Osteoarthritis

Overview

Osteoarthritis is a degenerative joint disease, in which cartilage, bone and other joint tissues change over time. It is the most common type of arthritis. It is more common in older people.

The joints most often affected include:

• Neck
• Shoulders
• Hands (ends of the fingers and base of the thumbs)
• Lower back
• Hips
• Knees
• Feet and ankles

Osteoarthritis affects each person differently. For some people, it is relatively mild and does not affect daily life. For others, it causes significant pain and disability. In some cases, people living with this disease can no longer work or perform daily tasks.

There is no cure for osteoarthritis. But symptoms can usually be managed with lifestyle changes and medicines.

Osteoarthritis affects millions of adults in the United States. It becomes more common as people get older. It occurs more often in women than men, especially after age 50.

Related Terms: Osteoarthritis is also called degenerative joint disease.

Signs and Symptoms

Osteoarthritis symptoms often begin slowly and usually start in one or a few joints. Symptoms range from mild stiffness to persistent, severe joint pain.

Common signs and symptoms include:

• Pain when using the joint, which may improve with rest
• For some people in later stages, pain that is worse at night
• Joint stiffness, usually lasting less than 30 minutes, in the morning or after resting
• Swelling in and around the joint, especially after a lot of activity
• Changes in the ability to move the joint
• A feeling that the joint is loose or unstable
• A crunching, grinding, cracking, or grating feelings or sounds when the joint moves.

Not everyone with osteoarthritis feels pain.

How Osteoarthritis Affects Specific Joints

• Hands: Bony knobs may appear on the end and middle joints of the fingers. Fingers can become enlarged and gnarled, and they may ache, feel stiff, or feel numb. The base of the thumb joint is also commonly affected. Osteoarthritis of the hands seems to run in families.
• Shoulders: You might feel pain, stiffness, or tenderness in the shoulder, especially when lifting your arm, reaching overhead, or reaching behind your back. You may also notice swelling, a grinding or clicking sensation, or reduced range of motion that makes activities such as dressing, combing your hair, or reaching for objects more difficult.
• Spine: You may feel stiffness and pain in the neck or lower back. In some cases, changes in the spine can put pressure on the nerves, causing weakness, tingling, or numbness in the arms and legs. In severe cases, these changes can even affect bladder and bowel function. Some people develop spinal stenosis which can lead to other symptoms.
• Hips: You might feel pain and stiffness in the hip joint or in the groin, inner thigh, or buttocks. Sometimes pain from hip osteoarthritis spreads to the knees. Over time, you may not be able to move your hip as far as you did before. Daily activities such as dressing and putting on shoes can become a challenge.
• Knees: You may hear a grinding or scraping noise when walking or moving. Stiffness, swelling, and pain can make it hard to walk, climb, and get in and out of chairs and bathtubs. Over time, the knee may start to buckle.
• Feet and Ankles: You might feel pain, stiffness, or swelling in the foot or ankle, especially when standing or walking. The joint may feel tender, less flexible, or unstable, and you may have difficulty walking, climbing stairs, or wearing certain shoes comfortably.

Over time, daily activities such as going up stairs, getting on or off the toilet, gripping a pen, or walking across a parking lot can become difficult. Pain and other symptoms may lead a person to feel depressed, get tired easily, or have trouble sleeping.

Related Health Effects

As soft tissue damage in the joint gets worse, pain, swelling, and loss of joint motion develop. If you have joint pain, you may become less active, which can lead to muscle weakness and put more stress on the joint. Over time, the joint may lose its normal shape.

Small bone growths called osteophytes, or bone spurs, may grow on the edges of the joint. Bits of bone or cartilage can also break off and float inside the joint space, causing more damage.

Causes and Risk Factors

Osteoarthritis happens when the cartilage and other tissues within the joint break down or change in structure. This does not happen because of simple wear and tear on the joints. Instead, changes in the tissue trigger the breakdown, which usually occurs gradually over time.

Researchers do not yet know what triggers or starts this breakdown.

Factors that may make it more likely for you to develop osteoarthritis include:

• Aging
• Being overweight or having obesity
• A history of injury or surgery to a joint
• Overuse from repetitive movements of the joint
• Joints that did not form correctly
• A family history of osteoarthritis

Anyone can get osteoarthritis, but it is more common as people age. Women are more likely than men to have it, especially after age 50. For many women it develops after menopause.

Younger people can also develop osteoarthritis, usually because of:

• Joint injury
• Abnormal joint structure
• A genetic defect in joint cartilage

Diagnosis

There is no single test for osteoarthritis. To make a diagnosis, most healthcare providers use a combination of methods.

Your doctor may:

• Ask about your symptoms and medical history, including any medicines you take and health problems in your close family members
• Perform a physical exam to check your general health, reflexes, and problem joints
• Order X-rays, which can show loss of joint space, bone damage, and bone spurs — though early joint damage does not usually appear on X-rays
• Use magnetic resonance imaging (MRI) to show damage to soft tissues in and around the joint
• Order blood tests to rule out other causes of your symptoms
• Take joint fluid samples to look for other causes of joint pain, such as infection or gout

If you have questions about your diagnosis, talk to your doctor. Your primary care provider may refer you to a rheumatologist, a doctor who specializes in arthritis and related conditions.

