The Empowered Patient's Guide to Osteoarthritis (OA)

It holds the dubious distinction of being the most common type of arthritis. And the older you are, the more likely this degenerative disease will have you in its grip. But you can ease the symptoms. Read on for all the intel and advances in treating OA. 

There is no one-size-fits-all treatment for osteoarthritis, but lifestyle changes including weight loss and regular exercise works for many people. OA flares can be treated with corticosteroid injections. For the worst cases, joint replacement surgery may be suggested.

Osteoarthritis (OA), the wear-and-tear form of arthritis, is like a houseguest that has literally and figuratively “worn out” its welcome. OA mooches off the cushioning cartilage of your joints, leaving you with pain and stiffness. It shadows you, making even the simplest tasks impossible. It can be a vicious cycle, too.

Taking time out and resting often leads to weight gain, which only makes joint pain worse over the long term. On the flip side, regular physical activity can keep weight down, but the wrong kind of exercise can also cause joint pain to flare. Ugh—would someone please show this houseguest the door? Well, while you can’t serve osteoarthritis an eviction notice, there is lots of exciting research underway that promises to help reduce OA pain and joint damage—no surgery required.

So, What Exactly Is Osteoarthritis (OA)?

Osteoarthritis, a degenerative disease that worsens over time, is the most common type of arthritis. It affects more than 32.5 millionadults in the United States, according to the Centers for Disease Control and Prevention (CDC). OA can strike any joint, but it usually occurs inthe hands, spine, hips, knees, and toes.

It can also develop in the shoulders, elbows, or wrists, but these spots are less common. Sometimes it affects just one joint, but other times OA can involve multiple joints. The pain, stiffness, and trouble using the affected joint can often leave you feeling sidelined whileeveryone else seems to be enjoying their life.

Some symptoms are universal, regardless of which joint has OA—namely pain, stiffness, and swelling.1 Other OA symptoms can be site-specific. OA in hand joints, for example, can make it difficult to tie a shoe or open a bottle, while spine OA may cause weakness or numbness in the legs or arms. With hip OA and knee OA, you may be more likely to fall due to instability.

Who Gets Osteoarthritis?

We’ll chase your question with two of our own. One) How many birthday candles have you blown out? Two) What’s the number on your bathroom scale? Advancing age and extra weight, which taxes the joints and triggers inflammation, are the two biggest risk factors.

Joint injury or overuse, genes, and gender also play a role: Women are at greater risk than men after age 50.1 Risks also vary by which joint is affected. For example, farmers and others whose jobs involve lots of lifting, kneeling, climbing, squatting, and standing are more likely to develop knee OA than their counterparts with desk jobs, according to a 2020 review published online in Arthritis Care & Research.2

OA doesn’t happen overnight. It can take decades to wear down enough cartilage to cause pain and bony changes.1 Cartilage is a smooth, slippery, shock-absorbing cushion between bones. It has no nerve endings, which means it is an excellent buffer from pain, says Grant E. Garrigues, MD, associate professor, director of upper extremity research, Rush University, Chicago.

When cartilage breaks down, bone, which contains many nerve endings, rubs against bone like sandpaper against sandpaper, causing pain and swelling. You may also hear some snaps, crackles, or pops when you bend the joint. With time, the underlying bone begins to change. This is considered joint damage, the CDC states.1

The Details—But Wait, Osteoarthritis Gets More Complicated

Thereare many things your health care team can do to manage OA pain, but joint damage, if it should occur, is irreversible. Medications may be able to stop pain, but what is done is done. There’s no turning back the clock, says Jonathan Samuels, MD, a rheumatologist and co-director of the Joint Preservation & Arthritis Center at NYU Langone in New York City.

And herein lies the problem.Take the idea of cholesterol and a heart attack as a comparison. It’s well-known that high cholesterol levels increase the chances of having a heart attack, so doctors intervene early and lower cholesterol and hopefully stave off a future heart attack. When it comes to OA, though, there is no “cholesterol” yet.

Much of the research is searching for a marker in the blood or on an X-ray that can predict who is likely to develop OA, so step can be taken to prevent it from occurring in the first place.

As of now, doctors don’t know where or when the OA process starts, so there is no “target” for OA like cholesterol is for heart disease.

What Else to Expect When Living with OA

OA pain isn’t just the physical pain of exhaustion—it can make you feel left out and alone. Chronic pain seeps into all aspects of your life, from relationships to your career. It also often travels with anxiety and depression.

