Healthy
joints help your body move, bend, and twist. Knees glide up and down stairs
without creaking or crunching. Hips move you along on a walk without a
complaint. But when
osteoarthritis affects your joints, such simple,
everyday movements can hurt. Taking the stairs can be painful. Walking a few
steps, opening a door, and even combing your hair can be hard.
Osteoarthritis is mainly a disease of the
hips, knees, hands, neck, and low back. But it can happen in other joints too.
A joint is where two bones connect. And you have them all over your body.
Osteoarthritis is most common in older people. Although you
cannot cure arthritis, there are many treatments that can help with your pain
and make it easier for you to move. And you can do things to keep the damage
from getting worse.
What causes osteoarthritis?
The simplest way to describe osteoarthritis
is that it is wear and tear on the
cartilage of your joints. Your joints have cushioning
inside them called
cartilage. This tissue is firm, thick, and slippery.
It covers and
protects the ends of bones where they meet to form a joint.
With
osteoarthritis, there are changes in the cartilage that cause it to break down.
When it breaks down, the bones rub together and cause damage and pain. Experts
do not know why this breakdown in cartilage happens. But aging, joint injury,
and genetics may be a part of the reason.
What are the symptoms?
Pain: Your joints may
ache, or the pain may feel burning or sharp. For some people, it may get better
after a while. Pain while sleeping or constant pain may be a sign that your
arthritis is getting worse.
Stiffness: When
you have arthritis, getting up in the morning can be hard. Your joints may feel
stiff and creaky for a short time, until you get moving. You may also get stiff
from sitting.
Muscle weakness: The muscles
around the joint may get weaker. This happens a lot with arthritis in the
knee.
Swelling: Arthritis can cause swelling
in joints, making them feel tender and sore.
Deformed joints: Joints can start to look like they are the
wrong shape, especially as arthritis gets worse.
Cracking and creaking: Your joints may make crunching,
creaking sounds.
How is osteoarthritis diagnosed?
Your doctor will want to make sure your pain is
caused by arthritis and not another problem. So first, you will need to
describe your symptoms as best you can. Your doctor will ask you questions
about your symptoms. Examples of questions include:
Is the pain burning, aching, or sharp?
Are your
joints stiff in the morning? If yes, how long does the stiffness
last?
Do you have any joint swelling?
Knowing these things will help your doctor make a
diagnosis. If your joints are tender and swollen and the muscles are weak, this
will also help your doctor confirm whether you have arthritis. You may also
have X-rays to check your joints for damage. Your doctor may want to do blood
tests or other tests to see if there are other causes for your pain.
How is it treated?
There are many
treatments for arthritis, but what works for someone else may not help you.
Work with your doctor to find what is best for you. Often a mix of things helps
most.
If your pain is mild, you may only need pain medicines you
can buy without a prescription. These include acetaminophen (such as Tylenol),
aspirin, ibuprofen, or naproxen (such as Aleve). But if you still have pain,
you may need a stronger prescription medicine. Because you will take these
medicines for a long time, you will need to have regular checkups from your
doctor.
Using ice or heat on the painful joint can help. Heat
may help you loosen up before an activity. Ice is a good pain reliever after
activity or exercise. Your doctor may give you gels or creams that you can rub
on the joint to make it stop hurting. Having shots of medicine in the joint
also helps some people.
If you are overweight, losing weight may
be one of the best things you can do for your arthritis. It helps take some
stress off your joints. Exercise is also good, because it can help make your
muscles stronger. Having stronger thigh muscles, for example, can help reduce
stress on your knees. Swimming, bicycling, and walking are good activities. But
make sure you talk to your doctor about what kind of activity is best for you.
You may also get help from a
physical therapist.
If your pain gets so
bad that you have trouble walking, you may need surgery. Hips and knees that
have been severely damaged can be replaced with man-made joints.
Osteoarthritis
results from chemical changes in the
cartilage that cause it to break down faster than it
can be produced. In most cases, experts don't know the cause of this cartilage
breakdown.
In some cases, osteoarthritis may develop as a result
of another condition (secondary osteoarthritis).
Excess weight puts extra strain on the joints,
particularly the large weight-bearing joints, such as the knees, hips, and
balls of the feet. Experts estimate that every
1 lb (0.5 kg) of body weight
means at least 3 lb (1.4 kg) of
stress at the knee joint, and even more at the hip joint. Studies show that
weight loss can decrease the symptoms of knee osteoarthritis or the chances of
developing those symptoms.1
A single major
joint injury or several minor joint injuries may result in cartilage changes
over time. Although normal activities of everyday life do not cause
osteoarthritis, certain types of activities-such as the frequent or repetitive
heavy lifting, squatting, and kneeling of some sports or jobs-put repeated
stress on a joint and may increase the risk of developing
osteoarthritis.
Muscle weakness increases the chances of developing
osteoarthritis. For example, weakness of the quadriceps muscles in the front of
the thigh makes osteoarthritis of the knee more likely.2
Daily activity in a joint that is not aligned
normally or is more loose and mobile than normal can lead to wear and tear and
increase the risk of osteoarthritis.
