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Osteoarthritis: 7 Things You Need to Know


How to help those aching joints — without surgery

by Jodi Helmer, AARP

Hand massaging another hand, Understanding Osteoarthritis (Getty Images)

Getty Images

Osteoarthritis is most common in the knees, hips and hands.

En Español l Osteoarthritis affects 27 million Americans — a number that is expected to skyrocket to 70 million by 2030 — and it's the leading cause of disability in older adults.

The disease is caused by a breakdown of the cartilage that cushions any of the body's joints. With too little cartilage, bones rub together, causing pain and stiffness. The condition is most common in the knees, hips and hands. Over time, osteoarthritis can lead to damage to the ligaments and muscles.

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While joint replacement surgery — like what NBC Nightly News anchor Brian Williams recently underwent on his knee — has become increasingly popular among millions of boomers, doctors still tell patients to try to manage their symptoms for as long as possible before turning to surgery. Any surgery, after all, comes with risks.

While there is no cure for osteoarthritis, there are some promising developments for early detection of this debilitating condition, as well as a possible treatment to slow its progress.

There are also a number of ineffective therapies that doctors warn osteoarthritis sufferers to avoid, based on an in-depth analysis issued this year by the American Academy of Orthopaedic Surgeons (AAOS).

Among the home remedies the group strongly recommends against: taking the supplements glucosamine and chondroitin. While some studies have shown that these popular supplements reduce pain and slow the disease's advance, the AAOS analysis showed the pills are no more effective than taking a placebo.

To reduce your risks, halt the progression of the disease or ease painful symptoms, here are seven things you need to know about osteoarthritis.

1. Osteoarthritis is not inevitable

Yes, age is a risk factor in developing osteoarthritis, but pain from osteoarthritis is "not an inevitable consequence of aging," says Marc C. Hochberg, M.D., professor of medicine and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine.

Although more than half of adults over age 65 have some evidence of osteoarthritis, Hochberg advises older patients to minimize their risks — keeping active and losing weight, for example — before the disease develops.

The thinking about osteoarthritis has also changed, from simply a "wear and tear" disease triggered by the breakdown of cartilage as we get older, to a condition that affects the entire joint, not just the cartilage. This shift in thinking may help doctors diagnose osteoarthritis before significant cartilage damage sets in, by looking for other signs of the disease, including morning stiffness, gelling (stiffness after rest and inactivity) and locking or buckling in the joint.

During an exam, Hochberg notes, a doctor may look for a bony enlargement of the joint or what's called crepitus, a grating sensation felt when the joint is extended. The doctor will then use X-rays to identify changes in the margins of the joints that indicate osteoarthritis. With an examination of the entire joint, earlier detection may be possible and better pain therapies can be prescribed.

2. Early detection tests are in the works

Despite the prevalence of osteoarthritis, the disease often goes undiagnosed until it's in advanced stages.

There is no Food and Drug Administration–approved diagnostic test for osteoarthritis, which means it can't be diagnosed with a blood test.

While it's possible to see cartilage on an MRI or ultrasound, subtle changes to the soft tissue that occur in earlier stages of the disease are hard to detect.

"A lot of times people don't go to the doctor until they're in pain, and by the time there is pain, the disease is in its later stages and a lot of cartilage has already been lost," says Roman Krawetz, an assistant professor at the McCaig Institute for Bone and Joint Health at the University of Calgary.

"A lot of times people don't go to the doctor until they're in pain, and by the time there is pain, the disease is in its later stages and a lot of cartilage has already been lost."

To help identify patients with early-stage osteoarthritis, researchers at the University of Calgary are developing a test that identifies markers of inflammation in blood or the synovial fluid in the joint. Early detection, Krawetz says, might help patients "change their behaviors and help slow the progression of the disease."

3. Technology to halt disease progression is on the horizon

While osteoarthritis has long been thought to be a disease of the cartilage, researchers at Johns Hopkins University discovered that the bone beneath the cartilage reacts to damage by forming new bone. This new, unwanted bone growth further stretches the cartilage, speeding its decline.

The research, published online May 19, 2013, in the journal Nature Medicine, found that injecting a beta inhibitor — called growth factor- Type I receptor — into the bone could halt its abnormal growth.

"There is no cure for osteoarthritis, and treatments are focused on symptom relief and maintaining joint function," says Rebecca Manno, M.D., assistant professor of medicine in the division of rheumatology at Johns Hopkins. "The goal of current osteoarthritis research is to come up with [a treatment] that will alter the process of the disease."

