Osteoarthritis

In this Article (Index)

• What is Osteoarthritis?
• Overview of OA
• Symptoms and Signs of OA
• Causes and Risk factors
• Prevention
• Treating Osteoarthritis
• Lifestyle measures
• Medication
• Supportive Therapies
• Surgery
• Complmentary and Alternative Medicine

What is Osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis. It is a disease that affects the joints, and it is caused by inflammation.

Under normal conditions the tissue that cushions the bones at the joints, known as cartilage, is firm and allows the bones to move smoothly and acts as a damper, absorbing energy from the movement. But in OA, the cartilage degrades, and wears away so that the bones rub together causing swelling, stiffness and pain. The bones become weaker and the connective tissue holding the joint together also deteriorates together with the joint lining.

It can affect the joints of the hands, knees, hips and spine.

Overview of OA

This condition can limit the range of movement of the affected joints and limbs. It can appear in knees, hips, spine and hands. It affects more women than men.

Although it is common in older people (in their 50s and 60s) injury or overuse of a joint can cause OA at a younger age. Over 20 million Americans suffer from this condition.

There is no cure for osteoarthritis, however it does not always get worse over time. There are a number of treatments to help relieve its painful symptoms.

Diagnosis

The condition is diagnosed using several methods as there is no single test to detect OA. Your caregiver will detect the limited joint motion and swelling, and use an X-ray of the area to verify the bone wear and joint damage.

Symptoms and Signs of OA

The following are signs and symptoms of osteoarthritis:

• Joint pain. The aching may be intermittent worsening when the joint is in movement or constant.
• Swelling, tenderness, inflammation. The area can be warm to the touch.
• Limitied range of motion.
• Stiffness. After sitting or lying down for more than 15 minutes or when you wake up in the morning.
• Bumps appear on the finger joints (Herberden's nodes).

Causes and Risk factors

The cause of OA is usually unknown. Howoever, you will have a higher chance of getting OA if you have some of the following risk factors:

• It can be caused by injuries such as fractures or a torn anterior cruciate ligament or ACL, at the knee during sports like football, basketball, tennis or skiing.
• Wear and tear caused by physically demanding jobs that lead to an overuse of the joint: sports, construction, farming
• Lifestyle: being overweight, sedentary, poor diet.
• Genetics: the joint did not form correctly, or a family history of osteoarthritis.

Prevention

A healthy weight will limit the strain on the joints as they will bear less weight. A balanced and healthy diet with anti-inflammatory foods such as vegetables, fruits, legumes, oily fish, olive oil and whole grains will also contribute to weight loss and lower inflammation. Limiting the intake of red meat, unhealthy fats, added sugars and processed foods will reduce reduce inflammation and improve your overall health.

Exercise and physical activity to keep the joints flexible can also help to your weight goals.

Treating Osteoarthritis

The treatment for OA aims at relieving pain and improving joint mobility. Usually a combination of conventional, complementary and alternative medicine are used to manage OA. We list them below and will discuss them in the following sections:

• Lifestyle measures, weight loss and exercise.
• Medication, for pain management.
• Supportive Therapies, physiotherapy, hot & cold packs, devices.
• Surgery, when the other treatments are not effective.
• Complmentary and Alternative Medicine, diet, supplements, herbs, nutraceuticals, acupunture.

Lifestyle Measures

Exercise

Regardless of your age or fitness, exercise is probably the most important treatment for OA. The goal of physical activity is to improve your overwall fitness and strenghten your muscles and they will support your joints better. As a bounus it will also contribute towards losing weight and keeping it off.

Exercise will improve your posture, coordination, flexibility and also relieve stress.

Weight Loss

Excess weight is carried by the joints in your feet, ankles, knees, hips! So losing weight will relieve the strain on these joints and slow down the wearing that damages your joints.

Before losing weight or engaging in an exercise program, check with your caregiver on how to do so in a safe, slow yet steady way.

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Pain Relief Medication

Pinkillers are used in combination with other therapiess to control the pain caused by osteoarthritis.

There is a wide range of medicines from OTC (over the counter) drugs like paracetamol and acetaminophen (Tylenol) to Non-steroidal anti-inflammatory drugs (NSAIDs)

Acetaminophen has negative effects on the liver during long term use.

NSAIDs relieve pain and reduce inflammation and swelling. They work well but extended use can cause ulcers, bleeding and increase your risk of heart problems. Over-the-counter NSAIDs include: ibuprofen (Advil) and naproxen (Aleve).
NSAIDs can also be appplied as creams on the affected joints. Medicine has side effects so you should alway check with your healthcare provider before taking any.

