Cartilage is smooth tissue that covers the bone in a joint. Osteoarthritis (OA) is a gradual wearing down of cartilage. It can cause pain and limit movement.
Cartilage is smooth tissue that covers the areas of bone that make up a joint. It provides a cushion for the bones and helps the joint work smoothly. Over time the impact, stress, and pressure on the joint can wear down the cartilage. The damage worsens over time. The cartilage may completely wear away and the bare bones rub together. Bone on bone friction causes pain and inflammation.
The wear and tear of the joint is a part of aging. However, it can be made worse. Injuries to the joint, weak muscles, or other medical conditions all add to and speed up the damage.
OA is more common in older adults. Other factors that may increase your chance of OA include:
- Excess body weight
- Family history of OA
- Having an injury or surgery to the joint surface, especially the cartilage
- Having a job or doing physical activities that put stress on the joints
- Certain endocrine, metabolic, or neuropathic disorders
- Avascular necrosis—death of bone from lack of blood flow
OA is most common in larger joints that support weight such as the spine, hips, and knees. It is also common in active joints like the hand and feet. Common symptoms include:
- Mild to severe pain in a joint, especially after overuse or long periods of rest
- Creaking or grating sound in the joint
- Swelling, stiffness, and problems moving the joint, especially in the morning
- Decreased stiffness after starting activity
You will be asked about your symptoms and medical history. A physical exam will be done. The doctor can often diagnose OA based on your symptoms.
Other tests are not always needed. The doctor may do more tests if your symptoms are not typical. The tests can help to rule out other issues like new injury. Test options may include:
OA cannot be cured. Treatment is focused on:
- Reducing joint pain and inflammation
- Improving joint function
- Slowing future damage
Options may include:
Losing weight can lessen the stress on joints. The closer you are to your ideal weight, the greater the benefit. A dietitian can help with meal planning.
Exercise and Therapy
Muscles affect the alignment of the joint, how they move, and how much stress is placed on them. The stronger the muscles the less wear and tear happens with each movement. This can help slow progression of OA.
Strengthening the muscles that support the joint may also decrease OA pain and improve movement. Low impact options may help. For example, swimming and water aerobics improve muscle health with less impact on the joints. The doctor or an exercise specialist can help to create a program.
OA can make everyday tasks difficult. Physical or occupational therapy can provide new steps or devices to help you such as:
- Shoes with shock-absorbing insoles
- Splints or braces to align joints and distribute weight
- Elastic supports
- Canes, crutches, walkers, and orthopedic shoes
- Home tools, such as handrails and grips or raised seats, including toilet seats
Other therapy options include:
- Transcutaneous electrical nerve stimulation (TENS)—electrical pulses that can reduce pain signals
- Manual therapy—therapies such as massage therapy can improve muscle balance and joint alignment
Medications may help to manage pain or swelling. Options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Topical pain medicines that are applied to the skin—capsacian is a common choice
- Prescription pain medicines
- Corticosteroid—may be by mouth or by injection
- Viscosupplementation injection (hyaluronic acid)—to replace low levels and help cushion the joint
Heat and Ice
Heat may help loosen stiff joints and improve movement. Hot water bottles, warm soaks, paraffin, or heating pads may help.
Ice may help decrease swelling and pain. It may be most useful after activity.
Alternative therapies may give some relief. They work best when used in combination with treatments above. It is important to work with your doctor to make sure all your efforts work together. Alternative options that have shown some promise with OA include:
Surgery may be needed for joints that are causing severe limits. It may be done to:
- Remove loose pieces of bone or cartilage from joints
- Reposition bones to balance stress on the joint
- Replace a damaged joint with an artificial one
To reduce your chance of OA:
- Maintain a healthy weight.
- Do regular exercise, such as walking, stretching, swimming, or yoga.
- Avoid repetitive motions and risky activities that may lead to joint injury. This is even more important after age 40.
- Reviewer: Warren A. Bodine, DO, CAQSM
- Review Date: 09/2017 -
- Update Date: 07/12/2018 -