Researchers are developing a clinical trial and are expected to begin recruiting patient participants in 2014.

4. Exercise is one of the best treatment options

For people who suffer from osteoarthritis, the idea of using exercise to reduce pain is often met with skepticism. Many of them have experienced greater osteoarthritis pain when they've upped their levels of activity, which is why Manno describes exercise for osteoarthritis patients as "a double-edged sword."

"When you rest the joint, you tend to feel less pain," she says, but the inactivity can ultimately lead to more discomfort.

Exercise, on the other hand, strengthens the muscles around the joint, which ultimately helps to reduce pain. In fact, a study published in 2012 in the Musculoskelatal Journal of Hospital for Special Surgery found that older adults reported improved physical performance and decreased pain after participating in an exercise program.

Exercise also releases endorphins, which moderate pain, and helps overweight patients lose weight and reduce the stress on their joints, Hochberg adds.

To encourage patients to gradually increase their activity, Manno tells them to start "slow and low," with low-impact exercises for short amounts of time, even if it's for just five minutes at first. As their muscles strengthen, they begin going for longer.

There may be "a small amount of discomfort when you start to exercise, but it improves over time," she says. Of course, if you experience severe pain or decreased ability to use the joint, stop immediately and consult a doctor.

Low-impact exercises like swimming, water aerobics, walking and biking will put the least strain on the joints. Yoga has also proved beneficial for decreasing osteoarthritis pain and improving patients' quality of life.

5. Extra pounds can make things worse

Excess weight not only puts extra pressure on the joints, it may also trigger inflammation and other changes that increase pain and stiffness, said the authors of a March study in the Journal of the American Academy of Orthopaedic Surgeons. The researchers estimated that half the cases of osteoarthritis of the knee in the United States could be avoided if obese Americans could reduce their weight.

A 2011 Wake Forest University study of about 400 overweight older adults, average age 65, found that diet and exercise helped improve their mobility and reduce pain "by as much as 50 percent," reported lead author Stephen P. Messier. Even more encouraging, said Messier, patients who follow a committed diet and exercise program "will see marked improvement in pain and function in six months or less."

If all this isn't enough, excess weight also affects how people who suffer from osteoarthritis experience the disease. Research published in the journal Pain found that overweight patients with osteoarthritis experience more pain than normal-weight patients.

6. Some treatments may be a waste of time and money

After evaluating the evidence for a variety of treatments for knee osteoarthritis, the American Academy of Orthopaedic Surgeons said there was "strong evidence against" these remedies: acupuncture, taking the supplements glucosamine and chondroitin, getting injections of hyaluronic acid in the knee, and "knee scraping" surgery to wash and smooth the joint.

David Jevsevar, M.D., an orthopedic surgeon and the chair of the clinical practice guidelines work group for the AAOS, noted that a lot of these are "legacy treatments" that doctors continue to suggest because they have been used for a long time, despite a dearth of evidence.

Unfortunately, many of these longtime treatments were never scientifically tested until recently to see if they really work. "The types of randomized trials we like to see now weren't done back when these treatments were first introduced," he says.

A review of current studies suggests that some of the treatments, including acupuncture and the supplements glucosamine and chondroitin, were less effective than placebos. Although patients with osteoarthritis of the knee continue to turn to these treatments, Jevsevar believes they would be better off spending their money "on things that work."

7. You can do something about the pain

Although osteoarthritis is a progressive disease and there are no treatments to restore cartilage or reverse joint damage, there are effective treatments to improve joint functioning and reduce pain.

Manno notes that over-the-counter medications like acetaminophen and ibuprofen, along with topical application of anti-inflammatory gels, can offer pain relief.

For more severe symptoms, doctors may suggest cortisone injections. Often sufferers of osteoarthritis are hesitant to exercise because of joint pain, even though remaining sedentary only makes things worse. Taking a pain reliever can help increase physical activity, which in turn helps reduce the stiffness and pain in the joints.

For advanced osteoarthritis, where the pain is disrupting sleep and normal daily activities, your doctor may recommend joint replacement surgery.

"There are treatments we can use that could make a difference in daily functioning and pain management," Manno says. "You don't have to resign yourself to living with painful joints."

Freelance writer Jodi Helmer writes frequently on health topics for AARP.