What Is Osteoarthritis?
(AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis,
especially among older people. Sometimes it is called degenerative
joint disease or osteoarthrosis.
is a joint disease that mostly affects the cartilage (KAR-til-uj).
Cartilage is the slippery tissue that covers the ends of bones in a
joint. Healthy cartilage allows bones to glide over one another. It
also absorbs energy from the shock of physical movement. In
osteoarthritis, the surface layer of cartilage breaks down and wears
away. This allows bones under the cartilage to rub together, causing
pain, swelling, and loss of motion of the joint. Over time, the
joint may lose its normal shape. Also, bone spurs--small growths
called osteophytes--may grow on the edges of the joint. Bits of bone
or cartilage can break off and float inside the joint space. This
causes more pain and damage.
osteoarthritis usually have joint pain and limited movement. Unlike
some other forms of arthritis, osteoarthritis affects only joints
and not internal organs. For example, rheumatoid arthritis--the
second most common form of arthritis--affects other parts of the
body besides the joints. It begins at a younger age than
osteoarthritis, causes swelling and redness in joints, and may make
people feel sick, tired, and (uncommonly) feverish.
Who Has Osteoarthritis?
is one of the most frequent causes of physical disability among
adults. More than 20 million people in the United States have the
disease. By 2030, 20 percent of Americans--about 70 million
people--will have passed their 65th birthday and will be at risk for
osteoarthritis. Some younger people get osteoarthritis from joint
injuries, but osteoarthritis most often occurs in older people. In
fact, more than half of the population age 65 or older would show
x-ray evidence of osteoarthritis in at least one joint. Both men and
women have the disease. Before age 45, more men than women have
osteoarthritis, whereas after age 45, it is more common in women.
How Does Osteoarthritis Affect
affects each person differently. In some people, it progresses
quickly; in others, the symptoms are more serious. Scientists do not
know yet what causes the disease, but they suspect a combination of
factors, including being overweight, the aging process, joint
injury, and stresses on the joints from certain jobs and sports
What Areas Does Osteoarthritis Affect?
Osteoarthritis most often occurs at the ends of the fingers,
thumbs, neck, lower back, knees, and hips.
hurts people in more than their joints: their finances and
lifestyles also are affected.
- The cost
lost because of disability.
Limitations on daily activities
participating in everyday personal and family joys and
challenges, most people with osteoarthritis can lead active
and productive lives. They succeed by using osteoarthritis treatment
strategies, such as the following:
- Rest and
education and support programs
self-care and having a "good-health attitude."
Osteoarthritis Basics: The Joint
and Its Parts
joints--the place where two moving bones come together--are designed
to allow smooth movement between the bones and to absorb shock from
movements like walking or repetitive movements. The joint is made up
Cartilage: a hard but slippery coating on the end of each
bone. Cartilage, which breaks down and wears away in
osteoarthritis, is described in more detail
Joint capsule: a tough membrane sac that holds all the
bones and other joint parts together.
Synovium (sin-O-vee-um): a thin membrane inside the joint
Synovial fluid: a fluid that lubricates the joint and keeps
the cartilage smooth and healthy.
Ligaments, tendons, and muscles: tissues that keep the bones
stable and allow the joint to bend and move. Ligaments are tough,
cord-like tissues that connect one bone to another. Tendons are
tough, fibrous cords that connect muscles to bones. Muscles are
bundles of specialized cells that contract to produce movement
when stimulated by nerves.
How Do You Know if You Have
osteoarthritis comes on slowly. Early in the disease, joints may
ache after physical work or exercise. Osteoarthritis can occur in
any joint. Most often it occurs at the hands, knees, hips, or spine.
Osteoarthritis of the fingers is one type of osteoarthritis that
seems to have some hereditary characteristics; that is, it runs in
families. More women than men have it, and they develop it
especially after menopause. In osteoarthritis, small, bony knobs
appear on the end joints of the fingers. They are called Heberden's
(HEB-err-denz) nodes. Similar knobs, called Bouchard's (boo-SHARDZ)
nodes, can appear on the middle joints of the fingers. Fingers can
become enlarged and gnarled, and they may ache or be stiff and numb.
The base of the thumb joint also is commonly affected by
osteoarthritis. Osteoarthritis of the hands can be helped by
medications, splints, or heat treatment.
