Osteoarthritis

Osteoarthritis is a condition that causes joints to become painful and stiff. It's the most common type of arthritis in the UK.

Osteoarthritis
Other names	Arthrosis, osteoarthrosis, degenerative arthritis, degenerative joint disease
The formation of hard knobs at the middle finger joints (known as Bouchard's nodes) and at the farthest joints of the fingers (known as Heberden's nodes) is a common feature of osteoarthritis in the hands.
Pronunciation	/ˌɒstioʊɑːrˈθraɪtɪs/
Medical specialty	Rheumatology, orthopedics
Symptoms	Joint pain, stiffness, joint swelling, decreased range of motion
Usual onset	Over years
Causes	Connective tissue disease, previous joint injury, abnormal joint or limb development, inherited factors
Risk factors	Overweight, legs of different lengths, job with high levels of joint stress
Diagnostic method	Based on symptoms, supported by other testing
Treatment	Exercise, efforts to decrease joint stress, support groups, pain medications, joint replacement
Frequency	237 million / 3.3% (2015), 528 million (2019), rise of 113% (since 1990)[WHO]

Normally it affects older (73% are over 55) female people. 60% of people with the condition are female) Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips and small joints of the hands.

The main symptoms of osteoarthritis are joint pain and stiffness, and problems moving the joint. It makes it difficult to move the affected joints and do certain activities. Joints will be stiff and painful, and may be swollen. The pain may be worse after exercise. It may get harder to move the joint.

Cause

As part of normal life, joints are exposed to a constant low level of damage. In most cases, the body repairs the damage itself and people do not experience any symptoms.

But in osteoarthritis, the protective cartilage on the ends of bones breaks down, causing pain, swelling and problems moving the joint. Bony growths can develop, and the area can become swollen and red. (Redness can be harder to see on brown and black skin.)

The exact cause is not known, but several things are thought to increase the risk of developing osteoarthritis, including:

• joint injury – overusing joints or a joint when it has not had enough time to heal after an injury or operation
• other conditions (secondary arthritis) – osteoarthritis can happen in joints severely damaged by a previous or existing condition, such as rheumatoid arthritis or gout
• specific metabolic diseases, such as diabetes
• age – the risk of developing the condition increases as someone gets older
• family history – osteoarthritis may run in families, although studies have not identified a single gene responsible
• obesity – being obese puts excess strain on joints, particularly those that bear most of the bodies weight, such as the knees and hips
• being a woman – osteoarthritis is more common in women than men

Exercise or a job that puts frequent strain on joints and forces them to bear an excessive load can increase the risk of osteoarthritis.

Symptoms

Some people also have signs and symptoms such as:

• swelling
• tenderness
• grating or crackling sound when moving the affected joints
• limited range of movement in joints
• increased pain and stiffness after not moving the joints or a joint for a while
• joints appearing slightly larger or more "knobbly" than usual
• weakness and muscle wasting (loss of muscle bulk)

The severity of osteoarthritis symptoms can affect different people differently by a lot, and between different affected joints.

The symptoms may come and go in episodes, which can be related to your activity levels and even the weather. For some people, the symptoms can be mild and may come and go. Other people can experience more constant and severe problems which make it difficult to carry out every day activities.

Diagnosis

If symptoms are slightly different, this may indicate another joint condition. Diagnosis is usually done in a clinic. Osteoarthritis starts being suspected if:

• Age > 45 (or older)
• Joint pain that gets worse with more use
• Joint stiffness is not there in the mornings, or lasts less than 30 minutes

Further tests are not usually necessary, but may be used to rule out other possible causes, such as rheumatoid arthritis or a fractured bone. X-rays and blood tests are some examples of other ways of looking at joints.

X-ray of knee with osteoarthritis.

Management

Exercise

If osteoarthritis is causing someone pain and stiffness, they could think exercise will make their symptoms worse. However, weight loss and exercise gives long-term treatment. Short-term treatments usually have risk of harm (in the long-term).

Try to do at least 150 minutes of moderate aerobic activity (such as cycling or fast walking) every week, plus strength exercises on 2 or more days each week that work the major muscle groups, to keep yourself generally healthy. Physical activity should include a combination of exercises to strengthen up muscles and exercises to improve general fitness.

It's important to follow the plan the patient makes with their doctor or GP, or maybe even a physiotherapist, because there's a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage joints.

Losing weight

Being overweight or obese increases the strain on joints and the risk of developing osteoarthritis. If someone is overweight, losing weight may help lower the chances of developing the condition.

Exercise is also good for losing weight, improving posture and relieving stress, all of which will ease symptoms.

Use the BMI healthy weight calculator to find out whether you're overweight or obese in your country.

Posture

It can also help to maintain good posture at all times and avoid staying in the same position for too long. While working at a desk, make sure the chair is at the correct height, and take regular breaks to move around.

Surgery

Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where daily life is seriously affected. There are several different types of surgery (joint fusing, knee replacement, partial bone removal) for osteoarthritis.

Related pages: Splint, Hip replacement.

Surgery cannot be guaranteed to get rid of all the symptoms of osteoarthritis. There may be pain and stiffness from the condition.

Supportive treatment

In addition to lifestyle changes and medicines, there may be some benefit from a number of supportive treatments that can help reduce pain and make everyday tasks easier. These include:

• Hot or cold packs
• Assistive devices (such as special shoes or insoles, a walking stick, or grabbing aides)
• Other complementary therapies, like diet, supplements
• Self care

However, there's a lack of medical evidence to suggest they're effective and they generally are not recommended by the National Institute for Health and Care Excellence (NICE).

Pain medicine

A doctor will be able to talk about medicines to relieve pain from osteoarthritis.

Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control pain as a form of management.

The type of painkiller recommended will depend on the severity of the pain and other conditions or health problems. The main medications used are below.

Paracetamol

Paracetamol is for short-term pain relief. It can be bought at supermarkets or pharmacies.

However, many people find that it doesn't work very well, and it is only normally tried if they can't take other medicines.

When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.

Non-Steroidal Anti Inflammatory Drugs (NSAIDs)

These are painkillers that work by reducing inflammation.

Some NSAIDs are available as creams (topical NSAIDs) that can be applied directly to the affected joints. Some topical NSAIDs are available without a prescription.

They can be particularly effective for managing osteoarthritis in the knees or hands. As well as helping to ease pain, they can also help reduce any swelling in joints.

Opioids

Opioids, such as codeine, are another type of painkiller that may help relieve severe pain.

They can only be used on a short-term basis because of side effects such as drowsiness, nausea and constipation. They are also very addictive. In a lot of countries they are available only on prescription.

A laxative to take alongside opioids may be prescribed to prevent constipation.

Capsaicin cream

Capsaicin cream may be prescribed for osteoarthritis in the hands or knees and topical NSAIDs have not been effective in easing pain. Capsaicin cream works by blocking the nerves that send pain messages in the treated area.

The cream has been used in medicine for a long time, for many different things.

Steroid injections

Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems. Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked.

The injection will be made directly into the affected area. There may be a local anaesthetic given first to numb the area and reduce the pain.

Steroid injections work quickly and can ease pain for several weeks or months.

Related pages

• Rheumatoid arthritis
• Gout
• Old age
• Skeleton