Osteoarthritis

Osteoarthritis is the most common form of arthritis worldwide, affecting millions of people. While there is no cure, understanding this condition and knowing how to manage it can help you maintain an active, fulfilling life and slow its progression.

Table of contents

• What is osteoarthritis
• Symptoms and signs
• Causes and risk factors
• Which joints are affected
• How osteoarthritis is diagnosed
• Treatment options
• Lifestyle changes and self-care
• Living with osteoarthritis

What is osteoarthritis

Osteoarthritis is a condition that affects your joints, causing them to become painful and stiff. It happens when the cartilage (the protective, smooth tissue that cushions the ends of your bones) wears down over time. Cartilage acts like a shock absorber and lubricant, helping the bones in your joints move smoothly against each other^[1][3].

When cartilage breaks down and becomes rough, your bones may eventually rub together when you move the joint. This can cause pain, swelling, and changes in the bone and other joint tissues. Extra bits of bone called bone spurs may also form around the affected joint^[1][7].

Osteoarthritis is a disease of the entire joint, not just the cartilage. It affects the bone, cartilage, ligaments, fat, and the tissues lining the joint. Over time, it can lead to changes that result in disability or make it hard to do everyday tasks^[2][4].

About 528 million people worldwide were living with osteoarthritis in 2019, representing a 113% increase since 1990. In the United States, it affects approximately 32.5 million adults^[7][8]. It is estimated that more than 80% of adults older than 55 have osteoarthritis, although not everyone experiences symptoms^[3].

Symptoms and signs

Osteoarthritis symptoms typically develop slowly and worsen over time. The severity of symptoms can vary greatly from person to person and between different affected joints. For some people, symptoms may be mild and come and go. Others can experience more continuous and severe problems^[1][6].

The most common symptoms include:

• Joint pain that gets worse during or after movement and often improves with rest^[1][4]
• Stiffness in the joint, especially noticeable upon awakening or after periods of inactivity. This stiffness usually lasts less than 30 minutes, unlike other forms of arthritis^[1][5]
• Swelling in and around the joint, which might be caused by soft tissue inflammation. Swelling may be especially noticeable after using the joint a lot^[1][4]
• Tenderness when you apply light pressure to or near the joint^[1]
• Loss of flexibility and reduced ability to move the joint through its full range of motion^[1][4]
• Grating sensation when using the joint, and you might hear popping or crackling sounds^[1]
• Feeling like the joint is loose or unstable^[4]

These symptoms result in loss of function, with many people limiting their daily activities because of pain and stiffness. If joint pain or stiffness doesn’t go away, it’s important to make an appointment with your healthcare professional^[1][5].

Causes and risk factors

Experts aren’t entirely sure what causes osteoarthritis. The condition can be classified into two main types. Primary osteoarthritis is the most common form and develops in your joints over time, usually as a result of normal wear and tear as you age. Secondary osteoarthritis happens when something directly damages one of your joints enough to cause the condition^[3][5].

Several things can increase your chances of developing osteoarthritis:

• Older age – The risk increases as people get older, with symptoms typically showing up more often in individuals over age 50^[1][4]
• Gender – Women are more likely to develop osteoarthritis than men, especially after age 50 and during postmenopause^[2][4]
• Obesity – Excess weight adds stress and pressure on joints, particularly weight-bearing joints like the knees and hips. Fat cells also promote inflammation^[2][4]
• Joint injury or trauma – A bone fracture, cartilage tear, ligament tear, or joint injury from sports or accidents can lead to osteoarthritis, sometimes developing much more rapidly within just a few years^[2][3]
• Repetitive joint stress or overuse – Using the same joints over and over in a job or sport, or doing activities with repeated knee bending, can increase risk^[2][4]
• Family history – People with family members who have osteoarthritis are more likely to develop it themselves^[2][4]
• Other health conditions – Conditions like diabetes, high cholesterol, and some autoimmune diseases can increase risk^[3]
• Weak muscles – If muscles don’t provide adequate joint support, poor alignment can result and lead to osteoarthritis^[2]
• Musculoskeletal abnormalities – Malalignment of bone or joint structures can contribute to faster disease development^[2]

Other forms of arthritis, including rheumatoid arthritis, gout, and psoriatic arthritis, can damage the cartilage in your joints enough to cause osteoarthritis^[3].