A previous infection of the
joint may alter the chemical makeup of cartilage and lead to
osteoarthritis.
In a few people, there seems to be a link between cartilage
breakdown and certain factors.
A family history of osteoarthritis may have
some influence on the makeup of cartilage.
Defects in joint development or growth can
accelerate cartilage loss and lead to osteoarthritis at a younger age. These
unusual conditions most commonly involve the hip joint.
Pain, commonly in the
hands,
hips,
knees, or
feet, and sometimes in the
spine. Pain usually is related to activity of the
joint and is worse at the end of the day or after periods of activity. As the
disease progresses, pain is present even during rest.
Stiffness
(lasting less than 1 hour) after periods of inactivity, such as in the morning
after a night's sleep or after sitting for a long time.
Limited
joint motion.
Tenderness and occasional swelling.
Joint deformity (usually in later stages of osteoarthritis).
Joint
cracking or "creaking" (crepitation), often accompanied by pain. This creaking
also may occur in a normal (nonarthritic) joint and is usually painless.
Symptoms of osteoarthritis range from minor to severe.
Symptoms may depend on which joints are involved. If your weight-bearing joints
(such as hips and knees) are affected, it often results in more problems than
if you have osteoarthritis in non-weight-bearing joints, such as your
fingers.
Usually, osteoarthritis is limited to one set of joints,
such as both knees. But osteoarthritis may affect more than one location in the
body (for example, the knees and hands). Osteoarthritis usually only causes
symptoms in one or more joints. Symptoms that affect the whole body, such as
fever, weight loss, or rash, are not seen in osteoarthritis.
As
osteoarthritis becomes more severe, symptoms may include a total loss of
function in the affected joints.
Osteoarthritis is a slow, progressive disease.
Cartilage gradually breaks down until the bones, which
were once separated by cartilage, begin to rub against each other.
The rate at which osteoarthritis progresses varies widely from person to
person. Symptoms may not develop for years, until bones and tissues become
damaged. It is hard to predict the course of osteoarthritis, as symptoms may
stop for periods of time. Joint symptoms may either remain constant or
gradually get worse over several years. You may have symptoms that come and go
(flares), as you would with other forms of
arthritis.
Although the disease process
of osteoarthritis affects joint cartilage throughout the body, you most likely
will have symptoms in only one or two joints or
groups of joints. Symptoms most often affect the spine, fingers, hips, knees, or
toes. At first, pain may occur only when you are active. As the disease
progresses, pain may also occur when you are resting.
Bowleg and knock-knee alignments of
the knees are common in osteoarthritis. These misalignments result in uneven
cartilage loss and, as the cartilage wears down, the
bowleg or knock-knee condition becomes even worse.
Many people can
manage their osteoarthritis symptoms with medicine and lifestyle changes,
although there is no cure for the condition. In a few people, osteoarthritis
becomes severe enough to require surgery to replace the worn joint or fuse the
bones together so that the joint will not bend. Surgical techniques and the
artificial joint parts used for the surgeries are constantly improving.
Certain factors seem to
increase the risk of developing
osteoarthritis, including:3, 4
Aging, which does not cause osteoarthritis but
is a factor in developing symptoms. Most people older than 65 years of age show
X-ray evidence of osteoarthritis in the hands, knees, or spine. But not all
people will have pain from osteoarthritis.
Extra body weight, which
is clearly associated with osteoarthritis of the knee. Being overweight puts
extra strain on the joints, particularly the large weight-bearing joints such
as the hips, the knees, and the balls of the feet. Carrying more than
healthy weight on your body may also alter the joint
structure and increase the risk for osteoarthritis.
Repeated minor
injuries or a single injury to a joint, which may change the normal joint
structure. Activities that put repeated stress on a joint include the
repetitive squatting, kneeling, or heavy lifting common to some sports and
jobs.
Increased bone density, which may result in bones that are
less able to absorb impacts and to protect cartilage from trauma. The opposite
is also true-women with
osteoporosis have a decreased risk of
osteoarthritis.
Decreased strength and a decrease in the sensations
that tell you where your body is positioned in the space around you
(proprioception). This can be seen in people who have nerve damage
(neuropathy), sometimes due to diabetes or a vitamin B12
deficiency.
Vitamin D
deficiency. Vitamin D is necessary for healthy bone and may also be important
for keeping cartilage healthy. Vitamin D deficiency is associated with faster
progression of osteoarthritis.
Sudden, unexplained swelling, warmth, or pain
in any joint or joints.
Joint pain associated with a fever or
rash.
Pain so severe that you are unable to use the
joint.
Mild joint symptoms that continue despite home treatment for
more than 6 weeks.
Side effects can develop from taking large doses of aspirin
or other arthritis medicine to relieve pain. Do not exceed the recommended dose
of medicine without first talking to your health professional.
Watchful Waiting
If you have mild joint pain and stiffness, try
home treatment first. If there is no improvement in 6
weeks, or if joint symptoms persist, call your doctor.
