Osteoarthritis is a disorder that affects the lives of 27 million Americans. It triggers pain in the joints that limits mobility and daily activities, potentially turning mundane tasks such as buttoning a shirt or walking the dog into an endurance test. The disease is the nation’s number one musculoskeletal disorder. Many impacted by it suffer because they are unaware of the broad range of innovative treatment options available to help them.
There are steps you can take, even starting today, to reduce your risk of developing the condition if you don’t have it, and to live with less pain if you do. Incorporating physical activity into your daily routine and adopting healthy eating habits to achieve a healthy weight are excellent first steps. Hospital for Special Surgery offers guidance and treatment to get you on your way.
What Is Osteoarthritis?
In its simplest terms, osteoarthritis involves the breakdown of cartilage in your joints — most commonly in the knees, hips and hands. This spongy tissue normally acts as a shock absorber between the bones in each joint. But over time, and particularly with age or injury, the cartilage breaks down due to normal wear and tear. In early-stage osteoarthritis, the cartilage has started to deteriorate, but the bones are unaffected.
As years pass, the bones lose this protective cushion, and they can rub against each other, causing the pain that characterizes osteoarthritis. This progression marks the later stage of the disease.
Arthritis specialists are increasingly learning that there’s more to the story than wear and tear: inflammation appears to play a role as well. Studies have shown that many people with osteoarthritis have inflammatory cells in their joints, especially among those who have suffered an injury (such as a torn meniscus or anterior cruciate ligament [ACL] in the knee) that puts them at an increased risk for developing osteoarthritis.
Research is demonstrating that in addition to mechanical damage to a joint, an individual’s response to that damage may influence the onset of osteoarthritis. And if doctors can understand what factors promote arthritis progression, they might be able to intervene earlier — such as by guiding patients to help them lose weight. With more research, we might even be able to define medical approaches that would prevent progression of joint damage.
Who Is at Risk?
While osteoarthritis can affect anyone, there are some risk factors that can increase your chance of developing the condition:
What Are the Symptoms?
By far the most common symptom of osteoarthritis is recurring joint pain. This pain may present in the following ways:
Making the Diagnosis
If you have joint pain, your doctor will do a series of examinations to determine the cause. The first is a physical examination to look for any swelling and to assess your level of pain, range of motion, and muscle strength. If your pain is in your knees or hips, your doctor may also look at how it is affecting your walking (gait). It is important to tell your doctor about your medical history, such as prior injuries and the nature of your pain.
X-rays can help visualize what is happening inside a joint, particularly if any wearing-down of the bone has begun. They can also be used to show cartilage deterioration, because the bones of a joint will move closer together when this happens. Magnetic resonance imaging (MRI) is very helpful for demonstrating bone and soft-tissue changes in arthritis at an earlier stage, while computed tomography (CT) scanning is valuable for assessing early bony changes, including bone spurs.
In some patients with suspected osteoarthritis, ultrasound is useful for imaging cysts. Your doctor may also do blood tests or withdraw some synovial fluid from a joint for analysis to rule out other causes of joint pain and to confirm a diagnosis of osteoarthritis.
What You Can Do
If you are at risk for developing osteoarthritis or are diagnosed with this condition, your doctor will discuss ways you can reduce your risk or slow its progression. By far the most effective and tangible way is to achieve and maintain a healthy weight, as well as strengthen your joints and maintain flexibility.
The management of osteoarthritis may require a team approach, bringing together your primary care physician, a rheumatologist (joint specialist), sports medicine doctor, physiatrist (rehabilitation medicine specialist), orthopedic surgeon, dietitian, and/or physical therapist as needed.
Your healthcare team may recommend anti-inflammatory drugs such as ibuprofen or naproxen to manage your symptoms, or prescription drugs such as celecoxib. Some patients benefit from joint injections or mechanical adjustments that shift the pressure being put on a joint, such as custom orthotics to be worn in your shoes to relieve hip or knee pain.
If, despite these measures, joint damage and pain in the knees or hips become so severe that they significantly interfere with your daily activities, your health care team may recommend joint replacement to get you back to your normal routine as quickly and comfortably as possible.