Which joints are affected

Although osteoarthritis can damage any joint in the body, the condition most commonly affects certain areas. The joints most frequently involved are the hands, knees, hips, and spine (including the neck and lower back)^[1][2].

• Hands
• Knees
• Hips
• Spine (neck – cervical spine)
• Spine (lower back – lumbar spine)
• Feet
• Shoulders

With a prevalence of 365 million people, the knee is the most frequently affected joint worldwide, followed by the hip and the hand^[7].

Osteoarthritis is often asymmetric, meaning it may severely affect one joint while the opposite joint remains relatively normal. For example, you might have severe, debilitating osteoarthritis in one knee with almost normal function of the opposite leg^[15].

How osteoarthritis is diagnosed

To find out if you have osteoarthritis, you should see a healthcare provider, ideally a specialist in arthritis called a rheumatologist^[4].

The diagnosis is based on several factors. Your provider will ask about your symptoms and medical history, including when you first noticed any symptoms and what activities make them worse. They will perform a physical exam to check your affected joints for tenderness, swelling, and flexibility, and to assess how well you can move the joint^[1][3].

Your provider may suspect osteoarthritis if you are aged 45 or older, have joint pain that gets worse the more you use your joints, and the stiffness in your joints is not present in the mornings or lasts less than 30 minutes^[6].

Imaging tests may help confirm the diagnosis:

• X-rays – While cartilage doesn’t show up on X-ray images, cartilage loss is revealed by a narrowing of the space between the bones in your joint. X-rays can also show bone spurs around a joint^[10]
• Magnetic resonance imaging (MRI) – An MRI produces detailed images of bone and soft tissues, including cartilage. It isn’t commonly needed to diagnose osteoarthritis but can provide more information in complex cases^[10]

Blood tests or joint fluid analysis might be performed to rule out other causes of joint pain, such as rheumatoid arthritis, gout, or infection, rather than osteoarthritis^[10].

Further tests such as X-rays or blood tests are not usually necessary for diagnosis, but may be used to rule out other possible conditions. It’s important to note that radiographic evidence of osteoarthritis is at least twice as common as symptomatic osteoarthritis, so X-ray changes alone don’t prove that osteoarthritis is the cause of a patient’s joint pain^[5][6].

Treatment options

Osteoarthritis can’t be reversed or cured, but treatments can reduce pain and help you move better. The goal of treatment is to relieve pain and stiffness and help you maintain normal activities^[1][12].

Optimal management involves a combination of approaches focused on preventing disease progression and improving your quality of life^[14].

Medications

Several types of medications can help relieve osteoarthritis pain:

• Acetaminophen (paracetamol) – Available over the counter, this medication can help some people with mild to moderate pain. However, many people find it doesn’t work very well. It’s important not to exceed the maximum recommended dose as this can cause liver damage^[10][13]
• Nonsteroidal anti-inflammatory drugs (NSAIDs) – Common pain relievers such as ibuprofen and naproxen sodium, taken at recommended doses, typically relieve osteoarthritis pain and reduce inflammation. NSAIDs are superior to acetaminophen for treating moderate to severe osteoarthritis. They are available as tablets or as topical creams and gels that you apply directly to affected joints. Topical NSAIDs can be particularly effective for knee or hand osteoarthritis^[10][12][13]
• Opioids – For severe pain not relieved by other medications, stronger pain relievers may be prescribed, but these carry a risk of addiction and side effects such as drowsiness, nausea, and constipation^[12][13]
• Capsaicin cream – Derived from chili peppers, this topical cream can help block knee pain, though it may cause a burning sensation or skin redness where applied^[19]

Injections

When oral medications aren’t enough, injections directly into the joint may help:

• Corticosteroid injections – These provide inexpensive, short-term relief (four to eight weeks) of osteoarthritis flare-ups, especially in the knee^[12][15]
• Hyaluronic acid injections – These are more expensive but can maintain symptom improvement for longer periods compared to corticosteroid injections^[12][15]

Surgical options

Surgery is considered as a last resort when chronic pain and disability persist despite maximal medical therapy. Total joint replacement of the hip, knee, or shoulder is recommended for patients with severe osteoarthritis who continue to have pain and limited function after trying other treatments^[15][16].

