OSTEOARTHRITIS

Symptoms, Causes, Risk Factors, Diagnosis

Home Remedies & Alternative Medicines

Definition

Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time.

Osteoarthritis can affect any joint in your body, though it most commonly affects joints in your hands, hips, knees and spine. Osteoarthritis typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your osteoarthritis pain.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

• Pain in a joint during or after use, or after a period of inactivity
  
• Tenderness in the joint when you apply light pressure
  
• Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
  
• Loss of flexibility may make it difficult to use the joint
  
• Grating sensation when you use the joint
  
• Bone spurs, which appear as hard lumps, may form around the affected joint
  
• Swelling in some cases

Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.

Causes

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone — causing the ends of your bones to become damaged and your joints to become painful.

It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Risk factors

Factors that increase your risk of osteoarthritis include:

• Older age. Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis.
  
• Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
  
• Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  
• Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  
• Obesity. Carrying more body weight places more stress on your weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.
  
• Other diseases that affect the bones and joints. Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

When to seek medical advice

If you have swelling or stiffness in your joints that lasts for more than two weeks, make an appointment with your doctor.

If you're already taking medication for osteoarthritis, contact your doctor if you're experiencing side effects from arthritis medications. Tell your doctor if you experience side effects such as nausea, abdominal discomfort, black or tarry stools, constipation, or drowsiness.

Tests and diagnosis

If your doctor suspects you have osteoarthritis, he or she will examine your affected joint and ask you questions about your joint pain. To better understand the cause of your pain, he or she may also recommend:

• X-rays. X-ray images of your affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint.
  
• Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  
• Joint fluid analysis. Your doctor may use a long needle to draw fluid out of the affected joint. Examining and testing the fluid around your joint can determine if your pain is caused by gout or an infection.
  
• Examining the joint with a tiny camera (arthroscopy) . In some cases, your doctor may recommend arthroscopy to see inside your joint in order to determine the cause of your pain. During arthroscopy, small incisions are made around your joint and a tiny camera is inserted to see inside your joint. Your doctor watches a video screen to look for abnormalities within your joint.

Complications

Osteoarthritis is a degenerative disease that worsens over time. As many as a third of people with osteoarthritis will eventually experience significant disability. Joint pain and stiffness may become severe enough to make getting through the day difficult, if not impossible. Some people are no longer able to work. When joint pain is this severe, doctors typically suggest joint replacement surgery. For those who aren't able to undergo surgery, pain medications and assistive devices can make daily tasks more manageable.

Treatments and drugs

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks. While medications and joint replacement surgery are key components of treatment for osteoarthritis, your doctor will likely recommend you try all other possible solutions before you consider those options. Eventually the pain may become severe so that medications and surgery may be necessary.

Initial treatment options for mild osteoarthritis

For mild osteoarthritis pain that is bothersome, but not enough to have a great impact on your daily activities, your doctor may recommend that you:

• Rest. If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively. Try taking a 10-minute break every hour.
  
• Exercise. With your doctor's approval, get regular exercise when you feel up to it. Stick to gentle exercises, such as walking, biking or swimming. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Avoid exercising tender, injured or swollen joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it.
  
• Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Aim to lose 1 or 2 pounds a week, at most. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.




• Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness and cold can relieve muscle spasms. Soothe your painful joint with heat using a heating pad, hot water bottle or warm bath. Heat should be warm, not hot. Apply heat for 20 minutes several times a day. Cool the pain in your joint with cold treatments, such as with ice packs. You can use cold treatments several times a day, but don't use cold treatments if you have poor circulation or numbness.




• Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise plan that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.




• Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  
• Apply over-the-counter pain creams. Creams and gels available at the drugstore may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Read the label so you know what you're using. Pain creams work best on joints that are close the surface of your skin, such as your knees and fingers.




• Try braces or shoe inserts. Consider trying special splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.

• Take a chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips for reducing joint pain or coping with your pain.

Treatment options for moderate osteoarthritis

Osteoarthritis pain that persists despite initial treatment may require medications in addition to initial treatment options. Don't assume that taking a medication is all you need. In order to get the most from your treatment, continue exercising when possible and resting when you need to. If you're overweight, continue working to lose weight.

Medications that may be useful for moderate arthritis include:

• Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask your doctor for guidance on limiting or abstaining from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you're taking it.
  
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.




• Tramadol. Tramadol (Ultram) is a centrally acting analgesic that's available by prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects - such as stomach ulcers and bleeding - than those of NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in combination with acetaminophen to increase pain relief.

Treatment options for severe osteoarthritis

If you've tried other treatments but are still experiencing severe pain and disability, you and your doctor can discuss other treatments including:

• Stronger painkillers. Prescription pain pills, such as codeine and propoxyphene (Darvon), may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
  
• Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.
  
