There are more than 100 kinds of arthritis, which literally means joint inflammation. According to the Centers for Disease Control and Prevention (CDC), about 50 million Americans are afflicted, and 27 million have osteoarthritis, by far the most common form, especially among older people.

1. Osteoarthritis
There are more than 100 kinds of arthritis, which literally means joint
inflammation. According to the Centers for Disease Control and Prevention (CDC),
about 50 million Americans are afflicted, and 27 million have osteoarthritis, by far
the most common form, especially among older people. Sometimes called
degenerative joint disease, osteoarthritis accounts for most of the hip and knee
replacement surgeries performed in the United States. As with other types of
arthritis, women are at higher risk than men for the condition.
Osteoarthritis affects structures throughout the joint. Among them the cartilage,
the slippery tissue that covers the ends of bones in a joint, is usually affected.
Healthy cartilage allows bones to glide over one another and absorbs energy from
the shock of physical movement. In osteoarthritis, the surface layer of cartilage
breaks down and wears away, which allows bones under the cartilage to rub
together. This causes bone remodeling and change in boney shape and loss of
motion of the joint. Over time, the joint loses its normal shape. Also, bone spurs—
small growths called osteophytes—may grow on the edges of the joint. By the
time a person has symptoms from osteoarthritis, it is no longer just a disease of
cartilage. Bone has changed, muscles across the joint have often weakened and
there is occasionally inflammation in the lining of the joint.
Unlike some other forms of arthritis, osteoarthritis only affects joints, not internal
organs. Rheumatoid arthritis—another common form of arthritis—affects other
parts of the body besides the joints. It causes inflammation and may make people
feel sick, tired and sometimes feverish, among other symptoms.
Some younger people get osteoarthritis from a joint injury, but osteoarthritis
most often occurs in people over 40. In fact, at least 80 percent of people over
age 55 have X-rayevidence of osteoarthritis in at least one joint, and
approximately one-third have symptoms of the disease. Since the number of
older Americans is increasing, so is the number of people with osteoarthritis.
Before age 55, more men have the condition (often the result of a sports or work
injury), while after age 55, osteoarthritis is more common in women.

2. Osteoarthritis affects each person differently. In some people, it progresses
quickly; in others, the symptoms develop slowly and may be stable for many
years. Researchers do not yet know what causes the disease, but they suspect a
combination of factors in the body and in the environment. Genetics, weight and
stresses on the joints from certain jobs, hobbies or other activities may affect the
disease and how a person reacts to it.
Usually, osteoarthritis develops slowly. Early on, joints may ache after physical
work or exercise. Osteoarthritis can occur in any joint but most often occurs at
the joints in the hands, hips and knees.
Hands: Osteoarthritis of the fingers is the one type of the disease that seems to
be predominantly hereditary. More women than men have it, and risk increases
aftermenopause. Small, bony knobs appear on the end joints of the fingers. They
are called Heberden’s nodes. Similar knobs (called Bouchard’s nodes) can appear
on the middle joints of the fingers. Fingers can become enlarged and gnarled and
may ache or be stiff and numb. The base of the thumb joint is also commonly
affected by osteoarthritis. This kind of osteoarthritis can be helped by
medications, splints or heat treatment.
Knees: The knees are among the body’s main weight-bearing joints. They are also
among the joints most commonly affected by osteoarthritis. An afflicted knee
may be stiff, swollen and painful, making it hard to walk, climb or get in and out of
chairs and bathtubs. If not treated, osteoarthritis in the knee can lead to
disability. However, even with treatment, osteoarthritis may progress.
Medications, losing weight, exercise and walking aids can reduce pain and
disability. In severe cases, knee replacement surgery may be required. Research
studies show that being overweightincreases the risk of developing osteoarthritis
of the knees and show that injuries to the knee are a major cause of disease.
Hips: Osteoarthritis in the hip can cause pain, stiffness and severe disability.
People most often feel the pain in their groin, front of thighs 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

3. pain and improve motion. A health care professional may recommend hip
replacement if the pain is severe and not helped by other treatments.
Researchers suspect that genes play a role in some cases of osteoarthritis. In one
rareform of disease starting as early as age 20, affected people may have a defect
in the gene that helps the body make collagen, the protein that makes up
cartilage. More commonly, minor genetic variations may increase the risk of
osteoarthritis. They may affect minor molecules in the joint, changing the
metabolism of joint structures, or they may change the shape of a joint during
growth, leaving slight defects in the way bones that come together in joints fit
together. This may cause cartilage to wear away more quickly than normal.
Double-jointedness, an inherited trait where the joints bend farther than usual,
may also increase risk for osteoarthritis.
Diagnosis
The warning signs of osteoarthritis include steady joint pain or intermittent pain
that usually worsens with activity, brief stiffness after getting out of bed, joint
swelling or tenderness in one or more joints and a crunching feeling or sound of
bone rubbing on bone.
No single test can diagnose osteoarthritis. Most health care professionals use a
combination of the following methods to diagnose the disease and rule out other
conditions:
Clinical history. The health care professional will begin by asking you to describe
your symptoms, and when and how the condition started. Be sure to provide an
accurate description of pain, such as what makes it worse or better, stiffness and
joint function and how they have changed over time. You should also share
information on other medical conditions and any medicines you are taking.
Physical examination. The health care professional will check your general health
and examine joints that bother you, as well as your reflexes and muscle strength.
He or she will observe your ability to walk, bend and carry out activities of daily
living.