Supplements

The evidence for dietary supplements is mixed. Glucosamine and chondroitin, two popular supplements, may decrease pain in patients with moderate to severe knee osteoarthritis when taken together, although the evidence is limited and inconsistent. A large National Institutes of Health study found that people with knee osteoarthritis who took glucosamine or chondroitin did not experience significant pain improvement over two years^[15][20].

Lifestyle changes and self-care

Lifestyle modifications and self-care are essential components of osteoarthritis management. These approaches can help slow joint damage, reduce symptoms, and improve your quality of life^[14][21].

Physical activity and exercise

Regular physical activity may be the most important piece of your overall treatment plan. Exercise is one of the most important treatments for people with osteoarthritis, regardless of age or fitness level. It helps maintain joint function, muscle strength, and overall health, while also reducing pain and improving mood^[6][12].

Exercise provides multiple benefits:

• Increases joint lubrication
• Improves the joint’s range of motion
• Strengthens supporting muscles
• Maintains strong bones
• Promotes circulation
• Reduces inflammation
• Slows joint deterioration^[12][23]

Aim for at least 150 minutes (2.5 hours) of moderate physical activity each week, such as walking, swimming, cycling, water aerobics, yoga, or tai chi. You can break this into smaller chunks, such as 30 minutes a day, 5 days a week. Low-impact exercises are especially recommended. Water-based exercises allow you to exercise while reducing pressure on your joints due to the water’s buoyancy^[6][21][23].

If joint pain or stiffness makes activity difficult, work with a physical therapist to develop an exercise plan and find modifications that work for you. It’s important to learn gentle exercises that promote healthy joints without adding stress^[12][23].

Weight management

Maintaining a healthy weight is one of the most important things you can do to reduce osteoarthritis pain and slow disease progression. Being overweight or obese makes osteoarthritis worse because it places extra strain on your joints, particularly weight-bearing joints like the knees and hips^[6][12].

Your body weight has a significant impact on osteoarthritis. Every pound you gain puts 30-60 pounds of pressure on your knees. Research has shown that every one pound lost results in four pounds less pressure on knees and other weight-bearing joints. Losing 10% to 20% of body weight can improve pain, function, and quality of life for older adults with obesity and osteoarthritis^[12][23].

If you need to lose weight, aim to do so at a slow, steady pace. Create a sustainable plan that includes exercise and a healthy, balanced diet^[6][23].

Anti-inflammatory eating

Following an anti-inflammatory meal plan, such as the Mediterranean diet or DASH eating plan, can ease joint pain and help slow joint degeneration. These diets are healthy and well-balanced, revolving around nutrient-rich foods that reduce inflammation, such as fish, vegetables, nuts, beans, whole grains, and unsaturated fats. They also help prevent high blood sugar, which promotes joint degeneration^[23].

Supportive devices and assistive tools

Various devices can help you perform daily tasks more easily and safely:

• Braces and splints – Custom or off-the-shelf braces and splints may help if your joints are out of alignment or feel unstable. Kinesiology taping of the thumb or knees with flexible tape can also help with pain and stability^[16][19]
• Canes, walkers, or wheelchairs – These can help you move around if you have hip or knee osteoarthritis that makes walking difficult^[16][19]
• Home modifications – Installing handrails, ramps, or grab bars in your bathroom or on stairs can make your home more accessible and comfortable. Using ergonomic furniture, tools, and equipment can also reduce strain on your joints^[24]