When your gait is unsteady as may be the case with knee or hip OA, youare about 2.5 times more likely to experience a fall or injury, the CDC notes.3 And problems beget problems; falls can lead to broken bones and long recovery periods.

OA also increases the chances of dying from heart disease, according to research in Osteoarthritis and Cartilage. Obesity tends to be linked with OA and can cause or worsen joint pain.The pain can sideline you, and over time this lack of physical activity an lead to more weight gain, which sets the stage for heart disease.

Many people with OA also have diabetes because being overweight or obese is a risk for both of these common conditions.4 High blood sugar levels, a hallmark of diabetes, can make cartilage stiffer and more likely to break down. This packs a one-two punch against your cartilage. Diabetes also increases risk for developing heart disease.5

Joint pain impacts restful sleep. It can wake you up at night and interfere your ability to fall asleep in the first place. You’re far from alone in you sleep struggles.

Roughly 70% of those with OA experience some type of sleep issue, according to the Arthritis Foundation.6  Poor sleep can worsen pain perception and feelings of depression and anxiety. It can become increasingly hard to tease out what is the chicken and what is the egg.

Are you tired from pain, or is pain making you tired? Are you depressed because you can’t do the things you used to do, or is the inactivity fueling your depression and anxiety?

How to Treat Osteoarthritis (OA)

There is no one-size-fits-all treatment for OA. What works for your friendwith OA may not do a thing for you. In general, treatment will include behavioral (weight loss and exercise), psychosocial (CBT), and physical (gait aids and braces) interventions, plus medications.7

Managing your weightIf you have OA is important losing weight is the closest thing there is to a universal OA treatment recommendation, especially if you are overweight or obese.

One pound of weight equals four pounds of pressure on a knee, says Dr. Samuels. This means that dropping some pounds takes an exponential amount of pressure off your achy, creaky joints.

Fat is also inflammatory. Inflammation can aggravate non-weight-bearing joints, like shoulders. You don’t need to lose much to feel a difference. Dropping just 5% to 10% or more of your body weight can have a positive effect on pain, he says. The more you lose, the better you will feel if you are overweight or obese.

Exercise is also strongly recommended for knee, hip, and/or hand OA, according to the latest OA recommendations from the American College of Rheumatology/Arthritis Foundation. This may seem counterintuitive because exercise can also cause pain in the short term.

However, physical activity boosts the muscles around the eroding joint and decreases pain in the long run. Work with a physical therapist to learn the best and safest moves for your joints. Some people also benefit from learning tai chi, a form of martial arts marked by slow, gentle movements and deep breathing. Taken together, weight loss and exercise can slash joint pain and help you get your life back.7

Medications, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatories (NSAIDS) such as ibuprofen (Advil) can reduce knee and hip pain, and topical painkillers may do wonders for your knee or hand joints, according to the American College of Rheumatology and the Arthritis Foundation guidelines.

How to Treat Osteoarthritis (OA)How to Treat Osteoarthritis (OA)

Next up are usually injections of steroids directly into the affected joints. These powerful shots cool inflammation around your joint. Results can last a couple of days. This may be all that is needed to curb an OA flare.7

There was once a lot of hope pinned on injections of hyaluronic acid (a substance that occurs naturally in the joints), which lubes up the joints so there is less painful bone-on-bone rubbing, but the latest guidelines caution against this type of viscosupplementation.7

Gait aids” such as hiking poles or walking sticks can also help alleviate pressure on achy joints for those who don’t want to be seen with a traditional cane, suggests Kenneth Urish, MD, PhD, associate professor of orthopedic surgery at University of Pittsburgh and Associate Medical Director of the bone and joint center at the UPMC Magee-Women’s Hospital in Pittsburgh.

While the joint changes of OA are irreversible, most people won’t need joint replacement surgery. It is a great option, though, and these surgeries that remove a damaged joint and replace it witha metal, plastic, or ceramic devicecan feel like a cure.

What’s Next in OA Treatment Options?
 

Researchers are actively searching for the holy grail: disease-modifying osteoarthritis drugs. There’s no clear-cut winner in the pack yet.

There is some buzz about platelet-rich plasma (PRP) injections in hips and knees. With PRP, your doctor takes asmall amount of your blood, places it into a machine that separates it into parts, and then re-injects the liquid plasma directly into the damaged joint.