• Visco-supplementati on. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid. Visco-supplementati on is only approved for knee osteoarthritis, though researchers are studying its use in other joints. Injections are typically given weekly over several weeks. Pain relief may last for a few months. Possible risks include infection, swelling and joint pain. People who are sensitive to birds, feathers or eggs shouldn't undergo visco-supplementati on treatments.

Surgery for osteoarthritis

Surgery is generally reserved for severe osteoarthritis that isn't relieved by other treatments. You may consider surgery if your osteoarthritis makes it very difficult to go about your daily tasks. Surgical treatments include:

• Joint replacement. In joint replacement surgery (arthroplasty) , your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. How long your new joint will last depends on how you use it. Some knee and hip joints can last 20 years. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it can also improve appearance and comfort and may improve your joint's mobility. Joint replacement surgery carries a small risk of infection and bleeding. Artificial joints can wear or come loose, and may need to eventually be replaced.
  
• Cleaning up the area around the joint (debridement) . Your surgeon may recommend removing loose pieces of cartilage and bone from around your joint to relieve your pain. Debridement is most useful if you're experiencing a locking sensation from a torn cartilage or loose debris in your knee joint. Debridement is typically done arthroscopically, meaning only small incisions are made in your body. A tiny video camera is inserted through the incision to allow your surgeon to see inside your joint. The surgeon uses special surgical tools to clean out any debris pieces from your joint.
  
• Realigning bones. Surgery to realign bones may relieve pain. These types of procedures are typically used when joint replacement surgery isn't an option, such as in younger people with osteoarthritis. During a procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by transferring the force of the joint away from the worn-out part of the knee.
  
• Fusing bones. Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility. Arthrodesis may be an option if you experience severe pain in your joint, but can't undergo joint replacement surgery.
  

Lifestyle and home remedies

Osteoarthritis pain may flare from time to time. In order to prevent and cope with these flares in pain and stiffness, try self-care techniques. Try to:

• Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there's no special diet effective for treating arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse.
• Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.
  
• Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores may also be places to look for ideas.
  
• Avoid grasping actions that strain your finger joints. For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully.
• Spread the weight of an object over several joints. Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.

• Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.

• Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

• Choose appropriate footwear. Wearing comfortable cushioned shoes that properly support your weight is especially important if you have arthritis in your weight-bearing joints or back.

Coping and support

Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own attitude. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Talk to your doctor if you're feeling frustrated. He or she may have ideas about how to cope or refer you to someone who can help. In the meantime, try to:

• 
  Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you're in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.

• Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

• Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness - a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.
  

Alternative medicine

People who aren't helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Mainstream doctors are becoming more open to discussing these options with their patients. But, since few of these treatments have been extensively studied in clinical trials, it's difficult to assess whether these treatments are helpful for osteoarthritis pain. In some cases, the risks of these treatments aren't known.

If you're interested in trying complementary and alternative medicine therapies for your osteoarthritis pain, discuss these treatments with your doctor first. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere with your current osteoarthritis medications.

Some common complementary and alternative treatments that have shown some promise for osteoarthritis include:

• Acupuncture. During acupuncture, tiny needles are inserted into your skin at precise spots. Practitioners believe the needles free or redirect your body's energy in order to relieve pain. Studies of acupuncture for knee osteoarthritis have been mixed. Most studies haven't found a benefit, though some have found some short-term relief of pain. Acupuncture can be safe if you select a reputable practitioner — ask your doctor to suggest someone. Risks include infection, bruising and some pain where needles are inserted into your skin.
• Ginger. The ginger plant is best known for its use in cooking, but some research has found ginger extract may be helpful in reducing osteoarthritis pain. Limited studies have been conducted with ginger in people with osteoarthritis, and results have been mixed. Side effects of ginger supplements can include heartburn and diarrhea. Talk to your doctor before taking ginger supplements, since they can interfere with prescription medications such as warfarin (Coumadin).

• Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. Some have found benefits for people with osteoarthritis, while others haven't. Tell your doctor if you're considering taking these supplements. Don't use glucosamine if you're allergic to shellfish. Chondroitin sulfate may affect blood levels of warfarin if you're taking that medication.

• Magnets. Some people believe placing magnets near your affected joint can relieve osteoarthritis pain. Some small studies have found magnets can provide temporary pain relief, though others haven't found any benefit from magnets. It isn't clear how magnet therapy might work. Still, a variety of magnetic products, such as bracelets, are available. Magnets appear to be safe.

• Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to abate stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. More study is needed to understand whether tai chi and yoga can relieve osteoarthritis pain. Talk to your doctor if you'd like to give tai chi or yoga a try. When led by a knowledgeable instructor, these therapies are safe. But don't do any moves that cause pain in your joints.