarthritis, they are caused by a condition unrelated to the osteoarthritis.

What Causes Osteoarthritis?

There are several factors that increase the risk for developing osteoarthritis, including heredity, obesity, injury, or overuse of certain joints.

People born with joint abnormalities are more likely to develop osteoarthritis. 

Some people have an inherited defect in one of the genes responsible for making collagen, a major component of cartilage. This causes defective cartilage, which leads to more rapid deterioration of joints.

Finally, people who are born with an abnormality of the spine (such as scoliosis or curvature of the spine) are more likely to develop osteoarthritis of the spine.

Obesity increases the risk for osteoarthritis of the knee. Maintaining ideal weight or losing excess weight may help prevent osteoarthritis, or decrease the rate of progression once osteoarthritis is established.

Injuries contribute to the development of osteoarthritis. For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone extending into the joint margin are prone to develop osteoarthritis in that joint.

Overuse of certain joints increases the risk of developing osteoarthritis. For example, jobs requiring repeated knee bending increase the risk for osteoarthritis of the knee.

How Is Osteoarthritis Diagnosed?

The diagnosis of osteoarthritis is based on a combination of the following factors:

• Your description of symptoms
• The location and pattern of pain
• Certain findings during a physical exam

Your doctor may use X-rays to help confirm the diagnosis and rule out other types of arthritis. X-rays show how much joint damage has occurred.

If fluid has accumulated in the joints, your doctor may remove some fluid from the joint (called joint aspiration) and examine it under a microscope to rule out other diseases.

Although there is no blood test to diagnose osteoarthritis, some blood tests may be helpful to rule out other types of arthritis.

How Is Osteoarthritis Treated?

Osteoarthritis is usually treated by reducing stress on the joints such as weight control and avoiding painful activity, physical therapy and exercise, application of heat or cold to the painful joint, medications, and use of supportive devices such as canes. Surgery may be helpful in severe cases to relieve pain when other treatment options have not been effective.

The goals of treatment are to accomplish the following:

• Decrease joint pain and stiffness
• Improve joint mobility and stability
• Increase your ability to do daily activities

The type of treatment prescribed will depend on several factors including the person's age, activities, occupation, overall health, medical history, and severity of the condition.

What Medications Are Used to Treat Osteoarthritis?

Pain-relieving drugs include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen. Some medications in the form of creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain. Medications may be prescribed to reduce pain caused by osteoarthritis. Some medications may be injected into the affected joint to relieve symptoms.

Unfortunately, drugs do not reverse or slow the progression of joint damage caused by osteoarthritis.

Glucosamine and chondroitin are two supplements that are commonly used for osteoarthritis. Research has not conclusively shown that these supplements are effective in reducing pain or improving function in patients with osteoarthritis.

When you are taking any medication or supplement, it is important to let your doctor know so he or she can assess for safety, drug interactions, and any side effects.

How Do Weight and Exercise Impact Osteoarthritis?

Losing weight if you are overweight or obese helps prevent osteoarthritis of the knees, reduces the stress on weight-bearing joints, and helps reduce pain in affected joints.

Exerciseis important to improve joint movement and to strengthen the muscles that surround the joints. Gentle, low-impact exercises, such as swimming or walking on flat surfaces, are recommended because they are less stressful on your joints. High-impact activity, such as jogging or high-impact aerobics, may increase joint pain. Strength training is also encouraged, particularly for muscles surrounding and supporting affected joints.

Heat or Cold Treatments for Osteoarthritis

If you have osteoarthritis, heat or cold treatments may be recommended to provide temporary relief of pain and stiffness. These treatments may be given in the form of a hot shower or bath, or by applying heating pads or cold compresses.

Supportive Devices for Osteoarthritis

Supportive or assistive devices may be helpful to decrease pressure on joints in osteoarthritis. Knee supports or braces may be helpful for some people to stabilize the ligaments and tendons and decrease pain. Canes may be helpful to take pressure off certain joints.

When Is Surgery Necessary for Osteoarthritis?

When osteoarthritis is severe, and pain is not controlled with medications or other mentioned treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.

There are several surgical procedures that could be used. They include:

• Arthroscopy to remove or repair loose or damaged tissue in the joint.
• Joint replacement surgery to replace the damaged joint with an artificial one. Even under the best of circumstances, surgery cannot return the joint to its original state. However, an artificial joint will very likely diminish pain. The two joints most often replaced are the hip joint and the knee joint.
• Joint fusion (arthrodesis) fuses the two bones on each side of the joint. The joint will no longer be flexible.
• Osteotomy realigns bones of the arm or leg to relieve pressure on the joint.

Talk to your doctor to determine if any of these treatment options are right for you.