Who To See
The following health professionals can evaluate and
manage the symptoms of osteoarthritis:
Individualized treatment programs can be designed that
consider the severity of your symptoms, level of physical activity, and general
health. In addition to your health professional, a therapeutic team may
include:
If you have symptoms in more than one joint, your doctor
should evaluate each joint individually so that he or she does not overlook any
other medical cause for your symptoms.3
Treatment Overview
Although there is no cure for
osteoarthritis, treatment can help you reduce your
symptoms. The more you understand about osteoarthritis and what you can do to
treat your pain and stay active, the less discomfort and disability you are
likely to have. You may also be able to limit further joint damage.
The goals of treatment are to:
Reduce symptoms.
Maintain joint
function.
Minimize disability.
Limit structural
changes.
Treatment is based on:
How severe your symptoms are (mild to
severe).
How your symptoms affect your daily
activities.
The success or failure of prior
treatments.
The amount of joint damage.
Initial treatment
When your doctor first diagnoses
your
osteoarthritis, he or she will probably recommend a
treatment plan that combines medicine with education about how to treat your
symptoms yourself. Your initial treatment plan may include:
Medicines, such as acetaminophen, or
nonsteroidal anti-inflammatory drugs (NSAIDs).
Learning all you can about
the natural course of osteoarthritis.
Ongoing treatment
Osteoarthritis
normally is a slowly progressing condition, though its course is difficult to
predict. Some people remain stable for a number of years or even experience
periods of
remission. For mild to moderate osteoarthritis, you
can usually manage your symptoms over many years with a program that
includes:
Research suggests that, for people who have depression
in addition to osteoarthritis, treatment of the depression may also decrease
the pain of osteoarthritis and improve the ability to perform daily
activities.5
Treatment if the condition gets worse
If pain and
stiffness from
osteoarthritis fail to improve or are getting worse,
your doctor may recommend treatment, such as:
You can take steps to help prevent the
development of
osteoarthritis or to help prevent the progression of
this condition. These steps include:
Weight control. Maintaining a healthy weight may be
the single most important thing you can do to prevent osteoarthritis.4 Being overweight puts extra strain on the joints,
particularly the large weight-bearing joints such as the knees, the hips, and
the balls of the feet. It is estimated that every
1 lb (0.5 kg) of body weight
means at least 3 lb (1.4 kg) of
stress at the knee joint, and even more at the hip joint. That would mean that
losing just 5 lb (2.3 kg) would
take at least 15 lb (6.8 kg) of
stress off your knees. Extra weight may also alter the normal structure of the
joint and increase the risk for osteoarthritis. Maintain a healthy weight to
prevent or reduce joint damage and lower the stress on osteoarthritic joints.
For more information, see the topic
Healthy Weight.
Injury prevention. Protect your joints from serious
injury or repeated minor injuries to decrease your risk of damaging cartilage.
Repeated minor injuries include those from job-related activities such as
frequent or constant kneeling, squatting, or other postures that place stress
on the knee joint.
Exercise.Exercise can help
reduce joint pain and stiffness. Light- to moderate-intensity physical activity
may prevent a decline in, and may even restore, health and function.6 But some people with osteoarthritis may be reluctant to
exercise because of joint pain after activity. You can take various steps to
help relieve pain, such as
heat and cold therapy or taking pain relievers, which
may make it easier for you to exercise and stay active. Choose partial- or
non-weight-bearing exercise, such as bicycling, swimming, or water exercise.
You can also try light weight-lifting exercises, with supervision.
Research shows that even modest weight loss combined with
exercise is more effective in decreasing pain and restoring function than
either weight loss or exercise alone.7
Young adults who have significant knee injuries have an increased risk of
future osteoarthritis. Prevention of joint injuries during youth depends in
good part on the use of proper sports equipment and on playing under safe
playing conditions.8 A young person who has a serious
knee injury can limit further damage by using a brace to stabilize the knee
joint and by changing the way he or she does high-impact exercise.
A physical therapist or athletic trainer can help advise you on
returning to activities after an injury.
Home Treatment
You can take steps to help relieve the
pain caused by
osteoarthritis and improve your joint function. Rest
your joint if it is extremely painful or swollen, but avoid long periods of
rest or inactivity that will cause muscle weakness and more instability in the
joint. To reduce your symptoms of osteoarthritis, try to:
Maintain a
healthy weight. Being overweight puts extra strain on
the joints, particularly the large weight-bearing joints such as the hips, the
knees, and the balls of the feet. It is estimated that every
1 lb (0.5 kg) of body weight
means at least 3 lb (1.4 kg) of
stress at the knee joint, and even more at the hip joint. That would mean that
losing just 5 lb (2.3 kg) would
take at least 15 lb (6.8 kg) of
stress off your knees. Extra weight may also alter the joint structure and
increase the risk for osteoarthritis.
