Although it is more common in older Americans, people in their 20s and 30s can suffer with osteoarthritis pain. However, there is often an underlying reason, such as joint injury or repetitive joint stress from overuse.
Commonly referred to as “wear and tear” of the joints, OA is actually a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone. It is characterized by a breakdown of the cartilage (tissue cushioning the bone of a joint), bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining (synovium).
Although some joint changes are irreversible, most OA patients will not need joint replacement surgery. The goal of osteoarthritis treatment is pain management and improved function. There is no cure for the disease, but some treatments attempt to slow disease progression.
Osteoarthritis (OA) is the most common chronic (long-lasting) joint condition. It is a slowly progressive joint disease typically seen in middle-aged to elderly people, although it can occur in adults of any age.
With OA, the cartilage within a joint begins to break down, and the underlying bone begins to slowly change, becoming worse over time. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. OA can also affect the fingers, thumb, neck, and large toe. The condition causes pain, stiffness, swelling, and reduced function. In some cases, the patient is no longer able to do daily tasks or work.
Osteoarthritis usually does not affect other joints, unless there is a previous injury, excessive stress, or an underlying disorder of cartilage. Cartilage is the firm, rubbery material that covers the ends of bones in the joints. Its primary function is to reduce friction and serve as a “shock absorber” during joint movement. The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).
In OA, the cartilage in a joint becomes stiff and loses its elasticity, making it more susceptible to damage. Over time, the cartilage may partially wear away significantly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.
OA can occur together with other types of arthritis, such as gout or rheumatoid arthritis. As OA worsens over time, bones may break down and develop growths called spurs. Furthermore, bits of bone or cartilage may chip off and float around in the joint.
What Causes Osteoarthritis?
Osteoarthritis is a disease that causes joint damage. This damage can accumulate over time, which is why age is one of the leading causes of OA. Scientists now view OA as a disease of the joint since certain risk factors, such as family history and gender, can increase the risk of OA. Other factors that increase a person’s chances of developing OA include:
Gender. Women are more likely to develop OA than men, especially after age 50.
Genes and heredity. Various genetic traits can make a person more likely to develop OA. One possibility is a rare defect in the body’s production of collagen, which is the protein that makes up cartilage. This abnormality can lead to more rapid deterioration of joints as early as age 20. People who have family members with OA are more likely to develop OA, and someone who has had hand OA is more likely to develop knee OA. Also, people born with joint abnormalities are more likely to develop osteoarthritis.
Injury and overuse. Repetitive movements or injuries to joints (such as a fracture, surgery, dislocated joints, or ligament injuries) can lead to OA. Repeated damage to joints, tendons, and ligaments can accelerate cartilage breakdown. Certain careers that require standing for long periods, repetitive bending, heavy lifting, or other movements can cause cartilage to wear away more quickly. An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.
Lack of physical activity. Weight-bearing exercise can help reduce the risk of getting OA. People with OA who do weight-bearing exercise can help minimize bone loss and strengthen muscles. Doctors encourage physical activity for most arthritis patients.
Obesity. Being overweight puts additional pressure on the hips and knees adding to the risk of OA in the knees, hips, and spine. Many years of carrying extra pounds can cause cartilage to break down more quickly. Obesity may also have metabolic effects that increase the risk of OA.
Other diseases. People with rheumatoid arthritis, the second most common type of arthritis, are more likely to develop osteoarthritis. Also, certain rare conditions, such as iron overload or excess growth hormone, may increase the chance of developing OA.
What are the Symptoms of Osteoarthritis?
Symptoms of osteoarthritis vary, depending on which joints are affected and the degree to which they are affected. However, the most common symptoms are pain and stiffness, particularly first thing in the morning or after resting. Affected joints may become swollen, especially after extended activity. These symptoms tend to build over time rather than show up suddenly.
Some of the common symptoms of OA include:
Joint pain or stiffness, particularly in the hips, knees, and lower back, especially after inactivity or overuse.
Limited range of motion or stiffness that goes away after movement.
Mild swelling around a joint.
Pain that is worse after activity or toward the end of the day.
