Osteoarthritis is a painful problem with the joints.
Healthy joints help your body move, bend, and twist. Knees glide up
and down stairs without creaking or crunching. Hips move you along on a walk
without a complaint. But when you have arthritis, such
simple, everyday movements can hurt. Using the stairs can
be painful. Walking a few steps, opening a door, and even combing your hair can
is mainly a disease of the
spine, hip, hand, knee, and foot. But it can happen in other joints too. A
joint is where two bones connect. And you have them all over your body.
Arthritis is most common in older people. Even
though you can't cure arthritis, there are many
treatments that can help with your pain and make it easier for you to move. And
you can do things to keep the damage from getting worse.
The simplest way to
describe arthritis is that it's wear and tear on the
cartilage of your joints. This cushioning tissue is firm, thick, and slippery.
It covers and
protects the ends of bones where they meet to form a joint.
arthritis, there are changes in the cartilage that cause it to break down. When
it breaks down, the bones rub together and cause damage and pain. Experts
don't know why this breakdown in cartilage happens. But
aging, joint injury, being overweight, and genetics may be a part of the
Your doctor will check that your
pain is not caused by another problem.
He or she will ask questions about your symptoms, such as:
If your joints are tender and swollen and the muscles are weak, this
will also help your doctor confirm whether you have arthritis. You may also
have X-rays to check your joints for damage.
Your doctor may want to do blood tests or other tests to see if there are other
causes for your pain.
There are many treatments for arthritis, but what
works for someone else may not help you. Work with your doctor to find what is
best for you. Often a mix of things helps the most.
Your treatment may
There are also some things you can do at home to help relieve your symptoms. For example, there are devices and tools that can take the stress and weight off of your joints and make it easier for you to hold objects, open and close things, and walk. Doorknob covers, tape, braces, splints, and canes may help.
You might also try changing activities or the way you do things to reduce the stress on the joint
that hurts and
allow you to move better. For example, walk instead of jog. Or use a sewing machine to make a quilt instead of making it by hand.
Learning about osteoarthritis:
Living with osteoarthritis:
Health Tools help you make wise health decisions or take action to improve your health.
when changes in
cartilage cause the cartilage to
break down faster than the body can produce it.
When cartilage breaks down, the bones rub together and cause damage
and pain. Experts don't know why this happens. But things like aging, joint
injury, being overweight, and genetics may increase your risk.
some cases, arthritis is caused by other conditions that damage cartilage.
osteoarthritis can range from mild to
They may include:
Arthritis of the spine can also narrow the openings
that make space for the spinal cord and for the nerves that branch off the
spinal cord (spinal nerves). This is called
spinal stenosis. It can lead to pressure on the spinal
cord or spinal nerves. This pressure can cause pain, weakness, or
conditions can cause symptoms similar to osteoarthritis.
One Man's Story:
"I thought the stiffness and pain in my
hip was just from the stress I was putting on my muscles. But when I changed my
exercise routine or stopped working out, the pain was still there ... The
pain would come and go. It wasn't a sharp pain, but a kind of ache that would
keep me awake a lot. I could never stay in one position for very long."—Steve
Read more about Steve and how he learned to cope with arthritis.
Osteoarthritis occurs when the cartilage that cushions your joints breaks down and
wears away. When this happens, the bones rub together and cause damage and
pain. In most cases, it takes years for cartilage to break down.
It's hard to know how fast arthritis may
You may not have any symptoms for years, until the bones
and tissues become damaged. Or symptoms may come and go, stay the
same, or get worse over time.
cause problems in any joint in the body. But in most cases, you'll have
symptoms in only one or two joints or
groups of joints. Arthritis may cause problems in your
feet, and sometimes in your
spine. At first, you may only
feel pain when you're active. As the disease
gets worse, you may also feel pain when you're
If you have arthritis in your
fingers, the joints at the tip or middle part of your fingers may get bigger
and form bumps. These are known as
Heberden's and Bouchard's nodes.
Even though there is no cure
for arthritis, most people can manage their symptoms with medicine
and lifestyle changes. But in a few people, arthritis or complications of arthritis may
get so bad that they decide to have surgery to replace the worn joint or to fuse the bones together so
that the joint won't bend.
Things that can
increase your risk for
osteoarthritis are called risk factors. Some risk
factors, such as your age or family history, can't be changed or
You may be able to reduce other risk factors by making lifestyle changes or taking medicine.
doctor if you have:
If you have mild joint pain and stiffness, first try
home treatment, such as using ice and heat. If you don't feel
better in 6 weeks, or if you have other
symptoms, call your doctor.