Exercise. Talk to
your doctor or physical therapist about exercises that will help relieve joint
pain. Studies show that exercise is beneficial for people with arthritis,
including hip and knee arthritis.2 Older adults with
osteoarthritis can improve posture and balance and thus reduce the chance of
falls by following a program of walking and weight lifting.9 If you start a weight-lifting program, start out with
supervision to make sure you lift weights safely.
Use
assistive devices and orthotics such as doorknob
extenders, tape, braces, splints, or canes. If you have osteoarthritis of the
knee, wedged insoles or cushioned shoes may help redistribute weight and reduce
joint stress. For more information on how to use assistive devices, see:
Change activities to reduce stress on
your joints. For example, walk instead of jog. Other types of exercise that are
less stressful on the joints include riding a bicycle, swimming, or water
exercise.
Many people benefit from joining a support group or taking
an arthritis management course from the Arthritis Foundation. Several studies
have shown that people in education courses and support groups have less pain
and depression and better joint activity.10 A small
study suggests people who participate in exercise classes in addition to their
home exercise have less pain with walking even after the class ends.11
Adopting a "good-health attitude" and healthy habits, such as eating a nutritious diet,
maintaining a healthy weight, and getting enough sleep, will make you feel
better and allow you to stay active.
Exercise can help keep osteoarthritis from getting worse.
But you want to make sure you do not damage your joints while exercising. Some
tips for exercising safely with osteoarthritis include:
If you have not exercised for a while, start exercising at a low
level and work your way up gradually to exercise for a longer time or at a
higher intensity.
If your joint pain gets worse after exercise,
take an NSAID before exercise and ice your painful joints after
exercise.
If your knees are swollen:
Avoid walking and
running.
Swim, or ride a stationary bike.
If an exercise causes joint pain that lasts for
more than a day, try one or more of the following:
Rest the joint until your pain returns to a
level it was before.
Exercise for less time or exercise
easier.
Try another exercise that does not cause pain.
Recognize when you have muscle soreness compared
to joint pain. If you have muscle soreness, you may exercise through the
soreness. But if you have joint pain, rest the joint or try another
exercise.
Medications
Medicine can often help you to relieve
the symptoms of
osteoarthritis and allow you to continue daily
activities. But pain relief medicine does not cure arthritis or decrease the
rate of
cartilage breakdown and should be used along with home
treatment and other treatments, as recommended by your health
professional.
You can often manage mild to moderate arthritis
pain with nonprescription pain relievers, such as acetaminophen or nonsteroidal
anti-inflammatory drugs (NSAIDs).
Moderate to severe pain may require stronger pain relievers, such
as opioids. Your doctor may also prescribe opioids if you cannot tolerate
NSAIDs.
Medication Choices
Medicines doctors use to treat osteoarthritis
include:
Opioids, which may
relieve moderate to severe pain.
Some studies have shown that acetaminophen and
nonsteroidal anti-inflammatory drugs are equally effective for mild to moderate
joint pain.2 Other studies suggest that NSAIDs are
more effective than acetaminophen and that side effects are similar.12, 13
Topical (applied to
the skin) agents may provide short-term pain relief.14
These include topical NSAIDs,
capsaicin, and pain-relieving creams.
What To Think About
Pain relief is important, not
just for quality of life and for your mood, but for maintenance of joint
function and rehabilitation. If you limit or decrease the movement of your
joints because of pain, you will develop tightening, shortening, and weakness
of the ligaments, tendons, and muscles that move the joint. This leads to less
mobility and function.
When using pain medicine, your goal is to
find relief without side effects. Acetaminophen has the fewest side effects of
any pain medicine for osteoarthritis. In some studies it is as effective as
nonsteroidal anti-inflammatory drugs (NSAIDs) and in some studies it is not.
But because it has the fewest side effects, it is the medicine to try first for
pain relief.
If you have no history of gastrointestinal bleeding
(such as stomach ulcers), kidney insufficiency, or
heart failure and if you are not taking blood
thinners, you can try nonprescription NSAIDs, including ibuprofen (such as
Motrin or Advil) or naproxen (Aleve). Take the lowest possible dose that
controls your pain. It may take a couple of weeks before NSAIDs can relieve
your pain well.
In addition to relieving pain, NSAIDS also reduce
inflammation. But inflammation does not commonly occur with osteoarthritis, so
most cases of osteoarthritis do not require an anti-inflammatory drug (NSAID).
Even so, many people with osteoarthritis say that NSAIDs work well for them.
Just remember that NSAIDS do not stop joint tissue from breaking down as
osteoarthritis progresses.
If you are taking NSAIDs every day,
especially for longer than 1 month, your doctor may want to check a blood count
or a blood test for kidney function. He or she may also suggest that you take
omeprazole to protect you from stomach ulcers. If NSAIDs are not effective,
contact your doctor, who may prescribe a higher dose, a different NSAID, or an
opioid.