As OA becomes more advanced, the pain associated with it may become more intense. Over time, swelling in the joint and surrounding area may also occur. OA is a progressive condition. People with severe OA have extensive or complete loss of cartilage in one or more joints. The bone-on-bone friction associated with this can cause severe symptoms such as:
Increased swelling and inflammation.The amount of synovial fluid within the joint may increase. The fluid helps to reduce friction during movement. However, larger amounts can cause swelling. Additionally, fragments of cartilage can break off and float within the synovial fluid, increasing pain and swelling.
Crepitus. A crackling or grating sensation when moving an affected joint. It is the result of the usually smooth surfaces inside the joint becoming rough as the bones rub together.
Bony protuberances or bone spurs under the skin near joints may develop. In many people, these protuberances grow larger over time.
Increased pain.Pain may increase during activity. There may be an increase in pain as the day progresses, or more swelling in the joints throughout the day.
Decreased range of motion.People suffering from OA may not be able to move as well, due to joint stiffness or pain, while also experiencing a loss of flexibility.
Joint instability.Joints may become less stable. People with severe OA in the knees may experience locking (sudden lack of movement) or a buckling (the knee “gives out”).
Other symptoms. As a joint continues to wear down, muscle weakness and joint deformity may also occur.
OA symptoms can hinder work, social life, and family life if steps are not taken to prevent joint damage, manage pain, and increase flexibility.
Many people believe that the effects of osteoarthritis are inevitable, so they don’t do anything to manage it. The joint damage caused by severe OA isn’t reversible, but treatment can help reduce the symptoms.
How is Osteoarthritis Diagnosed?
Most often doctors diagnose OA based on the patient’s description of the symptoms, the results of a physical exam, and possibly diagnostic tests. In some cases, X-rays or other imaging tests are useful to determine the extent of disease, or to help rule out other joint problems.
The information the doctor needs to help diagnose OA includes:
An accurate, detailed description of the symptoms.
Details about when and how the pain or other symptoms began.
Details about any other medical problems that may exist.
Location of the pain, stiffness, or other symptoms.
How the symptoms affect daily activity.
List of all current medications the patient is taking.
During the physical exam, the doctor examines the joints and tests range of motion (how well a joint moves through its full range). The doctor will want to find areas that are tender, painful, or swollen, in addition to joint damage.
Blood tests are usually not helpful in making a diagnosis; however, some tests may help confirm OA:
Joint aspiration.Some of the joint fluid is withdrawn and examined for evidence of crystals or joint deterioration. This test can help rule out other medical conditions or other forms of arthritis.
X-rays can show damage and other changes related to the osteoarthritis.
MRI (magnetic resonance imaging) provides a view that offers better images of cartilage and other structures to detect early abnormalities typical of osteoarthritis.
Sometimes a blood test may be conducted to rule out other conditions that cause joint pain, such as RA.
It’s important for the doctor to know if anyone else in the family has osteoarthritis. A family history of the disease is a risk factor for OA. Most people with primary osteoarthritis (OA that develops from normal wear and tear instead of a specific cause) have family members with the condition.
How is Osteoarthritis Treated?
The best OA treatment depends on the patient’s symptoms and the severity of the OA. Unfortunately, there is no proven treatment to reverse joint damage from OA. The goal is to reduce pain and improve function of the affected joints. Most often, this is possible with a mixture of physical measures and drug therapy, and sometimes surgery.
Most doctors begin OA treatment with simple, noninvasive options. However, more intensive treatment may be necessary if symptoms are not manageable with lifestyle changes and medication. For some people, a minimally invasive procedure such as stem cell therapy, or surgery, is the best way to manage the symptoms of OA.
Many people can help control their OA symptoms with basic lifestyle changes. A doctor can help you decide whether these options are right for you.
Exercise can play a significant role in reducing the pain that comes with OA. However, exercise should include aerobic conditioning, strength training, and stretching to support the joints and maintain flexibility. OA patients should stick to gentle, low-impact exercises. Any ache that lasts for more than a few hours after exercising means you’ve probably done too much.
Diet and Weight Loss. Maintaining a healthy weight reduces stress on joints. A patient that is overweight or obese should speak to a doctor about safely losing weight. Weight loss can help reduce systemic inflammation that contributes to OA.