Arthritis can be managed
Other health professionals may be
part of the treatment team, such as:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
In most cases, your doctor can
tell you if you have
osteoarthritis and recommend treatment based on your
symptoms and by doing a
physical exam. Your doctor may also do some
other tests to be sure that the diagnosis is correct or to rule out other
conditions that have similar symptoms.
These tests may
Other tests may include a
urine test and one or more blood
tests, such as:
there is no cure for
osteoarthritis, treatment can help reduce your
symptoms and make it possible for you to lead a full and active
The goals of
treatment are to:
Treatment is based on:
In most cases, people who have mild to
moderate arthritis can manage their symptoms for many
years with a treatment plan that may include:
Some people with arthritis also feel down or depressed. They may describe this as feeling "depressed," "unhappy," "short-tempered," "blue," or "down in the dumps." If you feel like this most of the time, tell your doctor. Treating these symptoms may help you feel better and make it easier for you to do your daily tasks.
If the pain and stiffness from arthritis don't get
better or they get worse, your doctor may
If your pain is very bad, you may decide to have
surgery to replace the joint. Or you may decide to have some other kind of surgery that
can help keep your joints moving well and prevent your arthritis from getting
Some types of surgery
For help deciding whether to have joint
replacement surgery, see:
You can take steps to help prevent
osteoarthritis. If you already have arthritis, these
same steps may keep it from getting worse.
When you have
osteoarthritis, you may find it hard to do your daily
tasks. Your joints may ache or feel stiff, and they may hurt when you
move. You can do some things at
home to feel better.
Try exercises that don't put a lot of stress on your joints, such as
swimming, biking, walking, water exercises, and lifting light weights. Make sure to talk to your doctor or physical
therapist about what kind of activity is best for you.
One Woman's Story:
"Gardening books and magazines always have wonderful ideas and innovations that you can use. For instance, I've cut off sections of the rubber insulation that is used to cover water pipes and slipped them over any of the garden tools that I'm going to use, because it gives me a little more cushion and a little extra width for my tools."—Bev
Read more about Bev and how she learned to cope with arthritis.
Living with arthritis can be stressful. At times you
may feel overwhelmed, tired, and angry. And you may worry about what your life
may be like as your condition gets worse. These feelings are normal. But there
are a lot of ways to cope with arthritis. For example, ask for help when you
need it, keep a positive attitude, and join a support group.
you are caring for someone who has arthritis, be sure to take time to care for
yourself and find ways to manage stress. Being a caregiver isn't easy. But it
can be rewarding, especially when you know that your care makes a positive
difference in someone's life.
Medicine can help reduce your
osteoarthritis and allow you to do
your daily activities.
The goal of medicine is to:
The type of medicine depends on how bad your pain
is. For instance:
Medicines used to treat arthritis
Medicine that you put on your skin (topical)
may relieve pain for a short time.5 These include topical NSAIDs,
capsaicin, and pain-relieving creams.
Here are a few things to think about:
Medicines that work for some people don't work for others. Be
sure to let your doctor know if the medicine you're taking doesn't help. You
may need to try several kinds of medicines to find one that works for
Here are a few things to think
In most cases, people can manage their
osteoarthritis symptoms with medicine and lifestyle
changes. But surgery may be an option
"I wasn't sure about having surgery
since I was so young. I had heard that an artificial hip could give out in 10
to 20 years ... But when the medicine I was taking stopped working, I figured
I had gone as far as I could go with this, and decided to go ahead with the
surgery ... It's a strange feeling to be able to walk without a limp and to
walk up and down stairs without grabbing on to the railing."—Steve
Types of surgery for arthritis
A newer procedure for arthritis of the knee
uses a small cup shaped like a "C." It's placed in the joint space of the inner
knee and acts as a cushion for the joint. It may help delay surgery to replace
If you're in poor health or have certain health problems, you may not be able to have surgery. Your doctor can help you decide if surgery is right for you.
Here are some things to think about if you're
thinking about surgery:
For help deciding whether to have joint replacement
In the days or weeks before your surgery, talk to your doctor about what you need to do to get ready for your return home. For example, you may need to arrange for someone to drive you home and to help
you after your surgery. Or you may need to make changes to your home, such as removing small rugs, to help you move around.
Nearly 4 out of 10 people use some form of complementary and alternative medicine to treat certain health problems, including osteoarthritis.8 Some people use
these treatments along with or, in some cases, in place of standard care to help relieve their
Some of these treatments may help you move more easily and deal with the stress and pain of arthritis. But in some cases, not much is known about how safe they are or how well they may work.
Be sure to tell your doctor if you're using a complementary or alternative therapy or if you're thinking about trying one. He or she can discuss the possible benefits and potential side effects of these treatments and whether any of these treatments may interfere with your standard care. For example, some diet supplements and herbal medicines may cause problems if you take them with another medicine.