Cartilage: The Key to Healthy Joints
Cartilage is 65 to 80 percent water. Three other components make
up the rest of cartilage tissue: collagen, proteoglycans, and
Collagen (KAHL-uh-jen): a fibrous protein. Collagen
is also the building block of skin, tendon, bone, and other
Proteoglycans (PRO-tee-uh-GLY-kanz): a combination
of proteins and sugars. Strands of proteoglycans and collagen
weave together and form a mesh-like tissue. This allows
cartilage to flex and absorb physical shock.
Chondrocytes (KAHN-druh-sytz): cells that are found
all through the cartilage. They mainly help cartilage stay
healthy and grow. Sometimes, however, they release substances
called enzymes that destroy collagen and other proteins.
Researchers are trying to learn more about chondrocytes.
The knees are the body's primary weight-bearing joints. For this
reason, they are among the joints most commonly affected by
osteoarthritis. They may be stiff, swollen, and painful, making it
hard to walk, climb, and get in and out of chairs and bathtubs. If
not treated, osteoarthritis in the knees can lead to disability.
Medications, weight loss, exercise, and walking aids can reduce pain
and disability. In severe cases, knee replacement surgery may be
Osteoarthritis in the hip can cause pain, stiffness, and severe
disability. People may feel the pain in their hips, or in their
groin, inner thigh, buttocks, or knees. Walking aids, such as canes
or walkers, can reduce stress on the hip. Osteoarthritis in the hip
may limit moving and bending. This can make daily activities such as
dressing and foot care a challenge. Walking aids, medication, and
exercise can help relieve pain and improve motion. The doctor may
recommend hip replacement if the pain is severe and not relieved by
Stiffness and pain in the neck or in the lower back can result from
osteoarthritis of the spine. Weakness or numbness of the arms or
legs also can result. Some people feel better when they sleep on a
firm mattress or sit using back support pillows. Others find it
helps to use heat treatments or to follow an exercise program that
strengthens the back and abdominal muscles. In severe cases, the
doctor may suggest surgery to reduce pain and help restore function.
Warning Signs of Osteoarthritis
Steady or intermittent pain in a joint
Stiffness in a joint after getting out of bed or sitting
for a long time
Swelling or tenderness in one or more joints
crunching feeling or the sound of bone rubbing on bone
Hot, red, or tender? Probably not osteoarthritis. Check
with your doctor about other causes, such as rheumatoid
Pain? Not always. In fact, only a third of people whose x
rays show evidence of osteoarthritis report pain or other
How Do Doctors Diagnose
No single test
can diagnose osteoarthritis. Most doctors use a combination of the
following methods to diagnose the disease and rule out other
history: The doctor begins by asking the patient to describe the
symptoms, and when and how the condition started. Good
doctor-patient communication is important. The doctor can give a
better assessment if the patient gives a good description of pain,
stiffness, and joint function, and how they have changed over time.
It also is important for the doctor to know how the condition
affects the patient's work and daily life. Finally, the doctor also
needs to know about other medical conditions and whether the patient
is taking any medicines.
examination: The doctor will check the patient's general health,
including checking reflexes and muscle strength. Joints bothering
the patient will be examined. The doctor will also observe the
patient's ability to walk, bend, and carry out activities of daily
Doctors take x rays to see how much joint damage has been done. X
rays of the affected joint can show such things as cartilage loss,
bone damage, and bone spurs. But there often is a big difference
between the severity of osteoarthritis as shown by the x ray and the
degree of pain and disability felt by the patient. Also, x rays may
not show early osteoarthritis damage, before much cartilage loss has
tests: The doctor may order blood tests to rule out other causes
of symptoms. Another common test is called joint aspiration, which
involves drawing fluid from the joint for examination.
It usually is
not difficult to tell if a patient has osteoarthritis. It is more
difficult to tell if the disease is causing the patient's symptoms.
Osteoarthritis is so common--especially in older people--that
symptoms seemingly caused by the disease actually may be due to
other medical conditions. The doctor will try to find out what is
causing the symptoms by ruling out other disorders and identifying
conditions that may make the symptoms worse. The severity of
symptoms in osteoarthritis is influenced greatly by the patient's
attitude, anxiety, depression, and daily activity level.
How Is Osteoarthritis Treated?
successful treatment programs involve a combination of treatments
tailored to the patient's needs, lifestyle, and health.