Rest. If your joints are swollen and achy, give them a break. If possible, avoid using an inflamed joint for 12 to 24 hours to allow the swelling to go down. It’s also a good idea to get enough sleep. Fatigue may increase your perception of pain. Getting enough sleep at night can also help you manage pain more effectively.
Cold and heattherapy can help treat OA symptoms. Applying ice to an aching area for 20 minutes helps to restrict blood vessels and reduce fluid in the tissues. It also decreases swelling and pain. You can repeat the treatment two or three times a day. Do the same 20-minute treatment pattern with a hot water bottle or a heating pad. Heat opens the blood vessels and increases circulation, supplying nutrients and proteins essential for repairing damaged tissue. Heat is also useful to help relieve stiffness.
Spa (hot tub), massage, and chiropractic manipulation can help relieve pain for a short time; however, they require repeated treatments. The long-term benefits of these alternative (sometimes called complementary or integrative) treatments are unproven but are under study.
OTC and Prescription Medications
Several types of over-the-counter (OTC) medications may help relieve OA symptoms. However, different drugs have different effects. It’s important to choose the right drugs to help with specific symptoms.
Acetaminophen (Tylenol) is an OTC painkiller. It reduces pain, but not inflammation. Taking too much can cause liver damage.
Nonsteroidal anti-inflammatory drugs can help combat multiple OA symptoms. As implied by their name, they reduce inflammation. They also help with pain. OTC NSAIDs include aspirin (Bayer), ibuprofen (Advil, Motrin, Nuprin), and naproxen (Aleve, Naprosyn). Over time, NSAIDs can potentially cause significant side effects including stomach problems and liver damage.
Topical medications. There are a variety of creams and gels available that can help relieve OA pain. These may contain active ingredients such as menthol (Bengay, Stopain) or capsaicin (Capzasin, Zostrix). Capsaicin is the substance that makes hot peppers “hot.” Diclofenac, an NSAID, also comes in a gel form (Voltaren gel) which is available by prescription.
Prescription medications. For some people with OA, prescription medications may be necessary when the symptoms affect the quality of life.
Prescription NSAIDs do the same thing as OTC NSAIDs but in stronger doses. Prescription NSAIDs can sometimes cause undesirable side effects.
Tramadol (Ultram) is a prescription painkiller that may cause fewer side effects than NSAIDs for some.
Minimally Invasive Procedures
In addition to lifestyle treatments and drugs, there are minimally invasive treatments for OA. These treatments aim to restore proper joint function, and include:
Cortisone shots can help reduce inflammation, which decreases swelling and pain in arthritic joints. Cortisone injections should only be administered by an experienced clinician and used judiciously to avoid complications and side effects.
Knee injections. Artificial joint fluid is an option for people who have symptomatic knee OA. The treatment involves a series of injections into the knee joint. The fluid lubricates and cushions the joint allowing it to move more easily. Relief from an injection last three to six months.
Physical therapy can help improve muscle strength, increase the range of motion, and reduce pain. A physical therapist can help you develop an exercise regimen suited to your needs.
Assistive devices can help with function and mobility. Items such as splints, braces, and shoe inserts can help support weakened joints, take pressure off injured bones, and reduce pain. Some custom products need to be prescribed by a doctor and fitted by a physical or occupational therapist. Scooters, canes, and walkers can help with mobility. Other tools such as jar openers, long-handled shoe horns, and steering wheel grips are also available without a prescription.
Severe cases of OA may require surgery to replace or repair damaged joints. There are several types of surgery used to treat OA.
Osteoarthritis Can Affect Overall Health
The pain, reduced mobility, side effects from medication, and other factors associated with OA can lead to adverse health effects not directly related to the joint disease.
People with OA have risk factors such as decreased function, muscle weakness, and impaired balance that makes them more likely to experience a fall. The side effects of pain relief medications can also contribute to falls. People with osteoarthritis also have a greater risk of fracture from a fall than those without OA.
OA is a chronic condition that doesn’t have a cure, but with treatment, the outlook is positive. Don’t ignore the symptoms of chronic joint pain and stiffness. The sooner you speak with a pain management doctor, the sooner you can receive a diagnosis, begin treatment, and improve your quality of life.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating osteoarthritis pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.