Pain management techniques

Several non-medication approaches can help ease pain:

• Heat and cold therapy – Hot packs, heating pads, and paraffin wax dips can soothe achy joints. Ice packs can reduce swelling and numb pain^[19]
• Complementary therapies – Massage can increase blood flow and bring warmth to the area. Some research shows that acupuncture may help relieve osteoarthritis pain^[10]
• Mind-body activities – Tai chi and yoga combine physical poses with breathing techniques and relaxation. Regular practice can help reduce pain, improve joint flexibility and function, lower stress and tension, and promote better sleep^[19]

Stress reduction and sleep

Stress makes you more sensitive to pain, triggers inflammation, and tightens muscles, adding pressure on arthritic joints and potentially accelerating degeneration. Learning to relax through activities like warm baths, listening to calming music, practicing mindfulness meditation, breathing exercises, and guided imagery can reduce stress and ease joint pain^[23].

Getting enough sleep is also important. The lack of sleep worsens pain and may lead to faster disease progression. Adjusting your bedtime routine, such as taking a warm bath, avoiding alcohol in the evening, and turning off all electronics and lights, can help your brain release the sleep hormone melatonin^[23].

Living with osteoarthritis

Living with osteoarthritis can be challenging and may affect your social and emotional health. You may worry about how it may change your life, work, and relationships. Your symptoms may come and go, stay the same, or get worse over time^[25].

Some people feel overwhelmed, tired, angry, or afraid that they might become disabled and not be able to care for themselves. Others may feel down or depressed. It’s okay to have these feelings. Most people who have arthritis feel this way at one time or another^[17][25].

Emotional and social support

There are simple things you can do to feel better and keep the joy in your life and relationships:

• Seek emotional support – Talk to your family members, friends, or healthcare providers about your feelings and concerns. Consider joining a support group for people with osteoarthritis, either online or in person. This is a great place to share your experiences, learn from others, and find comfort and encouragement^[24][25]
• Ask for help – Don’t be afraid to let people help you with some of your tasks, especially on days when you have a lot of pain^[25]
• Stay social – At times, you may not want to go out because you’re too tired or don’t want to be seen using assistive devices. But being social can help you feel better. If you isolate yourself, you may become depressed^[25]
• See a counselor – Cognitive behavioral therapy allows you to express your fears and concerns and learn new ways of coping with arthritis^[25]

If you feel depressed 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^[17][25].

Work and daily activities

If arthritis makes it hard to do your job, talk to your boss about changes you can make to your schedule and modifications to your work area. You might ask if you can have a later start time, work part-time or from home, or switch to a light-duty position if your job involves a lot of lifting, bending, or standing^[25].

Find ways to still do the things you enjoy. You may need to do things in a different way that doesn’t cause pain. Balance activity with rest. If you get tired when you do a task, break it down into smaller tasks and rest between them^[25].

Learning and self-management

The more you know about arthritis, the more you’ll be able to cope with any lifestyle changes you may need to make. There are low-cost self-management education workshops available that can help you learn to manage pain, exercise safely, and gain control of your arthritis. Learning skills to self-manage osteoarthritis can improve your quality of life^[16][21][25].

Encourage your family and friends to learn about arthritis too, so they can understand what you’re dealing with and learn ways they can help you^[25].

Maintaining a positive outlook

Try to stay positive. Adopting a “good-health attitude” and healthy habits, such as eating a balanced diet, staying at a weight that’s healthy for you, and getting enough sleep, will make you feel better and help you stay active. When you think in a positive way, you may be more able to care for yourself, handle the challenges of arthritis, and avoid or cope with stress, anxiety, and depression^[25].

Keep in mind that osteoarthritis is a chronic condition that has no cure, but with the right treatment and support, you can lead a healthy, active life. The condition does not necessarily get worse over time, and it can sometimes gradually improve^[6][24].

If you have continuous pain and disability from osteoarthritis despite trying all available treatments, you may be a candidate for joint replacement surgery, which can significantly improve your quality of life^[16].