Causes
OA is primarily caused by wear and tear on the joints over time. However, several factors can increase the risk of developing OA:- Age: The risk of OA increases with age as cartilage naturally breaks down over the years.
- Genetics: A family history of OA may increase your likelihood of developing the condition.
- Obesity: Excess weight puts additional stress on weight-bearing joints like the hips and knees, accelerating cartilage breakdown.
- Joint injury: Previous injuries to a joint, such as fractures or ligament tears, can increase the risk of OA later in life.
- Repetitive stress: Occupations or activities that involve repetitive joint motion can contribute to OA.
- Bone deformities: Congenital or acquired bone deformities can alter joint mechanics and increase the risk of OA.
- Sex: Women are more likely to develop OA than men, especially after age 50.
Symptoms
OA symptoms typically develop slowly and worsen over time. They can vary in severity, and may include:- Pain: Joint pain that worsens with activity and improves with rest.
- Stiffness: Joint stiffness, especially in the morning or after periods of inactivity.
- Tenderness: The joint may be tender to the touch.
- Reduced range of motion: Difficulty moving the joint through its full range of motion.
- Grating sensation: A grinding or grating sensation when the joint is moved.
- Bone spurs: Hard lumps or bumps may form around the affected joint.
- Swelling: Inflammation in the joint can cause it to swell.
Diagnosis
Diagnosing OA typically involves a combination of:- Medical history: The doctor will ask about your symptoms, their onset, and any factors that may be contributing to your joint pain.
- Physical examination: The doctor will examine the affected joint, checking for tenderness, swelling, redness, and range of motion.
- Imaging tests:
- X-rays: Can show cartilage loss, bone spurs, and joint space narrowing.
- MRI: May be used to provide more detailed images of cartilage and soft tissues, but is not always necessary for OA diagnosis.
- Blood tests: Generally not used to diagnose OA, but may be ordered to rule out other types of arthritis, such as rheumatoid arthritis.
- Joint fluid analysis: In some cases, fluid may be drawn from the joint to check for inflammation and rule out infection or other conditions.
Treatment
There is no cure for OA, but treatment focuses on managing pain, improving joint function, and slowing disease progression. Treatment options include:- Lifestyle modifications:
- Weight management: Losing excess weight can reduce stress on weight-bearing joints.
- Exercise: Regular low-impact exercise, such as walking, swimming, or cycling, can strengthen muscles around the joint and improve its function.
- Rest and joint care: Avoiding activities that aggravate joint pain and using supportive devices like braces or splints.
- Pain relievers:
- Over-the-counter pain relievers: Medications like acetaminophen, ibuprofen, or naproxen can help manage mild to moderate pain.
- Prescription pain relievers: Stronger pain relievers, such as tramadol or opioids, may be used for more severe pain, but carry a risk of side effects and dependence.
- Topical pain relievers: Creams, gels, or patches containing medications like NSAIDs or capsaicin can be applied to the skin over the affected joint.
- Anti-inflammatory medications:
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce both pain and inflammation. They are available in oral and topical forms.
- Corticosteroids: Oral or injected corticosteroids can reduce inflammation and pain, but long-term use can have significant side effects.
- Injections:
- Corticosteroid injections: Injections of corticosteroids into the joint can provide temporary pain relief and reduce inflammation.
- Hyaluronic acid injections: Injections of hyaluronic acid into the joint may provide some pain relief and improve joint function by lubricating the joint.
- Physical therapy: A physical therapist can teach exercises to strengthen muscles, improve range of motion, and reduce pain.
- Occupational therapy: An occupational therapist can help you find ways to perform daily activities with less joint stress.
- Assistive devices: Canes, walkers, braces, and shoe inserts can help support joints and reduce pain.
- Surgery: If other treatments are not effective, surgery may be an option:
- Joint replacement: Damaged joints are replaced with artificial ones (e.g., hip replacement, knee replacement).
- Arthroscopy: A minimally invasive procedure to repair or remove damaged cartilage.
- Osteotomy: A procedure to realign a bone to reduce stress on the joint.
- Complementary and alternative therapies: Some people find relief with therapies like acupuncture, massage, or supplements such as glucosamine and chondroitin. However, the evidence supporting these treatments is mixed.
What Actually Helps Osteoarthritis Pain
Osteoarthritis treatment is often approached backward: medication first, exercise as an afterthought, and surgery as the assumed destination. The evidence points the other way, and the order matters for how much pain people live with in the meantime.
Exercise is the treatment with the best evidence
Strengthening the muscles around a joint, particularly the thigh muscles for knee osteoarthritis, reduces pain as much as medication does and keeps working for as long as it is continued. Walking, cycling, water exercise, and tai chi all help, and some discomfort during exercise is acceptable as long as it settles within a day. A physical therapist who tailors the program is the highest-value referral in osteoarthritis care; our knee osteoarthritis without surgery article details what a good program includes.
Weight changes joint load more than anything else
Each pound of body weight puts roughly four pounds of force through the knee with every step, so a 10 percent weight loss produces a meaningful and lasting reduction in pain. In people with obesity, semaglutide has now been shown to reduce knee osteoarthritis pain substantially alongside the weight it removes.
Medication in the right order
A topical NSAID such as diclofenac gel is the first drug for knee and hand osteoarthritis, because it works nearly as well as tablets with a fraction of the systemic risk. Oral NSAIDs such as naproxen or meloxicam are effective but are used at the lowest dose for the shortest time, with care in kidney disease, heart disease, and anyone on a blood thinner. Acetaminophen helps modestly, duloxetine helps chronic pain in some people, and opioids are avoided because they work poorly for osteoarthritis and carry real harm.
Injections and supplements, honestly assessed
A corticosteroid injection reliably gives several weeks of relief and is useful for a flare or an event, but repeated injections are limited to three or four a year because of possible cartilage effects. Hyaluronic acid injections have mixed evidence, platelet-rich plasma remains unproven, and glucosamine and chondroitin have not shown consistent benefit in well-conducted trials.
When joint replacement is the right call
The decision rests on pain that limits daily life and sleep despite the measures above, not on how bad the X-ray looks; many severe-looking joints cause little trouble and some mild-looking ones cause a great deal. Outcomes are good, and delaying while function declines makes recovery harder. Pain with morning stiffness lasting over an hour, or in the small joints of the hands with swelling, raises the possibility of rheumatoid arthritis and is evaluated differently. Our musculoskeletal team coordinates therapy, injections, and surgical referral, and the arthritis and humidity article covers the local weather question. The NIAMS and the American College of Rheumatology publish patient guidance on treatment.
If joint pain is limiting how far you walk or how well you sleep, schedule a visit; the first step is usually a program, not a procedure.