Osteoarthritis treatment has four general goals:
Improve joint care through rest and exercise.
Maintain an acceptable body weight.
Control pain with medicine and other measures.
Achieve a healthy lifestyle.
Treatment Approaches to Osteoarthritis
and joint care
treatment plans often include ways to manage pain and improve
function. Such plans can involve exercise, rest and joint care, pain
relief, weight control, medicines, surgery, and nontraditional
Research shows that exercise is one of the best treatments for
osteoarthritis. Exercise can improve mood and outlook, decrease
pain, increase flexibility, improve the heart and blood flow,
maintain weight, and promote general physical fitness. Exercise is
also inexpensive and, if done correctly, has few negative side
effects. The amount and form of exercise will depend on which joints
are involved, how stable the joints are, and whether a joint
replacement has already been done.
Move: Fighting Osteoarthritis With Exercise
You can use exercises to keep strong and limber, extend your
range of movement, and reduce your weight.Some different types
of exercise include the following:
Strength exercises: These can be performed with exercise
bands, inexpensive devices that add resistance.
Aerobic activities: These keep your lungs and circulation
systems in shape.
Range of motion activities: These keep your joints
Agility exercises: These can help you maintain daily
Neck and back strength exercises: These can help you keep
your spine strong and limber.
doctor or physical therapist what exercises are best for you.
Ask for guidelines on exercising when a joint is sore or if
swelling is present. Also, check if you should (1) use
pain-relieving drugs, such as analgesics or anti-inflammatories
(also called NSAIDs), to make exercising easier, or (2) use ice
joint care: Treatment plans include regularly scheduled rest.
Patients must learn to recognize the body's signals, and know when
to stop or slow down, which prevents pain caused by overexertion.
Some patients find that relaxation techniques, stress reduction, and
biofeedback help. Some use canes and splints to protect joints and
take pressure off them. Splints or braces provide extra support for
weakened joints. They also keep the joint in proper position during
sleep or activity. Splints should be used only for limited periods
because joints and muscles need to be exercised to prevent stiffness
and weakness. An occupational therapist or a doctor can help the
patient get a properly fitting splint.
pain relief: People with osteoarthritis may find nondrug ways to
relieve pain. Warm towels, hot packs, or a warm bath or shower to
apply moist heat to the joint can relieve pain and stiffness. In
some cases, cold packs (a bag of ice or frozen vegetables wrapped in
a towel can relieve pain or numb the sore area. (Check with a doctor
or physical therapist to find out if heat or cold is the best
treatment.) Water therapy in a heated pool or whirlpool also may
relieve pain and stiffness. For osteoarthritis in the knee, patients
may wear insoles or cushioned shoes to redistribute weight and
reduce joint stress.
control: Osteoarthritis patients who are overweight or obese
need to lose weight. Weight loss can reduce stress on weight-bearing
joints and limit further injury. A dietitian can help patients
develop healthy eating habits. A healthy diet and regular exercise
help reduce weight.
Medicines: Doctors prescribe medicines to eliminate or reduce
pain and to improve functioning. Doctors consider a number of
factors when choosing medicines for their patients with
osteoarthritis. Two important factors are the intensity of the pain
and the potential side effects of the medicine. Patients must use
medicines carefully and tell their doctors about any changes that
types of medicines are commonly used in treating osteoarthritis:
Acetaminophen: Acetaminophen is a pain reliever (for
that does not reduce swelling. Acetaminophen does not irritate the
stomach and is less likely than nonsteroidal anti-inflammatory drugs
(NSAIDs) to cause long-term side effects. Research has shown that
acetaminophen relieves pain as effectively as NSAIDs for many
patients with osteoarthritis.
Warning: People with liver disease, people who drink
alcohol heavily, and those taking blood- thinning medicines or
NSAIDs should use acetaminophen with caution.
NSAIDs (nonsteroidal anti-inflammatory drugs): Many
NSAIDs are used to treat
osteoarthritis. Patients can buy some over the counter (for
example, aspirin, Advil, Motrin IB, Aleve, ketoprofen). Others
require a prescription. All NSAIDs work similarly: they fight
inflammation and relieve pain. However, each NSAID is a different
chemical, and each has a slightly different effect on the body.