4. X-rays and other imaging techniques. X-rays can show how much joint damage
has been done; they may show such things as cartilage loss, bone damage and
bone spurs. But there is often a big difference between the severity of
osteoarthritis that the X-ray shows and the degree of pain and disability the
patient has. In addition, X-rays may not show early osteoarthritis damage (before
much cartilage loss has taken place). Other types of imaging tests may also be
used to look for damage that cannot be seen on X-ray, such as magnetic
resonance imaging (MRI) or ultrasound.
Other tests. A health care professional may order blood tests to rule out other
possiblecauses of your arthritis. Another common test includes “joint aspiration,”
or “arthrocentesis,” during which fluid is drawn from the joint for examination.
The fluid can be examined to see if it contains the crystals that cause gout or
pseudogout or if it is moderately or severely inflamed, which suggests you have
rheumatoid arthritis.
It is usually 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 it may mask other conditions that are actually
responsible for symptoms. A health care professional will try to find out what is
causing the symptoms, ruling out other disorders and identifying conditions that
may make the symptoms worse.
Not everyone with osteoarthritis feels pain. In fact, about one-third of people for
whom X-rays show evidence of osteoarthritis report pain or other symptoms.
The most common way to measure pain is for a health care professional to ask
you about it. For example, you may be asked to describe the level of pain you feel
on a scale of one to 10. Use specific words to describe your pain-like aching,
burning, stinging or throbbing to better convey what is happening. It’s also
important to describe if and where the pain travels (for example, from the groin
down to the knee).
Since health care professionals rely on your description of pain to help guide
treatment, you may want to keep a pain diary to record your pain sensations. On

5. a daily basis, describe the situations that cause or alter the intensity of your pain,
the sensations and severity of your pain and your reactions to the pain. For
example: “On Monday night, sharp pains in my knees produced by housework
interfered with my sleep; on Tuesday morning, because of the pain, I had a hard
time getting out bed. However, I coped with the pain by taking my medication
and applying ice to my knees.” The diary will give your health care professional
some insight into your pain and may play a critical role in the management of
your disease.
Treatment
A successful treatment program for osteoarthritis may involve a combination of
therapies tailored to your needs, lifestyle and health. Work closely with your
health care provider to help create the most effective treatment for you.
In general, osteoarthritis treatment has three general goals:
 Control pain through drugs and other measures.
 Improve joint care through rest and exercise.
 Maintain an appropriate body weight and achieve a healthy lifestyle.
In addition to the guidance of your primary health care professional, you may
need care froma physicaltherapist, a rheumatologist (a physician who specializes
in diagnosing and treating disorders that affect the joints, muscles, tendons,
ligaments and bones) or a physiatrist (a physician who specializes in the diagnosis
and management of injuries and diseases causing pain, loss of function and
disability). Treatment plans often include the use of exercise, massage, heat,
relaxation techniques, splints and braces and local injections to relieve pain.
Osteoarthritis treatment plans also often include ways to manage pain and
improve function. Such plans can involve exercise, rest and joint care, pain relief,
weight control, medications, surgery and nontraditional treatments.
If you are diagnosed with osteoarthritis, you may be prescribed a variety of
medicines to eliminate or reduce pain and to improve functioning. Health care
professionals consider a number of factors when choosing medicines for their

6. patients with osteoarthritis. Two important factors are the nature of the pain and
a drug’s potential side effects. You must use medicines carefully, and tell your
health care professional about any changes that occur.
The following types of medicines are commonly used in treating osteoarthritis:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat
osteoarthritis. Patients can buy some NSAIDs over the counter (for example,
aspirin, ibuprofen and naproxen). Other NSAIDs areavailable by prescription only.
These drugs all reduce inflammation or swelling and relieve pain. However, each
NSAID is a different chemical and can have slightly different effects in the
body.NSAIDs can cause stomach irritation or affect kidney function and blood
pressure. Plus, there is the potential for cardiovascular events associated with the
use of NSAIDS. The longer you use NSAIDs, the more likely you are to have side
effects. Many other drugs cannot be taken with NSAIDs. NSAIDs are associated
with serious gastrointestinalproblems, including ulcers, bleeding and perforation.
They should be used with caution in people over 65 and in those with any history
of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency
and hypertension. It’s important to ask your health care professional for safety
information associated with pain relievers with your personal health history in
mind.
A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2),
which triggers pain and inflammation, while sparing an enzyme called COX-1,
which helps maintain the normal stomach lining. Celecoxib (Celebrex) is currently
the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart
attack and stroke; discuss theserisks with your health care professional. For more
information on the risks associated with Celebrex.
Recently, NSAIDs have become available in topical form in the United States. Such
preparations are much safer to use because lower levels of medication reach the
bloodstream, and they don’t pass through the stomach. They are less effective
than oral NSAIDs, however.

