Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease. It occurs when the cartilage between your bones disintegrates. Cartilage cushions your bones from rubbing together. As the cartilage disintegrates, it can cause pain, stiffness, and swelling. OA most often affects the following joints: knees hips neck lower back toes hands This condition can have a significant impact on your lifestyle, and may make it difficult to participate in daily activities. OA affects approximately 30 million Americans.

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The knee is one of the most common joints affected by OA.

Symptoms of knee OA

The most common symptoms of knee OA include:

stiffness and swelling of the knee

difficulty bending the knee

more pain or swelling in the morning or after resting

locking, creaking, clicking, snapping, or grinding of the knee

feeling like the knee is weak or buckling

increased pain after physical activity or wet weather

You can feel pain all over the knee when you have this type of OA. It can affect your mobility and restrict your ability to move. This is especially difficult for people who rely on walking a lot during the day.

Hip

Hip OA is a painful condition that can affect your mobility. People with hip OA have pain around the hip joint that gets worse over time. As time goes by, the pain can become more frequent and more severe. You may also experience more pain at night or when you’ve been resting.

Other symptoms of hip OA include:

pain in the groin or thigh that radiates out to the buttocks or knee

stiffness in the morning or after resting or standing

pain after physical activity

stiffness in the joint, or difficulty walking and bending

sticking, locking, or grinding of the hip joint

decline in range of motion

potential limp

increased pain during wet weather

OA of the neck

Neck OA can cause stiffness and pain in the neck. Symptoms of neck OA can include the following:

  • pain when holding the neck in the same position for long periods of time
  • headaches
  • grinding sensation or popping noise when turning the neck
  • numbness or weakness in hands, fingers, and arms
  • balance impairments
  • feeling weakness in the hands and legs
  • difficulty walking
  • muscle spasms in the shoulders and neck

Read more: 5 neck exercises for arthritis »

OA of the back

Back OA causes pain in the spine or lower back.

Symptoms of back OA may include the following:

  • back pain that is deep in the muscles
  • increased pain when sitting or standing upright, and reduced pain while lying down
  • lower back pain that is worse in the morning or after periods of inactivity
  • stiffness and limited motion in the spine
OA of the toe

For the most part, pain and stiffness will develop over time in the joint areas of the toe. Other symptoms of toe OA include:

  • pain when moving the toe
  • pain that gets worse after physical activity
  • difficulty walking
  • tenderness, swelling, warmth, or a redness on the joint
  • decreased range of motion

OA in your toe, foot, or ankle can impair your mobility. In severe cases, you may become immobilized.

OA of the hand

The hand and wrist include many small joints that work together to generate motion. When those joints are impaired, it can lead to pain and uncomfortable symptoms, as well as reduced or limited mobility in your hands.

Symptoms of hand OA include:

  • dull or burning sensation in the hand
  • increased pain after long periods of repetitive usage
  • pain in the morning
  • stiffness, swelling, or enlargement of the joint
  • cysts
  • feelings of grinding between joints

Read more: 7 hand exercises to ease arthritis pain »

Outlook

OA can cause pain and reduced mobility, but there are many treatments available. Work with your doctor to develop a treatment plan, and let them know if you have increased pain. OA is a degenerative disease, meaning it gets worse over time, so you may need to adjust your treatment plan as the condition progresses.

Read more: Natural relief from arthritis pain »

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Diagnosis

  • General: Once individuals are diagnosed with osteoarthritis, they should visit their healthcare providers regularly, at least once a year. Individuals should stay in close contact with their doctors to ensure that their symptoms are managed and joint damage is monitored
  • X-ray: X-rays are often the first test performed if a patient has symptoms of osteoarthritis. If the patient has osteoarthritis, the x-ray images will often show loss of cartilage in the affected joints, narrowing of the space between bones, and bumps called nodules.
  • Arthrocentesis: A procedure called arthrocentesis may also be performed at a healthcare provider’s office. During the procedure, a needle is inserted into the affected joint, and a small sample of fluid is removed. The fluid is then analyzed to rule out other conditions, such as gout or infection. This test may also temporarily relieve some pain and inflammation in the joint.
  • Arthroscopy: A surgical procedure called arthroscopy may also be performed. During the surgery, a small incision is made into the affected joint. Then a tube called an arthroscope is inserted into the joint. This tube has a small light and camera, which allows the healthcare provider to see the inside of the joint. If abnormalities, including cartilage or ligament damage are seen, the individual is diagnosed with osteoarthritis.