Side effects: NSAIDs can cause stomach irritation or, less
often, they can affect kidney function. The longer a person uses
NSAIDs, the more likely he or she is to have side effects, ranging
from mild to serious. Many other drugs cannot be taken when a
patient is being treated with NSAIDs because NSAIDs alter the way
the body uses or eliminates these other drugs. Check with your
health care provider or pharmacist before you take NSAIDs in
addition to another medication. Also, NSAIDs sometimes are
associated with serious gastrointestinal problems, including ulcers,
bleeding, and perforation of the stomach or intestine. People over
age 65 and those
with any history of ulcers or gastrointestinal bleeding should use
NSAIDs with caution.
inhibitors: Several new NSAIDs from a class of drugs known as
COX-2 inhibitors are now being used to treat osteoarthritis. These
medicines reduce inflammation similarly to traditional NSAIDs, but
they cause fewer gastrointestinal side effects. However, these
medications occasionally are associated with harmful reactions
ranging from mild to severe.
Doctors may prescribe several other medicines for osteoarthritis,
including the following:
pain-relieving creams, rubs, and sprays (for example, capsaicin
cream), which are applied directly to the skin.
narcotic painkillers, which--although very effective--may be
addictive and are not commonly used.
Corticosteroids, powerful anti-inflammatory hormones made
naturally in the body or manmade for use as medicine.
Corticosteroids may be injected into the affected joints to
temporarily relieve pain. This is a short-term measure, generally
not recommended for more than two or three treatments per year. Oral
corticosteroids should not be used to treat osteoarthritis.
Hyaluronic acid, a medicine for joint injection, used to treat
osteoarthritis of the knee. This substance is a normal component of
the joint, involved in joint lubrication and nutrition.
Questions To Ask Your Doctor or Pharmacist About Medicines
often should I take this medicine?
Should I take this medicine with food or between meals?
side effects can I expect?
Should I take this medicine with the other prescription
medicines I take?
Should I take this medicine with the over-the-counter
medicines I take?
used to treat osteoarthritis have side effects, so it is important
for people to learn about the medicines they take. Even
nonprescription drugs should be checked. Several groups of patients
are at high risk for side effects from NSAIDs, such as people with a
history of peptic ulcers or digestive tract bleeding, people taking
oral corticosteroids or anticoagulants (blood thinners), smokers,
and people who consume alcohol. Some patients may be able to help
reduce side effects by taking some medicines with food. Others
should avoid stomach irritants such as alcohol, tobacco, and
caffeine. Some patients try to protect their stomachs by taking
other medicines that coat the stomach or block stomach acids. These
measures help, but they are not always completely effective.
For many people, surgery helps relieve the pain and disability of
osteoarthritis. Surgery may be performed to
loose pieces of bone and cartilage from the joint if they are
causing mechanical symptoms of buckling or locking
Resurface (smooth out) bones
replace affected joints with artificial joints called prostheses.
These joints can be made from metal alloys, high-density plastic,
and ceramic material. They can be joined to bone surfaces by special
cements. Artificial joints can last 10 to 15 years or longer. About
10 percent of artificial joints may need revision. Surgeons choose
the design and components of prostheses according to their patient's
weight, sex, age, activity level, and other medical conditions.
to use surgery depends on several things. Both the surgeon and the
patient consider the patient's level of disability, the intensity of
pain, the interference with the patient's lifestyle, the patient's
age, and occupation. Currently, more than 80 percent of
osteoarthritis surgery cases involve replacing the hip or knee
joint. After surgery and rehabilitation, the patient usually feels
less pain and swelling, and can move more easily.
Nontraditional Approaches: Among the alternative therapies used
to treat osteoarthritis are the following:
Acupuncture: Some people have found pain relief using
acupuncture (the use of fine needles inserted at specific points
on the skin). Preliminary research shows that acupuncture may be a
useful component in an osteoarthritis treatment plan for some
remedies: Some patients seek alternative therapies for their
pain and disability. Some of these alternative therapies have
included wearing copper bracelets, drinking herbal teas, and
taking mud baths. While these practices are not harmful, some can
be expensive. They also cause delays in seeking medical treatment.
To date, no scientific research shows these approaches to be
helpful in treating osteoarthritis.
Nutritional supplements: Nutrients such as glucosamine and
chondroitin sulfate have been reported to improve the symptoms of
people with osteoarthritis, as have certain vitamins. Additional
studies are being carried out to further evaluate these claims.
