Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in the hands, knees, hips, and spine.

Osteoarthritis was once considered a simple “wear-and-tear” condition, but it is now understood as a complex disease involving the entire joint — cartilage, bone, ligaments, menisci, and synovium. Symptoms can range from mild to severe and tend to worsen gradually. While the underlying joint damage cannot be reversed, a combination of self-care, medicines, physical therapy, and, when necessary, surgery can substantially reduce pain and improve function.

Symptoms of osteoarthritis often develop slowly and worsen over time. They include:

• Pain during or after movement
• Stiffness, most noticeable upon waking or after a period of inactivity
• Tenderness when light pressure is applied to the joint
• Loss of flexibility and reduced range of motion
• Grating sensation or cracking sounds (crepitus) with joint movement
• Bone spurs (extra bits of bone that feel like hard lumps)
• Swelling caused by soft-tissue inflammation around the joint

Pain and stiffness are typically worse with activity and improve with rest in early disease; in advanced disease, pain may persist at rest or at night.

Osteoarthritis occurs when the cartilage that cushions the ends of bones in the joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the smooth surface of the cartilage becomes rough and eventually wears away entirely, leaving bone to rub on bone.

The process involves more than just cartilage loss; the bone beneath the cartilage changes, bone spurs may form, the joint lining can become inflamed, and the ligaments and muscles around the joint may weaken. Age-related changes, prior joint injury, repetitive stress, and metabolic factors all contribute to the disease process.

Factors that increase the risk of osteoarthritis include:

• Older age
• Female sex (especially after menopause)
• Obesity — increases stress on weight-bearing joints and may have metabolic effects on cartilage
• Joint injuries (from sports or accidents)
• Repeated stress on the joint from certain occupations or sports
• Genetics — some people inherit a tendency to develop osteoarthritis
• Bone deformities or joint malalignment
• Certain metabolic diseases (diabetes, hemochromatosis)
• Previous inflammatory joint disease

Osteoarthritis can lead to:

• Chronic pain that limits daily activities and reduces quality of life
• Loss of independence and mobility
• Sleep disturbance from pain
• Depression and anxiety related to chronic pain and disability
• Rapid progression in some individuals leading to severe joint destruction

Although osteoarthritis cannot always be prevented, the following measures can reduce risk or slow progression:

• Maintain a healthy weight to reduce stress on knees, hips, and spine
• Stay physically active with low-impact exercise (swimming, cycling, walking)
• Protect joints from injury by using proper technique in sports and occupational activities
• Practice good posture and body mechanics
• Control blood sugar if you have diabetes

Diagnosis is based primarily on history and physical examination. The clinician will check for tenderness, swelling, redness, flexibility, and grating sensations. Imaging and laboratory tests support the diagnosis and exclude other conditions:

• X-rays — can show cartilage loss (joint-space narrowing), bone spurs, and bony changes
• MRI — provides detailed images of cartilage and other soft tissues when needed
• Blood tests — mainly to rule out inflammatory or autoimmune arthritis
• Joint-fluid analysis — sometimes performed to exclude infection or gout

Make an appointment if you have joint pain or stiffness that persists for more than a few weeks, interferes with daily activities, or is accompanied by swelling. Early evaluation helps distinguish osteoarthritis from inflammatory forms of arthritis that require different treatment.

Treatment focuses on relieving symptoms and improving function:

• Self-care and lifestyle — weight loss, exercise, physical therapy, assistive devices, and activity modification
• Medicines — acetaminophen, NSAIDs (oral or topical), duloxetine for chronic pain, and intra-articular corticosteroid or hyaluronic-acid injections in selected cases
• Physical and occupational therapy — strengthening, range-of-motion exercises, and adaptive strategies
• Supportive devices — braces, canes, shoe inserts, or other aids
• Procedures — joint injections, radiofrequency ablation in selected situations
• Surgery — arthroscopy (limited role), osteotomy, or joint replacement (hip or knee arthroplasty) for advanced disease with severe pain and disability

A multimodal approach tailored to the affected joints and the individual’s goals produces the best results.

Daily strategies that help many people include:

• Regular low-impact aerobic and strengthening exercise
• Weight management
• Heat or cold therapy for symptom relief
• Use of assistive devices when recommended
• Pacing activities and balancing rest with movement
• Good footwear and joint-protection techniques
• Mind-body approaches (tai chi, yoga, mindfulness) for pain coping

Helpful information to bring:

• Description of which joints are affected, when symptoms began, and what makes them better or worse
• Impact on daily activities, work, and sleep
• List of medicines and previous treatments tried
• Previous imaging reports if available
• Questions about exercise recommendations, injection options, weight-loss strategies, and when surgery might be considered