Prevention

  • Individuals who maintain a healthy body weight have a decreased risk of developing osteoarthritis. Eating a healthy and well-balanced diet may help individuals control their weight. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new pyramid provides 12 different models, which are based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.
  • Regular exercise may also help individuals control their weight. There are many ways for people to exercise including: gardening, walking, sports activities, and dancing. Individuals who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as unhealthy, and may even cause permanent damage to the body.

Prevention

  • Individuals who maintain a healthy body weight have a decreased risk of developing osteoarthritis. Eating a healthy and well-balanced diet may help individuals control their weight. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new pyramid provides 12 different models, which are based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.
  • Regular exercise may also help individuals control their weight. There are many ways for people to exercise including: gardening, walking, sports activities, and dancing. Individuals who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as unhealthy, and may even cause permanent damage to the body.

Treatment

  • General: Osteoarthritis is managed with medications that reduce pain and inflammation. In severe cases, surgery may be necessary to repair damage.
  • In order to properly manage pain and prevent joint damage, individuals should take their medications exactly as prescribed by their healthcare providers. Individuals with osteoarthritis should also tell their healthcare providers if they are taking any other drugs (prescription, over-the-counter, or dietary supplements) because they may interfere with treatment.
  • Antidepressants: Some individuals with arthritis may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include the tricyclic antidepressants amitriptyline (Elavil®), nortriptyline (Aventyl®, Pamelor®), and trazodone (Desyrel®). Side effects of tricyclic antidepressant medications include drowsiness, fatigue (excessive tiredness), constipation, dry mouth, and blurred vision.
  • Arthroscopic lavage and/or debridement: In some cases, individuals with osteoarthritis may suffer from severe joint damage. In such cases, surgical procedures called arthroscopic lavage and/or arthroscopic debridement may be recommended. During the surgery, a small incision is made near the joint. A small tubular instrument called an arthroscope is then inserted. The arthroscope has a small light and camera attached to it, allowing the surgeon to see inside the joint. During arthroscopic lavage, the surgeon squirts saline into the joint. The saline is then removed along with any blood, fluid, or loose debris inside the joint. During arthroscopic debridement, loose fragments of bone or cartilage are removed from the joint. In some cases, built up scar tissue may also be removed.
  • Both of these procedures may provide temporary pain relief and improved joint function. However, recent studies suggest that they may not be effective in some individuals with osteoarthritis. Therefore, individuals should discuss the potential risks and health benefits of the procedure with their healthcare providers.
  • Corticosteroids: Corticosteroids, such as prednisone (e.g. Deltasone®) and methylprednisolone (Medrol®), are occasionally used to reduce inflammation and pain and slow joint damage caused by osteoarthritis. These drugs are generally very effective when used short-term (weeks to a few months). However, if these drugs are used for six months or longer, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.
  • Corticosteroids are usually prescribed for a certain amount of time, and then the individual is gradually tapered off the medication. Individuals should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.
  • Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint may help reduce swelling and pain.
  • Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, individuals may take a hot shower or bath before exercise to help reduce pain.
  • Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. Although the joint may be pain-free after bone fusing, the joint no longer has any flexibility and cannot bend or move, which may limit an individual’s ability to move around easily.
  • Joint replacement surgery: In some cases, individuals with osteoarthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed
  • Individuals who maintain a healthy body weight have a decreased risk of developing osteoarthritis. Eating a healthy and well-balanced diet may help individuals control their weight. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new pyramid provides 12 different models, which are based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.
  • Regular exercise may also help individuals control their weight. There are many ways for people to exercise including: gardening, walking, sports activities, and dancing. Individuals who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as unhealthy, and may even cause permanent damage to the body.
  • Strong scientific evidence:
  • Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called chi, circulates. These pathways contain specific “points” that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. There has been substantial research into the efficacy of acupuncture in the treatment of osteoarthritis (OA). Most studies focus on knee, cervical, and hip OA symptoms. In recent years, the evidence has improved and is now considered strong enough to recommend trying acupuncture in OA of the knee, which is one of the most common forms of this condition.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders, or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.