"After I have a massage and acupuncture, I feel
like a new person. I encourage people to find out what treatments others have
tried and what things have worked for them. I'm a believer in other people's
ideas. Obviously, what works for one person may not work for another, but
unless you try it, you'll never know if it'll help."—Bev
There are many
treatments for arthritis, but what works for someone else may not work for you.
You may need to try several different treatments to find what works for
Experts are testing new
medicines and methods that they hope will one day help prevent, reduce, or
repair cartilage damage. For example, they're looking at cartilage transplants
and the use of stem cells to grow new cartilage. So far, therapies to repair
cartilage have only been studied in younger people with small, well-defined
holes in their knee cartilage. This isn't a common problem for most older
adults who have arthritis of the knee.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The American Occupational Therapy Association (AOTA) is the
nationally recognized professional association of approximately 35,000
occupational therapists, occupational therapy assistants, and students of
occupational therapy. AOTA's mission is to advance the quality, availability, use,
and support of occupational therapy through standard-setting, advocacy,
education, and research on behalf of its members and the public.
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
This website for older adults offers aging-related
health information. The website's senior-friendly features include large
print, simple navigation, and short, easy-to-read segments of information. A
visitor to this website can click special buttons to hear the text aloud, make
the text larger, or turn on higher contrast for easier viewing.
site was developed by the National Institute on Aging and the National
Library of Medicine, both part of the National Institutes of Health
(NIH). NIHSeniorHealth features up-to-date health information from NIH. Also,
the American Geriatrics Society provides independent review of some of the
material found on this website.
CitationsMessier SP, et al. (2005). Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis and Rheumatism, 52(7): 2026–2032.Messier SP, et al. (2004). Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial. Arthritis and Rheumatism, 50(5): 1501–1510.Messier SP, et al. (2000). Long-term exercise and its effect on balance in older, osteoarthritic adults: Results from the Fitness, Arthritis, and Seniors Trial (FAST). Journal of the American Geriatrics Society, 48(2): 131–138.McCarthy CJ, et al. (2004). Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology, 43(7): 880–886.Lozada CJ (2009). Management of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1563–1577. Philadelphia: Saunders Elsevier.Towheed TE, et al. (2006). Acetaminophen for osteoarthritis. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.Laupattarakasem W, et al. (2008). Arthroscopic debridement for knee osteoarthritis (Review). Cochrane Database of Systematic Reviews (3).Barnes PM, et al. (2008). Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Report #12. Hyattsville, MD: National Center for Health Statistics.Foster NE, et al. (2007). Acupuncture as an adjunct to exercise-based physiotherapy for osteoarthritis of the knee: Randomised controlled trial. BMJ. Published online August 15, 2007 (doi:10.1136/bmj.39280.509803.BE).Manheimer E, et al. (2007). Meta-analysis: Acupuncture for osteoarthritis of the knee. Annals of Internal Medicine, 146(12): 868–877.Other Works ConsultedAmerican Academy of Orthopaedic Surgeons (2007). Activities after a knee replacement. Available online: http://orthoinfo.aaos.org/topic.cfm?topic=a00357.American Academy of Orthopaedic Surgeons (2008). Treatment of Osteoarthritis of the Knee (Non-arthroplasty): Full Guideline. Available online: http://www.aaos.org/Research/guidelines/OAKguideline.pdf.American Academy of Orthopaedic Surgeons (2009). Activities after hip replacement. Available online: http://orthoinfo.aaos.org/topic.cfm?topic=a00356.Boureau F, et al. (2004). The IPSO study: Ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip. Annals of the Rheumatic Diseases, 63(9): 1028–1034.Dunlop DD, et al. (2011). Physical activity levels and functional performance in the Osteoarthritis Initiative. Arthritis and Rheumatism, 63(1): 127–136.Felson DT, et al. (2004). The effect of body weight on progression of knee osteoarthritis is dependent on alignment. Arthritis and Rheumatism, 50(12): 3904–3909.Hochberg MC, et al. (2012). American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 64(4): 465–474.Lin EHB, et al. (2003). Effect of improving depression care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial. JAMA, 290(18): 2428–2434.National Institute of Arthritis and Musculoskeletal and Skin Diseases (2010). Handout on Health: Osteoarthritis. Available online: http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp.Oesch PR, Bachmann S (2009). Introduction to physical medicine and rehabilitation. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 1023–1033. Philadelphia: Saunders Elsevier.Peak EL, et al. (2005). The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. Journal of Bone and Joint Surgery, 87-A(2): 847–853.Zhang W, et al. (2004). Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases, 63(8): 901–907.
April 8, 2011
Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology
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