...less medical jargon in a 'Quick Glance' format!
Osteoarthritisis not a single disease but rather the end result of a variety of disorders leading to the structural or functional failure of 1 or more of your joints. This disease involves the entire joint including the nearby muscles, underlying bone, ligaments, joint lining, and the joint cover.
Limited joint motion
Tenderness and occasional swelling
With osteoarthritis, the articular cartilage that covers the ends of bones in the joints gradually wears away. Where there was once smooth articular cartilage that made the bones move easily against each other when the joint bent and straightened, there is now a frayed, rough surface. Joint motion along this exposed surface is painful.
This disease usually develops after many years of use. It affects people who are middle-aged or older. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint, and family history of osteoarthritis.
There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks. While medications and joint replacement surgery are key components of treatment for osteoarthritis, your doctor will likely recommend you try all other possible solutions before you consider those options. Eventually the pain may become severe so that medications and surgery may be necessary.
. . . Initial treatment options for mild osteoarthritis
For mild pain that is bothersome, but not enough to have a great impact on your daily activities, your doctor may recommend that you:
Rest If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively. Try taking a 10-minute break every hour.
Exercise With your doctor's approval, get regular exercise when you feel up to it. Stick to gentle exercises, such as walking, biking or swimming. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Avoid exercising tender, injured or swollen joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it.
Lose weight Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Aim to lose 1 or 2 pounds a week, at most. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
Use heat and cold to manage pain Both heat and cold can relieve pain in your joint. Heat also relieves stiffness and cold can relieve muscle spasms. Soothe your painful joint with heat using a heating pad, hot water bottle or warm bath. Heat should be warm, not hot. Apply heat for 20 minutes several times a day. Cool the pain in your joint with cold treatments, such as with ice packs. You can use cold treatments several times a day, but don't use cold treatments if you have poor circulation or numbness.
Work with a physical therapist Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise plan that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.
Find ways to avoid stressing your joints Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.
Apply over-the-counter pain creams Creams and gels available at the drugstore may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Read the label so you know what you're using. Pain creams work best on joints that are close the surface of your skin, such as your knees and fingers.
Try braces or shoe inserts Consider trying special splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.
Take a chronic pain class The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips for reducing joint pain or coping with your pain.
. . . Treatment options for moderate osteoarthritis
Pain that persists despite initial treatment may require medications in addition to initial treatment options. Don't assume that taking a medication is all you need. In order to get the most from your treatment, continue exercising when possible and resting when you need to. If you're overweight, continue working to lose weight.
Medications that may be useful for moderate arthritis include:
Acetaminophen Acetaminophen (Tylenol, others) can relieve pain, but doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask your doctor for guidance on limiting or abstaining from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you're taking it.
NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.
Tramadol (Ultram) is a centrally acting analgesic that's available by prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects - such as stomach ulcers and bleeding - than those of NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in combination with acetaminophen to increase pain relief.
. . . Treatment options for severe osteoarthritis
If you've tried other treatments but are still experiencing severe pain and disability, you and your doctor can discuss other treatments including:
Stronger painkillers Prescription pain pills, such as codeine and propoxyphene (Darvon), may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
Cortisone shots Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.
Visco-supplementation Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid. Visco-supplementation is only approved for knee osteoarthritis, though researchers are studying its use in other joints. Injections are typically given weekly over several weeks. Pain relief may last for a few months. Possible risks include infection, swelling and joint pain. People who are sensitive to birds, feathers or eggs shouldn't undergo visco-supplementation treatments.
. . . Surgery for osteoarthritis
Surgery is generally reserved for severe cases that are not relieved by other treatments. You may consider surgery if your osteoarthritis makes it very difficult to go about your daily tasks. Surgical treatments include:
Joint replacement In joint replacement surgery, your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. How long your new joint will last depends on how you use it. Some knee and hip joints can last 20 years. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it can also improve appearance and comfort and may improve your joint's mobility. Joint replacement surgery carries a small risk of infection and bleeding. Artificial joints can wear or come loose, and may need to eventually be replaced.
Cleaning up the area around the joint (debridement) Your surgeon may recommend removing loose pieces of cartilage and bone from around your joint to relieve your pain. Debridement is most useful if you're experiencing a locking sensation from a torn cartilage or loose debris in your knee joint. Debridement is typically done arthroscopically, meaning only small incisions are made in your body. A tiny video camera is inserted through the incision to allow your surgeon to see inside your joint. The surgeon uses special surgical tools to clean out any debris pieces from your joint.
Realigning bones Surgery to realign bones may relieve pain. These types of procedures are typically used when joint replacement surgery isn't an option, such as in younger people with osteoarthritis. During a procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by transferring the force of the joint away from the worn-out part of the knee.
Fusing bones Surgeons also can permanently fuse bones in a joint to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility. Arthrodesis may be an option if you experience severe pain in your joint, but can't undergo joint replacement surgery.