  • Chondroitin: Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other joints (spine, hips, and finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatory). The weight of scientific evidence points to a beneficial effect when chondroitin is used for six to 24 months. Longer-term effects are not clear. Preliminary studies of topical chondroitin have also been conducted.
  • Avoid with prostate cancer or an increased risk of prostate cancer. Use cautiously if allergic or hypersensitive to chondroitin sulfate products or with shellfish allergy. Use cautiously with bleeding disorders or if taking blood-thinners like warfarin (like Coumadin®). Avoid if pregnant or breastfeeding.
  • Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Based on human research, there is strong evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness, and to test different formulations of glucosamine.
  • Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
  • Willow bark: Willow (Salix alba) bark that contains salicin has been used to treat many different kinds of pain. Willow bark is a traditional analgesic (pain relieving) therapy for osteoarthritis. Several studied have confirmed this finding. Additional study comparing willow bark to conventional medicinal agents for safety and effectiveness is warranted.
  • Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Avoid operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders or kidney disorders. Avoid if taking other NSAIDs, acetazolamide or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Use cautiously with gastrointestinal problems, such as ulcers, hepatic disorders, diabetes, gout, high blood pressure, hyperlipidemia, history of allergy or asthma, or leukemia. Use cautiously if taking protein-bound medications, antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, Phenytoin (Dilantin®), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if predisposed to headaches. Use cautiously with tannin-containing herbs or supplements. Avoid if pregnant or breastfeeding.
  • Good scientific evidence:
  • Avocado: A combination of avocado/soybean unsaponifiables (ASU) has been found beneficial in osteoarthritis of the knee and hip. Additional study using avocado (Persea Americana)alone in OA is needed.
  • Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Avoid with monoamine oxidase inhibitors (MAOIs). Use cautiously with anticoagulants (like warfarin). Doses greater than found in a normal diet is not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.
  • Devil’s claw: Devil’s claw (Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. There is increasing scientific evidence suggesting that devil’s claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease or osteoarthritis (8-12 weeks), and may be equally effective as drug therapies such as non-steroidal anti-inflammatory drugs like ibuprofen (Advil®, Motrin®), or may allow for dose reductions or stopping of these drugs in some patients. However, most studies have been small with flaws in their designs. Additional well-designed trials are necessary.
  • Avoid if allergic to devil’s claw or to plants in the Harpagophytum procumbens family. Use cautiously with stomach ulcers or with a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers, or with prescription drugs used for these conditions. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Glucosamine: Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
  • Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injuries. Several techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Limited available study compared physical therapy to a sham group (sub therapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Rose hip: Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent. A constituent isolated from dried and milled fruits of Rosa canina has demonstrated anti-inflammatory properties, and Hyben Vital®, a standardized rose hips extract, has been shown to have anti-oxidant properties. Rose hip extracts have been studied in patients with osteoarthritis, with some evidence of benefit. Additional high quality clinical research is needed in this area to confirm early study results.
  • Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or antiplatelet agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
  • SAMe: S-adenosyl-L-methionine (SAMe) is a naturally occurring molecule that is found in humans. SAMe is present in almost every tissue and fluid in the body, and has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and is well tolerated in this patient population. Although an optimal dose has yet to be determined, SAMe appears as effective as non-steroidal anti-inflammatory drugs (NSAIDS). Additional study is warranted to confirm these findings.
  • Avoid if allergic or hypersensitive to SAMe. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding. Use cautiously with diabetes, anxiety disorders, or during the third trimester of pregnancy.

Bibliography

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  2. Arthritis Foundation. .
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  4. Centers for Disease Control and Prevention. .
  5. Clark KL. Nutritional considerations in joint health. Clin Sports Med. 2007;26(1):101-18.
  6. Dillon CF, Hirsch R, Rasch EK, et al. Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991-1994. Am J Phys Med Rehabil. 2007;86(1):12-21.
  7. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). .
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. Penninx BW, Messier SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001 Oct 22;161(19):2309-16.
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