Osteoarthritis is sometimes called "wear-and-tear" arthritis because the condition involves the erosion of cartilage, the cushioning material on the ends of bones that helps reduce friction within a joint. As we age, the constant movement of our joints makes the cartilage thinner, and when it wears away completely, bone can rub on bone. Unlike rheumatoid arthritis, which is a disease that affects multiple joints, osteoarthritis can affect a single joint, typically a large weight-bearing joint such as the hip, knee, or ankle. Osteoarthritis is also common in the shoulder, elbow, wrist, and hand.
Common symptoms of osteoarthritis include stiffness, pain, swelling, inflammation, and deformity. In many patients, small bone growths called osteophytes can develop within the joint and physically block joint motion. Osteoarthritis is mostly seen in middle-aged or older individuals; however younger people can develop osteoarthritis within a joint, too, as a result of overuse in work or sports, or trauma to the joint.
To diagnose osteoarthritis and determine the extent to which it has progressed, a doctor relies upon your complete medical history, physical examination, radiographs (X-rays), and possibly lab tests.
Medical history: Tell the doctor everything in your medical history, including your current symptoms. When did joint pain begin? Is the pain continuous, or does it come and go? Is pain worse at night? Is it worse when you walk or run? Be sure to mention if you have ever injured the joint, or if you also have pain in other parts of the body.
Physical examination: The doctor will look at the affected joint and may ask you to move it into various positions. He or she may check for pain and restricted motion, crepitus (crackling sound and/or sensation with joint motion), muscle atrophy, involvement of other joints or signs of injury to muscles, tendons, and ligaments.
Radiographs: Radiographs (X-rays) can show the extent of joint deterioration, including narrowing of the joint space, thinning or erosion of bone, excess fluid in the joint, bone spurs, or other abnormalities.
Lab tests: Sometimes laboratory tests can help rule out other diseases that cause symptoms similar to osteoarthritis.
Early nonsurgical treatment can slow the progression of osteoarthritis, increase motion, and improve strength. Most treatment programs combine lifestyle modifications, medications, and physical therapies.
Lifestyle modifications: The doctor may recommend that you rest or change activities to avoid provoking osteoarthritis pain. This could mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling). If osteoarthritis is affecting one or more weight-bearing joints (such as the knee, hip, or ankle) and you are overweight, you may also need to start a weight-loss program.
Medications: Nonsteroidal anti-inflammatory medications, such as aspirin and ibufrofen, can help reduce inflammation. Sometimes the doctor may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint for temporary relief of pain and swelling. Dietary supplements called glucosamine and chondroitin sulfate may also help relieve osteoarthritis pain. Glucosamine stimulates formation and repair of articular cartilage and chondroitin sulfate prevents cartilage from degrading.
CAUTION: The U.S. Food and Drug Administration does not test or analyze dietary supplements. These compounds may also cause negative interactions with other medications or cause excessive bleeding during surgical procedures. Always consult your doctor before taking dietary supplements.
Physical therapy The doctor may prescribe a balanced fitness program, physical therapy, and/or occupational therapy to improve joint flexibility; increase range of motion; strengthen muscle, bone, and cartilage tissues; and reduce pain. You may need to use supportive or assistive devices (braces, splints, elastic bandages, canes, crutches, walkers) and/or apply ice or heat to the affected joint for short periods, several times a day.
If conservative treatments do not stop the pain, the doctor may consider surgery, depending upon your age and activity level, the condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, joint fusion, and joint replacement.
Arthroscopy: A surgeon uses a pencil-sized instrument (arthroscope) and two or three small incisions to remove bone spurs, cysts, damaged joint lining, or loose fragments in the joint.
Joint fusion: A surgeon eliminates flexibility and motion at the joint by binding together the ends of bone (fusion). Pins, plates, screws or rods may hold bones in place while they heal.
Joint replacement A surgeon removes parts of the bones and creates an artificial joint with metal or plastic components (total joint replacement or arthroplasty).
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