Prevention

You can lower your chances of developing osteoarthritis by changing the risk factors you can control. For example, managing your weight reduces stress on your joints, which may help prevent injury and lessen pain.

Treatment and Management

There is no cure for osteoarthritis. Doctors focus on treatments to ease pain, help you move better, and stop the disease from getting worse. The goals of treatment include:

• Reducing pain and other symptoms
• Improving joint function
• Slowing disease progression
• Maintaining quality of life and helping prevent disability

Exercise

A safe, well-rounded exercise program can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Options include:

• Range-of-motion and stretching activities to keep joints limber
• Strengthening exercises with weights or exercise bands to support affected joints
• Water exercises to reduce stress on joints while staying active
• Balance and agility exercises to help with daily living skills
• Low-impact activities such as walking, cycling, swimming, tai chi, or water aerobics

Always talk with your doctor before starting a new exercise program, and start slowly.

Weight Management

If you have overweight or obesity, managing your weight can reduce stress on your joints, lower pain, prevent more injury, and increase mobility — especially in weight-bearing joints like the knees and hips.

Medicines

Some people need medicines to help manage symptoms. Options include:

• Over-the-counter oral pain relievers and arthritis creams
• Oral anti-inflammatory medicines to treat pain and inflammation
• Topical creams, rubs, or sprays applied to the skin over sore joints
• Corticosteroids, which are strong inflammation-fighting drugs. These drugs are usually injected into the joint to temporarily relieve pain
• Hyaluronic acid substitutes (viscosupplements), injected into the knee to help with lubrication: Evidence of benefit is limited and professional recommendations differ. Your doctor may occasionally consider it for knee osteoarthritis after discussion of benefits and risks with you.
• Duloxitine, taken orally to help some patients with chronic osteoarthritis pain

Surgery

If other treatments are not helping and joint damage is extensive, your doctor may suggest surgery. Options include:

• Osteotomy: Surgical removal of a small piece of bone to relieve pressure on the affected joint
• Joint replacement surgery: Removal of part or all of the damaged joint and replacing it with a new joint made of plastic, metal, or ceramic

Many factors determine whether surgery is right for you. This may include your age, pain level, how much arthritis affects your lifestyle, level of disability, and occupation.

Living With Osteoarthritis

There are many things you can do to help manage osteoarthritis day to day:

• Use heat and cold treatments to reduce joint pain. Heat therapy increases blood flow, pain tolerance, and flexibility. Cold therapy numbs the nerves around the joint to reduce pain and may relieve inflammation.
• Use a cane, walker, or other assistive devices to move around safely and reduce pain.
• If you have arthritis in your hands, use devices such as jar openers to help with gripping.
• Try shoe inserts or braces to support your joint and reduce pain and pressure when you stand or walk.
• Avoid repetitive motions such as frequent bending when possible.
• Practice good posture to reduce pressure on joints.
• Make several trips and keep loads small when carrying groceries or other items.
• Keep regular appointments with your healthcare provider to stay involved in your treatment and discuss your symptoms.
• Consider joining a class that provides information on osteoarthritis and how to manage symptoms so you can stay active.
• Reach out to support groups, both online and in your community. You can get tips for coping with arthritis and living a healthy lifestyle.

Find Clinical Trials

 Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on osteoarthritis.

Find Treatment

Treating osteoarthritis works best as a team effort involving you and several types of healthcare professionals. Your care team may include:

• Rheumatologists, who specialize in arthritis and diseases of the bones, joints, and muscles
• Primary care doctors, such as a family physician or internal medicine specialist, who coordinate your care and treat other problems as they arise
• Orthopedic surgeons, who specialize in treatment and surgery for bone and joint diseases
• Physical therapists, who help improve joint function
• Occupational therapists, who teach ways to protect joints, reduce pain, and perform daily activities
• Dietitians, who teach about nutrition and maintaining a healthy weight
• Nurse educators, who help you understand your condition and start treatment plans
• Physiatrists (physical medicine and rehabilitation specialists), who supervise exercise programs
• Psychologists or social workers, who help with emotional and social challenges caused by medical conditions
• Chiropractors, who focus on the relationship between the body’s structure — mainly the spine — and its functioning

Community Support

The following organizations offer information and support for people with osteoarthritis:

• U.S. Food and Drug Administration
• Centers for Disease Control and Prevention, National Center for Health Statistics
• American Academy of Orthopaedic Surgeons
• American College of Rheumatology
• American Physical Therapy Association
• Arthritis Foundation
• National Spine Health Foundation
• Osteoarthritis Action Alliance

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research on osteoarthritis. Current studies are examining:

• The causes and development of osteoarthritis
• Different risk factors for the disease
• Treatment options, prevention, and diagnosis
• Imaging methods for cartilage and joints
• The underlying sources of osteoarthritis pain
• Human genetics of bone and cartilage and how they interact with the environment
• Biomarkers for osteoarthritis as potential indicators of disease onset and progression
• The effectiveness of weight loss and exercise in managing symptoms in people with knee osteoarthritis
• How different biological factors may influence pain relief in people with osteoarthritis
• Strategies for improving osteoarthritis care through clinical and community partnerships

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.