Professionals Who Treat Osteoarthritis
Many types of health professionals care for people with
Primary care physicians. Doctors who treat patients before
they are referred to other specialists in the health care
Rheumatologists. Medical doctors who specialize in
treating arthritis and related conditions that affect joints,
muscles, and bones.
Orthopaedists. Doctors who specialize in treatment of and
surgery for bone and joint diseases.
Physical therapists. Health professionals who work with
patients to improve joint function.
Occupational therapists. Health professionals who teach
ways to protect joints, minimize pain, and conserve energy.
Dietitians. Health professionals who teach ways to use a
good diet to improve health and maintain a healthy weight.
Nurse educators. Nurses who specialize in helping
patients understand their overall condition and implement
their treatment plans.
Physiatrists (rehabilitation specialists). Doctors who
help patients make the most of their physical potential.
Licensed acupuncture therapists. Health professionals who
reduce pain and improve physical functioning by inserting fine
needles into the skin at various points on the body.
Psychologists. Health professionals who help patients cope
with difficulties in the home and workplace resulting from
their medical conditions.
Social workers. Professionals who assist patients with
social challenges caused by disability, unemployment,
financial hardships, home health care, and other needs
resulting from their medical conditions.
Practice Self-Care and Keep a
osteoarthritis can enjoy good health despite having the disease.
How? By learning self-care skills and developing a "good-health
central to successfully managing the pain and disability of
osteoarthritis. People have a much better chance of having a
rewarding lifestyle when they educate themselves about the disease
and take part in their own care. Working actively with a team of
health care providers enables people with the disease to minimize
pain, share in decision making about treatment, and feel a sense of
control over their lives. Research shows that people with
osteoarthritis who take part in their own care report less pain and
make fewer doctor visits. They also enjoy a better quality of life.
Self-Management Programs Do Help
People with osteoarthritis find that self-management programs
Understand the disease
Reduce pain while remaining active
physically, emotionally, and mentally
greater control over the disease
Build confidence in their ability to live an active,
Self-Help and Education Programs: Three kinds of programs help
people learn about osteoarthritis, learn self-care, and improve
their good-health attitude. These programs include
Arthritis self-management programs
Arthritis support groups.
teach people about osteoarthritis, its treatments, exercise and
relaxation, patient and health care provider communication, and
problem solving. Research has shown that these programs have clear
and long-lasting benefits.
Exercise: Regular physical activity plays a key role in
self-care and wellness. Two types of exercise are important in
osteoarthritis management. The first type, therapeutic exercises,
keep joints working as well as possible. The other type, aerobic
conditioning exercises, improve strength and fitness, and control
weight. Patients should be realistic when they start exercising.
They should learn how to exercise correctly, because exercising
incorrectly can cause problems.
with osteoarthritis exercise best when their pain is least severe.
Start with an adequate warmup and begin exercising slowly. Resting
frequently ensures a good workout. It also reduces the risk of
injury. A physical therapist can evaluate how a patient's muscles
are working. This information helps the therapist develop a safe,
personalized exercise program to increase strength and flexibility.
enjoy sports or other activities in their exercise program. Good
activities include swimming and aquatic exercise, walking, running,
biking, cross-country skiing, and using exercise machines and
osteoarthritis should check with their doctor or physical therapist
before starting an exercise program. Health care providers will
suggest what exercises are best for you, how to warm up safely, and
when to avoid exercising a joint affected by arthritis. Pain
medications and applying ice after exercising may make exercising
Exercises for Osteoarthritis
with osteoarthritis should do different kinds of exercise for
different benefits to the body.
Spirit: Making the most of good health requires careful
attention to the body, mind, and spirit. People with osteoarthritis
must plan and develop daily routines that maximize their quality of
life and minimize disability. They also need to evaluate these
routines periodically to make sure they are working well.
also requires a positive attitude. People must decide to make the
most of things when faced with the challenges of osteoarthritis.
This attitude--a good-health mindset--doesn't just happen. It takes
work, every day. And with the right attitude, you will achieve it.
Focus on your abilities instead of disabilities.
Focus on your strengths instead of weaknesses.
Break down activities into small tasks that you can manage.
Incorporate fitness and nutrition into daily routines.
Develop methods to minimize and manage stress.
Balance rest with activity.