The hope is that the plasma, which is rich in growth factors, will help tissues repair themselves. Research is ongoing at this time. At least one study showed that a single PRP injection was as effective as a steroid shot for people with mild to moderate knee OA, but the PRP results lasted longer. The study appeared in the Journal of Orthopaedic Surgery and Research.8

Stem cell therapy is another hot research area for OA. Stem cells are cells that have the potential to develop into many different cell types. The hope is that when injected into a damaged joint, they will grow into cartilage cells. There are many trials looking at this potential treatmentnow, but it’s too early to draw any firm conclusions.9

Vitamin D, also known as the sunshine vitamin because our bodies produce it when exposed to the sun’s rays, has been the “it” vitamin for a while because low blood levels of vitamin D up the risk for many diseases and conditions. There are receptors for vitamin D all over the body.

When vitamin D binds with receptors in the bone, it could help strengthen bones.9 Research and clinical trials around vitamin D and OA are still ongoing.

OA also has an inflammatory component, and it’s possible that some of the drugs used to treat other types of arthritis (like rheumatoid arthritis) by blocking inflammatory proteins could work for OA, too.9 What’s more, there's also some research that suggests botulinum toxin—the same toxin used to reduce wrinkles—can also paralyze nerves and reduce joint pain.10

What to Expect from a Primary Care Doc Versus a Specialist

If your joints are achy and the pain lasts three days or more, or if you are having a few bouts of joint pain over the course of a month, check in with your physician to see what’s going on.11 Most primary care doctors can diagnose and treat OA. If you fall or twist your ankle, you may go to the ER or an urgent care center and learn that you have OA that way.

Most often, doctors will diagnose OA based on the symptoms and results of the physical exam. In some cases, X-rays or other imaging tests may help determine the extent of disease or help rule out other joint problems.

Cartilage doesn't show up on X-rays, but a narrowing of the space between the bones in your joint suggests cartilage loss. Doctors don’t treat pain, they treat people.12 Pain is highly subjective, Dr. Urish notes.

Sometimes a person may report a little knee pain when going up the stairs, but their X-rays reveal end-stage knee OA. By contrast, others are in terrible pain, yet their X-rays don’t show any damage yet, Dr. Urish says.

If pain doesn’t improve within six weeks, it may be time to see an orthopedic surgeon, orthopedist, physiatrist, sports medicine specialist, or rheumatologist to rule out other conditions that share symptoms with OA, such as rheumatoid arthritis(RA) or gout, and possibly consider more advanced treatments.This can include more imaging exams or blood tests to get a better understanding of what is driving your joint pain.12

Your primary care doctor may also refer you to a physical or occupational therapist who can teach you exercises and hacks that will help you build muscles around your joint and learn to make modifications that will allow you to do the things you enjoy. Occupational therapists can also design braces for joints to reduce pain and improve stability.12

Why Your Mental Health Matters When Dealing with Osteoarthritis

Mental illness seems to ride shotgun with OA, particularly in the early stages of diagnosis. A 2017 study published in Reumatologia found that 58.5% of people with OA had mental health disorders, including anxiety and depression.

The greater risk of mental health disorders was found to be in the first months of being diagnosed with OA compared to those who had the disease for more than six months.13

Having any form of arthritis, including OA, can leave you feeling sad, anxious, hopeless, and alone. These feelings contribute to pain because you are less likely to do the things you should to stay on track, such as working with a physical therapist and eating a healthydiet. 

Most people are not referred to psychologists for OA pain, but physical and occupational therapists and other physicians have all borrowed some tools from psychologists to help individuals with OA learn how to cope with pain—namely cognitive behavioral therapy (CBT).

CBT is a time-limited form of talk therapy that aims to change the way you react to pain or other triggers and extinguish the negative thoughts that may worsen symptoms.

It works and is effective, says Francis Joseph Keefe, PhD, Professor, Psychiatry and Behavioral Sciences; Psychology and Neuroscience; Anesthesiology; and Medicine at Duke University in Durham, North Carolina. CBT is also sometimes called psychologically-informed physical therapy (PIPT), Keefe says.

CBT starts with better aligning treatments with goals. Say you are asked to do 20 knee extensions. CBT makes you think about the why. For example, doing these exercises may make it easier for you to play with your grandson or go on vacation with your wife. This increases motivation.

Replacing negative thoughts with healthier, more rational ones will ultimately lift mood and change behavior. Both the American College of Rheumatology and the Arthritis Foundation recommend adding CBT to your arthritis-management tool box.7

There’s also a free online resource, pain TRAINER, that teaches these principles. Relaxation techniques such as deep breathing and guided imagery also help blunt the effects of stress that can make pain and other symptoms worse, he says.