Doctors may prescribe opioid pain relievers (such as
codeine or hydrocodone) for people who cannot take NSAIDs or whose pain is
unrelieved by other therapies. Used correctly, opioids can be a safe and
effective means of pain control. Studies show that you can discontinue opioids
without withdrawal difficulties if the opioid is tapered off.15
Talk to your health professional about what
medicines may be best for you. The effectiveness of medicines and the risk of
side effects are different for different people. You can try different
medicines until your symptoms are controlled.
Medicines that are
being studied for osteoarthritis include diacerein and doxycycline. Diacerein
helps reduce inflammation. Doxycycline is an
antibiotic but it may help keep the joint space from
getting smaller in osteoarthritis. These medicines are not available yet for
use with osteoarthritis.
Surgery
Surgery is reserved for people with severe
osteoarthritis who do not get pain relief from
medicine, home treatment, or other treatments and who have significant loss of
cartilage.
Surgery relieves severe,
disabling pain and may restore joint function and mobility. Some surgical
procedures, such as osteotomy or arthroscopy, may postpone total joint
replacement.
Surgery Choices
Surgeries to treat osteoarthritis may include:
Arthroscopy,
which can provide temporary (and sometimes long-term) relief of symptoms of
osteoarthritis. Arthroscopy also can fix a joint if it becomes 'locked' or
stuck due to loose
cartilage or bone fragments.16
Osteotomy of the knee or hip, used in
cases of hip deformity and abnormality of the legs in active people younger
than 60 with mild osteoarthritis.
Joint replacement surgery,
considered when pain and disability have not been controlled by conservative
treatment such as exercise and medicine, and joint damage is visible on
X-rays.16
Hip resurfacing surgery, which doctors
use primarily for younger, more active people with pain and disability due to
hip deterioration. No long-term results are available yet, but short-term
results are positive up to about 8 years after surgery.17
Arthrodesis, surgery that joins (fuses)
two bones in a diseased joint so that the joint can no longer move. Doctors may
use it for the spine, ankles, hands, and feet, but rarely for the knees and
hips.
Small joint surgery, used if the joints of the hands
or feet are so disabled that function is impossible. Severe finger deformity is
more commonly seen in
rheumatoid arthritis than in osteoarthritis. Doctors
replace toe joints occasionally, in cases of severe pain and disability, but
rarely in younger or more active people.
Surgery for osteoarthritis is
considered a choice (elective surgery). Surgery may not be appropriate for some
people who are in poor health or who have other diseases that would make
surgery less successful.
You will need several months of
rehabilitation following surgery.
An artificial joint may only
last for 10 to 20 years. You may need repeat surgery if an implanted joint
wears out. Shoulder replacement for osteoarthritis is less common, and
generally less successful, than hip or knee replacement.
Many
people with arthritis have symptoms and degeneration in the inner knee. A new
procedure inserts a small C-shaped cup called a UniSpacer in the joint space of
the inner knee. The intent is to cushion the joint to delay the need for a knee
replacement. Studies on the UniSpacer continue.
If you decide to have surgery: Before you go to the
hospital, it's a good idea to make sure your home is ready for your return. Be
sure you have someone to help you for a few days after you come home, and put a
telephone and important phone numbers near where you will be spending time. If
your surgery will be on your leg or foot, you may need to avoid stairs for a
while. Be sure there's a bed for you to sleep in without having to go up or
down stairs. If your bed is low, consider raising it with extensions under the
legs or even an extra mattress on top. Finally, clear away any extra furniture
and clutter, small rugs, or cords on the floor. You need a safe walking surface
with plenty of space to move around safely.
Other Treatment
Other treatment, such as
experimental medical therapies and complementary and alternative therapies, may
be used to relieve pain and improve joint function for people who have
osteoarthritis.
Other Treatment Choices
Other medicines used to treat osteoarthritis
include:
Glucosamine and chondroitin. It is not clear if
glucosamine and chondroitin, taken alone or together, can relieve pain of
osteoarthritis.18, 19 But some
studies show that chondroitin alone may relieve pain and improve
function.19
Capsaicin. Capsaicin is a cream you apply to the skin
for pain relief.
Other non-medicine treatment choices for osteoarthritis
include:
Ultrasound, which uses sound waves to produce heat in
body tissues for pain relief.
Diathermy, which uses heat to
increase blood flow for pain relief and rapid healing.
Taping. This
involves using an adhesive tape to help position the knee cap for pain
relief.21 You can do taping at home, but an experienced
health professional, such as your doctor or physical therapist, should teach
you how to do it first.
Braces to try to shift weight off of the
affected area of your knee joint. It is unclear how well these work, but there
is little risk in trying them.
