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OsteoarthritisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/osteoarthritis/DS00019
Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.
While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.
Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.
Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:
- Pain. Your joint may hurt during or after movement.
- Tenderness. Your joint may feel tender when you apply light pressure to it.
- Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
- Loss of flexibility. You may not be able to move your joint through its full range of motion.
- Grating sensation. You may hear or feel a grating sensation when you use the joint.
- Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.
When to see a doctor
If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.
Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.
Factors that increase your risk of osteoarthritis include:
- Older age. The risk of osteoarthritis increases with age.
- Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
- Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
- Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
- Obesity. Carrying more body weight puts added stress on your weight-bearing joints, such as your knees.
- Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
- Other diseases. Having diabetes, underactive thyroid, gout or Paget's disease of bone can increase your risk of developing osteoarthritis.
Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.
Preparing for your appointment
While you may initially bring your concerns to your family doctor, he or she may refer you to a doctor who specializes in joint disorders (rheumatologist) or orthopedic surgery.
What you can do
You may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you've had
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
Your doctor may ask some of the following questions:
- When did your joint pain begin?
- Is the pain continuous, or does it come and go?
- Do any particular activities make the pain better or worse?
- Have you ever injured this joint?
Tests and diagnosis
During the physical exam, your doctor will closely examine your affected joint, checking for tenderness, swelling or redness. He or she will also check the joint's range of motion. Your doctor may also recommend imaging and lab tests.
Pictures of the affected joint can be obtained during imaging tests. Examples include:
- X-rays. Cartilage doesn't show up on X-ray images, but the loss of cartilage is revealed by a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. Many people have X-ray evidence of osteoarthritis before they experience any symptoms.
- Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage. This can be helpful in determining what exactly is causing your pain.
Analyzing your blood or joint fluid can help pinpoint the diagnosis.
- Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
- Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there's inflammation and if your pain is caused by gout or an infection.
Treatments and drugs
There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement.
Osteoarthritis symptoms can be relieved by a variety of medications, including:
- Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Older people have the highest risk of complications.
- Narcotics. These types of prescription medication typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
A combination approach to treatment often works best. Your doctor may suggest:
- Physical therapy. A physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase the range of motion in your joint and reduce your pain.
- Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
- Braces or shoe inserts. Consider trying splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.
- A chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.
Surgical and other procedures
If conservative treatments don't help, you may want to consider procedures such as:
- Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can worsen joint damage over time.
- Lubrication injections. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These agents are similar to a component normally found in your joint fluid.
- Realigning bones. During a surgical procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by shifting your body weight away from the worn-out part of your knee.
- Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced.
Lifestyle and home remedies
Lifestyle changes and home treatments also can help reduce osteoarthritis symptoms. You might want to try some of the following tips:
- Rest. If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively.
- Exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Stick to gentle exercises, such as walking, biking or swimming. If you feel new joint pain, stop. New pain that lasts for hours after you exercise probably means you've overdone it.
- Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
- Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.
- Apply over-the-counter pain creams. Creams and gels available at drugstores may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Pain creams work best on joints that are close to the surface of your skin, such as your knees and fingers.
- Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Carry the cane in the hand opposite the leg that hurts. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores also may be places to look for ideas.
People who aren't helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Common treatments that have shown some promise for osteoarthritis include:
- Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in people who have knee osteoarthritis. During acupuncture, hair-thin needles are inserted into your skin at precise spots on your body. Risks include infection, bruising and some pain where needles are inserted into your skin.
- Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while most indicate that these supplements work no better than placebo. Don't use glucosamine if you're allergic to shellfish. Glucosamine and chondroitin may interact with blood thinners such as warfarin (Coumadin) and cause bleeding problems.
- Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. When led by a knowledgeable instructor, these therapies are safe. Avoid moves that cause pain in your joints.
Coping and support
Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own outlook on life. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Talk to your doctor if you're feeling frustrated. He or she may have ideas about how to cope or refer you to someone who can help.
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