Develop a support system of family, friends, and health
role in osteoarthritis research is played by the National Institute
of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), within
the National Institutes of Health (NIH). The NIAMS funds many
researchers across the United States to study osteoarthritis. It has
established a Specialized Center of Research devoted to
osteoarthritis. Also, many researchers study arthritis at NIAMS
Multipurpose Arthritis and Musculoskeletal Diseases Centers and
Multidisciplinary Clinical Research Centers. These centers conduct
basic, laboratory, and clinical research aimed at understanding the
causes, treatment options, and prevention of arthritis and
musculoskeletal diseases. Center researchers also study
epidemiology, health services, and professional, patient, and public
education. The NIAMS also supports multidisciplinary clinical
research centers that expand clinical studies for diseases like
scientists thought that osteoarthritis was simply a disease of "wear
and tear" that occurred in joints as people got older. In the last
decade, however, research has shown that there is more to the
disorder than aging alone. The production, maintenance, and
breakdown of cartilage, as well as bone changes in osteoarthritis,
are now seen as a series or cascade of events. Many researchers are
trying to discover where in that cascade of events things go wrong.
By understanding what goes wrong, they hope to find new ways to
prevent or treat osteoarthritis. Some key areas of research are
Models: Animals help researchers understand how diseases work
and why they occur. Animal models help researchers learn many things
about osteoarthritis, such as what happens to cartilage, how
treatment strategies might work, and what might prevent the disease.
Animal models also help scientists study osteoarthritis in very
early stages before it causes detectable joint damage.
Tools: Some scientists want to find ways to detect
osteoarthritis at earlier stages so that they can treat it earlier.
They seek specific abnormalities in the blood, joint fluid, or urine
of people with the disease. Other scientists use new technologies to
analyze the differences between the cartilage from different joints.
For example, many people have osteoarthritis in the knees or hips,
but few have it in the ankles. Can ankle cartilage be different?
Does it age differently? Answering these questions will help us
understand the disease better.
Studies: Researchers suspect that inheritance plays a role in 25
to 30 percent of osteoarthritis cases. Researchers have found that
genetics may play a role in approximately 40 to 65 percent of hand
and knee osteoarthritis cases. They suspect inheritance might play a
role in other types of osteoarthritis, as well. Scientists have
identified a mutation (a gene defect) affecting collagen, an
important part of cartilage, in patients with an inherited kind of
osteoarthritis that starts at an early age. The mutation weakens
collagen protein, which may break or tear more easily under stress.
Scientists are looking for other gene mutations in osteoarthritis.
Recently, researchers found that the daughters of women who have
knee osteoarthritis have a significant increase in cartilage
breakdown, thus making them more susceptible to disease. In the
future, a test to determine who carries the genetic defect (or
defects) could help people reduce their risk for osteoarthritis with
Engineering: This technology involves removing cells from a
healthy part of the body and placing them in an area of diseased or
damaged tissue in order to improve certain body functions.
Currently, it is used to treat small traumatic injuries or defects
in cartilage, and, if successful, could eventually help treat
osteoarthritis. Researchers at the NIAMS are exploring three types
of tissue engineering. The two most common methods being studied
today include cartilage cell replacement and stem cell
transplantation. The third method is gene therapy.
Cartilage cell replacement: In this procedure, researchers
remove cartilage cells from the patient's own joint and then clone
or grow new cells using tissue culture and other laboratory
techniques. They then inject the newly grown cells into the
patient's joint. Patients with cartilage cell replacement have
fewer symptoms of osteoarthritis. Actual cartilage repair is
cell transplantation: Stem cells are primitive cells that can
transform into other kinds of cells, such as muscle or bone cells.
They usually are taken from bone marrow. In the future,
researchers hope to insert stem cells into cartilage, where the
cells will make new cartilage. If successful, this process could
be used to repair damaged cartilage and avoid the need for
surgical joint replacements with metal or plastics.
therapy: Scientists are working to genetically engineer cells
that would inhibit the body chemicals, called enzymes, that may
help break down cartilage and cause joint damage. In gene therapy,
cells are removed from the body, genetically changed, and then
injected back into the affected joint. They live in the joint and
protect it from damaging enzymes.