7. Acetaminophen (Tylenol). This analgesic and fever-reducer (antipyretic) is not an
NSAID and does not reduce inflammation. It is less likely to irritate the stomach
than NSAIDs. Its availability over the counter, low cost and mild side effects make
it the drug of choice for treating mild to moderate arthritis pain, but NSAIDS are
usually more effective for patients with moderate to severe pain. Long-term use
of acetaminophen taken multiple times daily may be associated with liver damage
or inflammation of the kidneys (nephritis). Patients with liver disease and heavy
alcohol drinkers should not use acetaminophen without first talking to a health
care professional.
Health care professionals may prescribe several other medications for
osteoarthritis. They include:
Tramadol hydrochloride (Ultram). Ultram is a prescription narcotic analgesic that
provides pain relief for short-term acute flare-ups of osteoarthritis with fewer
side effects than NSAIDs. Your health careprofessionalmay recommend tramadol
in combination with acetaminophen for maximum pain relief.
Rubs and sprays (for example, capsaicin cream) applied directly to the skin.
Mild narcotic medications (opioids), which, while very effective, are potentially
addictive and may have multiple side effects.
Corticosteroids. These powerful anti-inflammatory hormones are made naturally
in the body or produced synthetically. Corticosteroids are typically injected into
affected joints to relieve pain temporarily. This is a short-term measure.
Colchicine. This drug is often prescribed to treat crystalarthritis, which sometimes
coexists with osteoarthritis. Colchicine may help people who have crystal arthritis
(either pseudogout or gout), in addition to their osteoarthritis. People who have
kidney or liver diseasemay be unable to usecolchicines. Discuss benefits and risks
with your health care professional.
Medicines used to treat osteoarthritis may have side effects, so it is important to
learn about the drugs you are taking. Even nonprescription drugs should be
reviewed. Certain patients may be at greater risk for side effects, such as those

8. with a history of peptic ulcers or digestive tract bleeding, those taking oral
corticosteroids or anticoagulants (blood thinners), those who smoke and those
who consume alcohol. The risk of certain side effects in some osteoarthritis
medications may be reduced by taking the drug with food. Some patients should
avoid stomach irritants such as alcohol, tobacco and caffeine. Other medicines
may be taken to protect the stomach lining by coating the stomach or blocking
stomach acids. These measures help but are not always completely effective.
Other options for relieving the pain and damage caused by osteoarthritis include:
Viscosupplements. These medications use hyaluronic acid (or hyaluronate) to
replace the synovial fluid that helps lubricate the joints, which is lost in patients
with osteoarthritis. (Hyaluronic acid is one of the two natural lubricants in
synovial fluid.) It is approved by the U.S. Food and Drug Administration for the
treatment of knee pain in osteoarthritis patients who are unresponsive to
nonpharmacologic measures and analgesic medications and who have
significantly increased flares of inflammation or extensive inflammation. Even
though FDA approved, controversy remains over the effectiveness of hyaluronic
acid injections. The drugs, which include hyaluronan (Hyalgan) and hylan-GF-20
(Synvisc), are injected directly into the joint. These drugs are usually injected into
the knee, but their use in other joints is being studied. Injections are typically
given weekly over several weeks, and the pain relief may last for a few months.
Because it is made from rooster combs, people with sensitivity to birds, feathers
or eggs should not receive viscosupplements. Researchers are testing whether
hyaluronic acid can slow the progression of osteoarthritis.
Physical or occupational therapy. The goals of occupational and physical therapy
are to preserve the use of your joints, restore lost abilities, maintain your fitness,
help you adapt to new levels of activity and help you maintain the ability to
partake in the activities you enjoy. Occupational therapy can teach you how to
reduce the strain on your joints during daily activity, and physical therapy can
teach you exercises designed to preserve and strengthen your joints. Some of the
therapeutic methods available include restduring flare-ups; applying heat or cold;
exercise, including water exercises, strength exercises and recreational exercise;

9. specific exercise to help you prepare for or recover from surgery if surgery is
prescribed; joint protection activities and exercises; and assistive devices, such as
a bath stool in your shower or a shoe horn.
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