Self Care for Osteoarthritis Matter, Too

And by self care, we don’t mean bubble baths and wine pairings. We mean the daily decisions you make each day to properly fuel your body and ease OA symptoms. There is no specific osteoarthritis meal plan but eating a healthy diet that is low in saturated fat and high in fresh fruits, vegetables, whole grains, and lean proteins such as the Mediterranean diet may help reduce inflammation.14

Getting regular exercise and maintaining a normal weight will also help you feel better. This, in turn, will have spillover benefits on your sleep, energy level, and relationships. Make yourself a priority and carve out the time to do the things you need to do to stay healthy.

What Can I Do Right Now?

Tame a flare fast. Take a break, ice the joint, and pop an ibuprofen. Relaxation techniques can also stop the pain in its tracks. Still flaring? See your doctor for a steroid injection to break the cycle, Dr. Urish says.

Check in on your mental health. The best way to do that is through support groups. Beyond the obvious benefits (taking you out of isolation, being able to connect with people who have the same condition), support groups also allow you to see osteoarthritis from different perspectives.

That’s critical, particularly if you’re prone to catastrophizing (focusing on the pain and feelings of helplessness) your condition. A few first steps to seeking support:

  • Call your local Arthritis Foundation chapter for a list of local or virtual support groups.
  • The American Chronic Pain Association offers support groups for people living with ongoing pain issues.
  • Your local hospital or medical center likely also has programs available. Ask your doctor or check out their website to see what is offered.

Locate a good doctor. Finding the right doctor—one experienced in diagnosing and treating OA—makes a difference.

  • Check out the American Academy of Orthopaedic Surgeons’ Find an Orthopaedist tool to locate a specialist near you.
  • The Arthritis Foundation also makes it easy to find a doctor with its search tool.
  • When it comes to your mental health, the American Psychological Association can connect you with a therapist—even one who specializes in CBT and pain.

 

Prep for your next doctor visit. Whether it’s a telehealth visit or an in-person one, being prepared can help you get the most out of your next OA check-up.These questions are keyto bring up during your appointment:

 

  • How or when will I be able to participate in [insert meaningful activity] again?
  • What else can I do to relieve my joint pain?
  • When will I know if the treatment is making a difference?
  • What are the next steps?

 

Make sure to keep a pain diary and bring it with you to show your doctor exactly when—and how much—your joints ache. This will help your doctor find the most appropriate treatments for you.

How to Have Those Hard OA Conversations

Living in pain takes its toll on your personal relationships. Loved ones or colleagues may feel that you are not holding up your side of the bargain anymore. (But of course, it’s hard to walk upstairs to the laundry room and prepare meals when your knee is in pain or buckling.)

Your partner may be sick and tired of hearing you complain about your pain and all of the things you can’t do. OA pain can be a family affair. There’s so much emotion on both sides that can really boil up if it is not discussed.

At work, your colleagues may feel like more work is falling on them because you might need more breaks during the workday.

Don’t expect others to read your mind. Having productive conversations starts with active listening, Keefe says. Tell your loved one that you are in pain or how your pain is in the moment. He or she should listen or reflect back on what they are hearing.

This is the first step toward better conversations. Once you feel understood, you can start discussing problem-solving. 

OA FAQs

What causes osteoarthritis?

Osteoarthritis is the wear-and-tear form of the disease that occurs when the protective cartilage that cushions the ends of your bones wears down, causing pain, stiffness, and trouble moving the affected joint

What is the best treatment for osteoarthritis?

There is no one-size-fits-all treatment for osteoarthritis, but weight loss, regular physical activity, and pain relievers such as acetaminophen or ibuprofen tend to work for many people. Injections of corticosteroids can also help treat an OA flare. Some individuals may need joint replacement surgery down the road. 

How can I prevent osteoarthritis? 
 
Maintaining a normal weight and getting regular physical activity may help prevent osteoarthritis. There are other risk factors that you can’t control, including your age, genes, gender, and race. 

What is the difference between osteoarthritis and rheumatoid arthritis?

Osteoarthritis occurs with wear and tear, while rheumatoid arthritis (RA) occurs when your body’s immune system misfires against its own joint and bones. 

 

Updated on: 06/22/21
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Knee Osteoarthritis: Overview
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