Osteoarthritis

Osteoarthritis (OA) is a condition in which the cartilage and bone in joints wear down over time. The most common joints affected are the hands, hips, and knees. Usually, it affects people who are older than 50, but younger people can get it as well. 

OA is more than just mechanical wear and tear. In addition to the erosion of the bone and surrounding tissues, OA generates inflammation inside the joint. This inflammation contributes to joint damage. As a result, it causes a lot of the symptoms associated with OA. 

OA progresses slowly over time. And it involves every part of a joint, including:  

• Bone
• Cartilage: This is a strong material that covers the ends of bones. It provides a smooth and cushioned surface to help with joint movement.
• Ligaments: These are bands of strong connective tissue that connect bones and hold a joint together.
• Synovium: This is a layer of tissue that provides a protective bubble around the joint.

There’s a lot of variation in the way osteoarthritis starts in different people. And it’s not always clear why some people are more at risk for the development or progression of OA. But there are some known risk factors:

• Older age: Your risk for OA increases with age.
• Previous injuries: If you’ve had a broken bone or joint injury in the past, that joint is more likely to develop OA.
• Overuse: If you overuse a joint, it can lead to OA over time.
• Obesity: Having obesity puts more stress on joints, which can lead to, or accelerate, OA.
• Poor physical condition: If muscles are weak, they might not be able to keep the joints aligned properly. This may lead to abnormal force or friction that can wear down the bone and cartilage. 
• Genetics: OA tends to run in families, so genetics probably play a role.
• Sex: Women are more likely than men to develop OA

Osteoarthritis most commonly develops in the knees, hips, and hands. Symptoms can include:

• Pain, particularly with activity or during weight-bearing activities
• Joint stiffness, which is usually worse in the mornings
• Clicking, popping, or scraping sounds with joint movement
• Joint swelling
• Decreased range of motion, either from pain, swelling, or the way the joint changes shape with OA

The severity of symptoms varies from person to person, and even from day to day. Symptoms can be very mild for some people, or severe and debilitating for others. Most people experience a progression of their symptoms over time.

Diagnosis

An osteoarthritis diagnosis usually involves consultation with a provider. This is most often a primary care provider. But some people may see an orthopedist, sports medicine specialist, or a rheumatologist. 

The diagnosis is usually made from a description of your symptoms and a physical exam. In some cases, additional testing can be helpful. Some examples include:

• Joint X-rays: This is the most common imaging test for OA. Joint X-rays can show evidence of joint breakdown.
• Magnetic resonance imaging (MRI): An MRI is a more advanced test and isn’t needed to make the diagnosis. But sometimes it can help rule out other problems if there’s a question about the diagnosis. This is because it provides more detailed views of the bone, cartilage, and ligaments in the joint.
• Joint aspiration: This is a test of the fluid inside the joints. For this test, a small needle is inserted into the joint, and a sample of joint fluid is collected. Like an MRI, this test isn’t needed to make the diagnosis. It’s usually performed to check for other joint conditions, like gout or infections.

Medications

There are many different medications that can treat osteoarthritis. Some are available over the counter, while others will need a prescription. Here are some examples:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Topical medications like lidocaine or capsaicin creams
• Prescription pain medications like hydrocodone/acetaminophen or oxycodone for short periods when the pain feels more severe

NSAIDs are the mainstay of treatment for OA, and they’re usually very effective at treating joint pain. But not everyone will need these medications. And some people never require any medications at all.

Treatments

There are other options aside from medications that can treat osteoarthritis. And they can be used alone — or in combination with medications — to ease the symptoms and progression of OA.

Physical therapy uses specific exercises to strengthen the muscles around the joints. This helps stabilize the joints and keep them in proper alignment. Other physical activities that decrease the amount of stress on the joints — like water aerobics — can also be helpful.

Joint injections are another common treatment for OA. This is a minor procedure. A healthcare provider injects medications directly into a joint to help with symptoms and swelling. Some of these medications include:

• Corticosteroids, which are anti-inflammatory medications
• Lubricants, like hyaluronate
• Numbing medications, like lidocaine

Surgery is also a treatment option. This is typically used for people with severe symptoms that aren’t improving with other treatments. Surgical options include:

• Arthroscopy: This is a procedure in which a surgeon uses minimally invasive tools to repair damage to joints.
• Joint replacement: This is also called arthroplasty, and it involves removing the joint and replacing it with an artificial joint.

Living

Osteoarthritis can have a daily impact on your life, particularly when it leads to frequent pain with basic movements. But that doesn’t mean it has to limit your physical activity. Some people are able to alleviate these symptoms by working healthy habits into their daily routine. Here are some examples:

• Exercise: Low-impact activities, like swimming or biking, are best for OA. Start slow, and aim to work up to 30 minutes per day.
• Weight loss: Losing weight can help minimize stress on the joints.
• Stretching: This helps to prevent joint and muscle stiffness.
• Supportive devices: These include devices like canes and walkers, which can alleviate stress on the joints and prevent falls.

Emotional support is also important, especially when the pain is impacting your mental health. Consider talking to a healthcare provider, therapist, or even friends or family if you’re struggling with the symptoms of your OA.

Prevention

Many people wonder if they can prevent osteoarthritis before it starts. While it’s not always possible to avoid OA, there are still ways to prevent it or slow its progression:

• Maintain a healthy weight. This helps to minimize the stress on joints over time.
• Exercise consistently. Consistently doing low-impact activities, like swimming, can help keep joints strong and properly aligned. Try to do 30 minutes per day, 5 days per week to help prevent OA. 
• Protect your joints. Do this as much as reasonably possible. This means keeping joints healthy with exercise and stretching.