Experimental medical therapies
Because
osteoarthritis is caused by the breakdown of
cartilage, research continues for developing therapies
that prevent or reduce cartilage damage. Cartilage repair, an experimental
medical therapy for osteoarthritis of the knee, has been studied in small
numbers of selected people. Cartilage repair techniques include removing
damaged cartilage and stimulating remaining tissue to try to fill in new
cartilage, transplantation of cartilage from one joint to another,
transplantation of cartilage from another donor, and transplantation of cells
that are grown in a lab and then injected into the joint. These therapies are
still under study. To date, researchers have only studied cartilage repair
therapies in younger people with small, well-defined holes in cartilage, an
uncommon situation for the great majority of older people with osteoarthritis
of the knee.22
Complementary and alternative therapies
Complementary and alternative medicine is the term for a wide variety of health
care practices that may be used along with or in place of standard medical
treatment. There may or may not be studies that show if these therapies work or
how well they work. But, many people with osteoarthritis use complementary
therapies to help relieve joint pain and improve joint function.23
Complementary and alternative therapies for osteoarthritis
include dietary supplements.23 Some dietary supplements
include:
Glucosamine and chondroitin, which may be thought of
as dietary supplements. It is not clear if glucosamine and chondroitin, taken
alone or together, can relieve pain of osteoarthritis.18, 19 But some studies show that
chondroitin alone may relieve pain and improve function.19
Vitamin D, to slow the progression of
osteoarthritis.
Vitamin E, for pain.
Avocado/soybean
(ASU) extract, to decrease pain.
Vitamin B3, to ease pain and
stiffness.
S-adenosylmethionine (SAM-e), for pain and
stiffness.
Boron, to decrease pain and inflammation.
Complementary and alternative therapies for
osteoarthritis include physical therapies such as:
Acupuncture, which appears to improve
function and provide pain relief for people with osteoarthritis.24
Pulsed
electromagnetic field therapy, to stimulate cartilage growth. Small positive
results have been shown, but further research is needed.25
Magnetic bracelets. A small study suggests
that hip and knee pain from arthritis may decrease when a person wears a
magnetic bracelet, although why this may happen is not clear.26 Most evidence shows the effect is no greater than with a
placebo.
These therapies may be helpful for some people, although their effectiveness
has not been proven. Most of the studies on complementary and alternative
therapies for osteoarthritis have been done on glucosamine and acupuncture and
involve osteoarthritis of the knee. Most of these studies show that either of
these therapies is better than treatment with a placebo.
What To Think About
Talk to your doctor about other
treatments for osteoarthritis. There are many medicines, exercises, braces,
assistive devices, and other treatments, and different combinations of
treatments work for different people.
Research continues on
developing medicines and other ways to change the structure of cartilage.
Researchers hope these methods will reduce cartilage destruction and stimulate
repair of existing damage. Tetracyclines are some of the medicines that
researchers are currently studying. Other agents being studied include protease
and collagenase inhibitors, growth factors, and cytokine inhibitors.
Researchers are also investigating cartilage transplants and use of stem cells
to grow new cartilage.1, 3
Note that most research studies for osteoarthritis have been of
knee osteoarthritis. So it is hard to know if treatments that work for the knee
might also work for other joints such as the hands, hip, or spine
joints.
Other Places To Get Help
Online Resource
NIHSeniorHealth
National Institutes of Health
Web Address:
http://NIHSeniorHealth.gov
This Web site for older adults offers aging-related health
information. The site was developed by the National Institute on Aging (NIA)
and the National Library of Medicine (NLM), both part of the National
Institutes of Health (NIH). NIHSeniorHealth features up-to-date health
information from Institutes and Centers at NIH. In addition, the American
Geriatrics Society provides independent review of some of the material found on
this Web site. The Web site's senior-friendly features include large print,
simple navigation, and short, easy-to-read segments of information. A visitor
to this Web site can click special buttons to hear the text aloud, make the
text larger, or turn on higher contrast for easier viewing.
Organizations
American College of Rheumatology
1800 Century Place
Suite 250
Atlanta, GA 30345
Phone:
(404) 633-3777
Fax:
(404) 633-1870
Web Address:
www.rheumatology.org
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
The ACR
Web site offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
professionals.
Arthritis Foundation
1330 West Peachtree Street
Suite 100
Atlanta, GA 30309
Phone:
1-800-283-7800
Web Address:
www.arthritis.org
The Arthritis Foundation provides grants to help find a cure,
prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS Web site provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Lozada CJ (2005). Management of osteoarthritis. In ED
Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1528-1540. Philadelphia: Elsevier
Saunders.
Subcommittee on Osteoarthritis Guidelines, American College of Rheumatology (2000). Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis and Rheumatism, 43(9): 1905-1915.
Wise C (2005). Osteoarthritis. In DC Dale, DD
Federman, eds., ACP Medicine, section 15, chap. 10. New
York: WebMD.
Hinton R, et al. (2002). Osteoarthritis: Diagnosis and therapeutic considerations. American Family Physician, 65(5): 841-848.
Lin EHB, et al. (2003). Effect of improving depression
care on pain and functional outcomes among older adults with arthritis: A
randomized controlled trial. JAMA, 290(18):
2428-2434.
American Geriatrics Society Panel on Exercise and
Osteoarthritis (2001). Exercise prescription for older adults with
osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society, 49(6):
808-823.
Messier SP, et al. (2004). Exercise and dietary weight
loss in overweight and obese older adults with knee osteoarthritis: The
arthritis, diet, and activity promotion trial. Arthritis and Rheumatism, 50(5): 1501-1510.