Comprehensive Treatment Strategies: Effective treatment for
osteoarthritis takes more than medicine or surgery. Getting help
from a variety of care professionals often can improve patient
treatment and self-care. Research shows that adding patient
education and social support is a low-cost, effective way to
decrease pain and reduce the amount of medicine used.
a key part in comprehensive treatment. Researchers are studying
exercise in greater detail and finding out just how to use it in
treating or preventing osteoarthritis. For example, several
scientists have studied knee osteoarthritis and exercise. Their
results included the following:
Strengthening the thigh muscle (quadriceps) can relieve symptoms
of knee osteoarthritis and prevent more damage.
can result in better functioning, and the more you walk, the
farther you will be able to walk.
with knee osteoarthritis who were active in an exercise program
feel less pain. They also function better.
shown that losing extra weight can help people who already have
osteoarthritis. Moreover, overweight or obese people who do not have
osteoarthritis may reduce their risk of developing the disease by
NSAIDs: Many people who have osteoarthritis have persistent pain
despite taking simple pain relievers such as acetaminophen. Some of
these patients take NSAIDs instead. Health care providers are
concerned about long-term NSAID use because it can lead to an upset
stomach, heartburn, nausea, and more dangerous side effects, such as
working to design and test new, safer NSAIDs. One example currently
available is a class of selective NSAIDs called COX-2 inhibitors.
Traditional NSAIDs prevent inflammation by blocking two related
enzymes in the body called COX-1 and COX-2. The gastrointestinal
side effects associated with traditional NSAIDs seems to be
associated mainly with blocking the COX-1 enzyme, which helps
protect the stomach lining. The new selective COX-2 inhibitors,
however, primarily block the COX-2 enzyme, which helps control
inflammation in the body. As a result, COX-2 inhibitors reduce pain
and inflammation but are less likely than traditional NSAIDs to
cause gastrointestinal ulcers and bleeding. However, research shows
that some COX-2 inhibitors may not protect against heart disease as
well as traditional NSAIDs, so check with your doctor if you have
Prevent Joint Damage: No treatment actually prevents
osteoarthritis or reverses or blocks the disease process once it
begins. Present treatments just relieve the symptoms. Researchers
are looking for drugs that would prevent, slow down, or reverse
joint damage. One experimental antibiotic drug, doxycycline, may
stop certain enzymes from damaging cartilage. The drug has shown
some promise in clinical studies, but more studies are needed.
Researchers also are studying growth factors and other natural
chemical messengers. These potential medicines may be able to
stimulate cartilage growth or repair.
Acupuncture: During an acupuncture treatment, a licensed
acupuncture therapist inserts very fine needles into the skin at
various points on the body. Scientists think the needles stimulate
the release of natural, pain-relieving chemicals produced by the
brain or the nervous system. Researchers are studying acupuncture
treatment of patients who have knee osteoarthritis. Early findings
suggest that traditional Chinese acupuncture is effective for some
patients as an additional therapy for osteoarthritis, reducing pain
and improving function.
Supplements: Nutritional supplements are often reported as
helpful in treating osteoarthritis. Such reports should be viewed
with caution, however, since very few studies have carefully
evaluated the role of nutritional supplements in osteoarthritis.
Glucosamine and chondroitin sulfate: Both of these nutrients
are found in small quantities in food and are components of normal
cartilage. Scientific studies on these two nutritional supplements
have not yet shown that they affect the disease. They may relieve
symptoms and reduce joint damage in some patients, however. The
National Center for Complementary and Alternative Medicine at the
NIH is supporting a clinical trial to test whether glucosamine,
chondroitin sulfate, or the two nutrients in combination reduce
pain and improve function. Patients using this therapy should do
so only under the supervision of their doctor, as part of an
overall treatment program with exercise, relaxation, and pain
Vitamins D, C, E, and beta carotene: The progression of
osteoarthritis may be slower in people who take higher levels of
vitamin D, C, E, or beta carotene. More studies are needed to
confirm these reports.
Acid: Injecting this substance into the knee joint provides
long-term pain relief for some people with osteoarthritis.
Hyaluronic acid is a natural component of cartilage and joint fluid.
It lubricates and absorbs shock in the joint. The Food and Drug
Administration (FDA) approved this therapy for patients with
osteoarthritis of the knee who do not get relief from exercise,
physical therapy, or simple analgesics. Researchers are presently
studying the benefits of using hyaluronic acid to treat
In studies of older women, scientists found a lower risk of
osteoarthritis in women who had used oral estrogens for hormone
replacement therapy. The researchers suspect having low levels of
estrogen could increase the risk of developing osteoarthritis.
Additional studies are needed to answer this question.