Gelber AC, et al. (2000). Joint injury in young adults
and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine, 133(5): 321-328.
Messier SP, et al. (2000). Long-term exercise and its
effect on balance in older, osteoarthritic adults: Results from the Fitness,
Arthritis, and Seniors Trial (FAST). Journal of the American Geriatrics Society, 48(2): 131-138.
Friedrick MJ (1999). Steps toward understanding, alleviating osteoarthritis will help aging population. JAMA, 282(11): 1023-1025.
McCarthy CJ, et al. (2004). Supplementing a home
exercise programme with a class-based exercise programme is more effective than
home exercise alone in the treatment of knee osteoarthritis. Rheumatology, 43(7): 880-886.
Pincus T, et al. (2004). Patient preference for
placebo, acetaminophen (paracetamol) or celecoxib efficacy studies (PACES): Two
randomised, double blind, placebo controlled, crossover clinical trials in
patients with knee or hip osteoarthritis. Annals of the Rheumatic Diseases, 63(8): 931-939.
Towheed TE, et al. (2006). Acetaminophen for
osteoarthritis. Cochrane Database of Systematic Reviews
(1). Oxford: Update Software.
Scott D, et al. (2004). Osteoarthritis.
Clinical Evidence (11): 1560-1588.
Lipman AG (2001). Treatment of chronic pain in osteoarthritis: Do opioids have a clinical role? Current Rheumatology Reports, 6(3): 513-519.
Günther K-P (2001). Surgical approaches for osteoarthritis. Best Practice and Research Clinical Rheumatology, 15(4): 627-643.
Daniel J, et al. (2004). Metal-on-metal resurfacing of
the hip in patients under the age of 55 years with osteoarthritis.
Journal of Bone and Joint Surgery, 86-B(2):
177-183.
Clegg DO, et al. (2006). Glucosamine, chondroitin
sulfate, and the two in combination for painful knee osteoarthritis.
New England Journal of Medicine, 354(8):
795-808.
Chard J, et al. (2005). Osteoarthritis of the knee.
Clinical Evidence (14): 1506-1522.
Scharf H-P, et al. (2006). Acupuncture and knee
osteoarthritis: A three-armed randomized trial. Annals of Internal Medicine, 145(1): 12-20.
Hinman RS, et al. (2003). Efficacy of knee tape in the
management of osteoarthritis of the knee: Blinded randomised controlled trial.
BMJ, 327(7407): 135.
Sledge CB (2005). Principles of reconstructive surgery
for arthritis: The knee. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1890-1900. Philadelphia:
Elsevier Saunders.
Luskin FM, et al. (2003). Select populations: Elderly
patients. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 482-502. St.
Louis: Mosby.
Berman BM, et al. (2004). Effectiveness of acupuncture
as adjunctive therapy in ostearthritis of the knee: A randomized, controlled
trial. Annals of Internal Medicine, 141(12):
901-910.
Cochrane Musculoskeletal Group (2004). Electromagnetic
fields for the treatment of osteoarthritis. Cochrane Database of Sytematic Reviews (4). Oxford: Update Software.
Harlow T, et al. (2004). Randomised controlled trial
of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee.
BMJ, 329(7480): 1450-1454.
Other Works Consulted
American Academy of Orthopaedic Surgeons. Activities after a hip replacement. Available online: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=274&topcategory=Hip.
American Academy of Orthopaedic Surgeons. Activities after a knee replacement. Available online: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=275&topcategory=Knee.
Archibeck MJ, White RE Jr (2003). What's new in adult
reconstructive knee surgery. Journal of Bone and Joint Surgery, 85-A(7): 1404-1411.
Biundo JJ Jr, Rush PJ (2005). Rehabilitation of
patients with rheumatic diseases. In ED Harris Jr et al., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp.
826-838. Philadelphia: Elsevier Saunders.
Boureau F, et al. (2004). The IPSO study: Ibuprofen,
paracetamol study in osteoarthritis. A randomised comparative clinical study
comparing the efficacy and safety of ibuprofen and paracetamol analgesic
treatment of osteoarthritis of the knee or hip. Annals of the Rheumatic Diseases, 63(9): 1028-1034.
Brosseau L, et al. (2004). Efficacy of continuous
passive motion following total knee arthroplasty: A meta-analysis.
Journal of Rheumatology, 31(11): 2251-2264.
Felson DT, et al. (2004). The effect of body weight on
progression of knee osteoarthritis is dependent on alignment. Arthritis and Rheumatism, 50(12): 3904-3909.
Guccione AA, et al. (1994). The effects of specific
medical conditions on the functional limitations of elders in the Framingham
Study. American Journal of Public Health, 84(3):
351-358.
Kremers HM, Gabriel SE (2005). Broad issues in the
approach to rheumatic diseases. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp.
407-414. Philadelphia: Elsevier Saunders.
Morelli V, et al. (2003). Alternative therapies for
traditional disease states: Osteoarthritis. American Family Physician, 67(2): 339-344.
Roth SH, Shainhouse JZ (2004). Efficacy and safety of
a topical diclofenac solution (Pennsaid) in the treatment of primary
osteoarthritis of the knee: A randomized, double-blind, vehicle-controlled
clinical trial. Archives of Internal Medicine 164(18):
2017-2023.
Silva M, et al. (2004). The biomechanical results of
total hip resurfacing arthroplasty.Journal of Bone and Joint Surgery, 86-A(1): 40-46.
Zhang W, et al. (2004). Does paracetamol
(acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of
randomised controlled trials. Annals of the Rheumatic Diseases, 63(8): 901-907.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Lozada CJ (2005). Management of osteoarthritis. In ED
Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1528-1540. Philadelphia: Elsevier
Saunders.
Subcommittee on Osteoarthritis Guidelines, American College of Rheumatology (2000). Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis and Rheumatism, 43(9): 1905-1915.
Wise C (2005). Osteoarthritis. In DC Dale, DD
Federman, eds., ACP Medicine, section 15, chap. 10. New
York: WebMD.
Hinton R, et al. (2002). Osteoarthritis: Diagnosis and therapeutic considerations. American Family Physician, 65(5): 841-848.
Lin EHB, et al. (2003). Effect of improving depression
care on pain and functional outcomes among older adults with arthritis: A
randomized controlled trial. JAMA, 290(18):
2428-2434.
American Geriatrics Society Panel on Exercise and
Osteoarthritis (2001). Exercise prescription for older adults with
osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society, 49(6):
808-823.
Messier SP, et al. (2004). Exercise and dietary weight
loss in overweight and obese older adults with knee osteoarthritis: The
arthritis, diet, and activity promotion trial. Arthritis and Rheumatism, 50(5): 1501-1510.
Gelber AC, et al. (2000). Joint injury in young adults
and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine, 133(5): 321-328.
Messier SP, et al. (2000). Long-term exercise and its
effect on balance in older, osteoarthritic adults: Results from the Fitness,
Arthritis, and Seniors Trial (FAST). Journal of the American Geriatrics Society, 48(2): 131-138.
Friedrick MJ (1999). Steps toward understanding, alleviating osteoarthritis will help aging population. JAMA, 282(11): 1023-1025.
McCarthy CJ, et al. (2004). Supplementing a home
exercise programme with a class-based exercise programme is more effective than
home exercise alone in the treatment of knee osteoarthritis. Rheumatology, 43(7): 880-886.
Pincus T, et al. (2004). Patient preference for
placebo, acetaminophen (paracetamol) or celecoxib efficacy studies (PACES): Two
randomised, double blind, placebo controlled, crossover clinical trials in
patients with knee or hip osteoarthritis. Annals of the Rheumatic Diseases, 63(8): 931-939.
Towheed TE, et al. (2006). Acetaminophen for
osteoarthritis. Cochrane Database of Systematic Reviews
(1). Oxford: Update Software.
Scott D, et al. (2004). Osteoarthritis.
Clinical Evidence (11): 1560-1588.
Lipman AG (2001). Treatment of chronic pain in osteoarthritis: Do opioids have a clinical role? Current Rheumatology Reports, 6(3): 513-519.
Günther K-P (2001). Surgical approaches for osteoarthritis. Best Practice and Research Clinical Rheumatology, 15(4): 627-643.
Daniel J, et al. (2004). Metal-on-metal resurfacing of
the hip in patients under the age of 55 years with osteoarthritis.
Journal of Bone and Joint Surgery, 86-B(2):
177-183.
Clegg DO, et al. (2006). Glucosamine, chondroitin
sulfate, and the two in combination for painful knee osteoarthritis.
New England Journal of Medicine, 354(8):
795-808.
Chard J, et al. (2005). Osteoarthritis of the knee.
Clinical Evidence (14): 1506-1522.
Scharf H-P, et al. (2006). Acupuncture and knee
osteoarthritis: A three-armed randomized trial. Annals of Internal Medicine, 145(1): 12-20.
Hinman RS, et al. (2003). Efficacy of knee tape in the
management of osteoarthritis of the knee: Blinded randomised controlled trial.
BMJ, 327(7407): 135.
Sledge CB (2005). Principles of reconstructive surgery
for arthritis: The knee. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1890-1900. Philadelphia:
Elsevier Saunders.
Luskin FM, et al. (2003). Select populations: Elderly
patients. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 482-502. St.
Louis: Mosby.
Berman BM, et al. (2004). Effectiveness of acupuncture
as adjunctive therapy in ostearthritis of the knee: A randomized, controlled
trial. Annals of Internal Medicine, 141(12):
901-910.
Cochrane Musculoskeletal Group (2004). Electromagnetic
fields for the treatment of osteoarthritis. Cochrane Database of Sytematic Reviews (4). Oxford: Update Software.
Harlow T, et al. (2004). Randomised controlled trial
of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee.
BMJ, 329(7480): 1450-1454.