Capsaicin cream is applied topically on the joints and it works by blocking the pain signals sent by the nerves in the inflammed area. It takes from 1 week to 1 month to be fully effective.

Steroid injections are another alternative when other treatments haven't worked.

Supportive Therapies

Complementing the other treatments, you can also try the following:

Hot and cold packs

Applying hot or cold packs to the joints can help ease the pain and OA symptoms.

Devices

These help you get around with less pain such as special insoles or shock-absorbing shoes, leg braces, a splint to support a joint and redistribute the weight, walking stick to support your weight. All mechanical aides should be custom-fitted by your doctor or occupational therapist.

Physiotherapy

Stiffness and pain can reduce the movement of a limb and cause loss of muscular mass. Physical therapy can help stretch and mobilize the muscles and keep the joints flexible and reduce pain.

Supervised exercise can also improve muscle strenght and joint motion. It may help avoid or delay the need for joint replacement surgery.

Surgery

Surgery is only required on very few occasions and it may help when other treatments have failed. It could imporve life quality but may not eliminate all symptoms and pain and stiffness may persist.

There are different types of surgery; arthroplasty or joint replacement removes an affected joint and replaces it with prosthetic one that can last for up to 20 years. It is used in knees and hip joints.
Resurfacing is used on the knees, and is a partial replacement surgery with cartilage repair that is less invasive than an arthroplasty. Arthroscopic surgery is used to trim torn and damaged cartilage and repair th e joint.

Joint fusing or arthrodesis consists on straightening the damaged joint, removing the cartilage and allowing the bones to mend together. The downside is that the joint will no longer be movable.

Osteotomy, is adding or removing bone at the knee that the load is distributed away from the damaged part to a healthy one, relieving the painful OA symptoms.

Complementary and alternative therapies

• Acupunture
• Hydrotherapy or spa therapy

There are several complementary or alternative therapies for OA.

Acupunture

A recent meta-analysis by Tian et al. (2022) reported that: "acupuncture had beneficial effect on knee osteoarthritis in reducing pain and improved patients function activities... this treatment can be recommended as a beneficial alternative therapy" (1).

Hydrotherapy, Balneotherapy or Spa Therapy

Balneotherapy is one of the oldest pain relief therapies for treating arthrities. It is simply bathing in thermal or natural mineral waters at spas to reduce the negative impact of OA's symptoms, easing pain, increasing muscular strength and joint motion.

There is still little evidence from clinical studies to support its use due to the lack of adequate randomized trials; most studies are based on subjectives measures of wellbeing instead of hard facts.
However, some studies have found that "balneotherapy has a beneficial effect on pain and quality of life for OA patients... balneotherapy is an appropriate treatment in case of multi-joint type OA with comorbidities.... [an] effective and safe, non-pharmacological therapy... but further multicentric studies are necesseray to prove its efficacy" (2).

How thermal waters act to improve OA symptoms is unclear perhaps it is a combination of thermal, chemical and mechanical effects: tempearature, buoyancy and water pressure could stimulate the muscles. Heat increases the output of some biochemcials in the body (adrenocorticotropic hormone, cortisol, prolactin, growth hormone, among others) and they have analgesic, immunosuppressive and anti-inflammatory effects (3).

Tai Chi

An ancient Chinese martial art with slow, precise, focused movements it is low impact and gentle. Clinical studies show it has benefits. Wang (2009) reported that " Tai Chi reduces pain and improves physical function, self-efficacy, depression and health-related quality of life for knee OA" (4).

Dietary Supplements and Nutrition

Diet and natural supplements are part of the complementary and alternative therapies.

Diet and Nutrition

A balanced and healthy diet can help reduce inflammation and lower body weight. A lower weight reduces the strain on the joints that the extra pounds.

A diet that includes vegetables, fruit, pulses, lean meats, fish, and healthy oils (like olive oil), includes probiotics to reinforce the gut microbiome, and avoids processed foods, unhealthy fats and alcohol can help reduce inflammation and provide other health benefits.

Don't forget to keep adequately hidrated by drinking plenty of fluids.

Combine this diet with the regular exercises mentioned further up and you will be able to lose weight.

Supplements

Supplements can be expensive and there is no strong evidence supporting their effectiveness as a treatment for OA.

These products have side effects for those taking blood thinners and it may interfere with some medications. Check with your doctor before taking any supplement, natural or botanical product.

• Glucosamine & chondroitin
• Omega-3 fatty acids
• Bromelian
• Turmeric
• Cat's claw
• Ginger
• Willow bark
• Capsaicin
• Vitamin D
• Collagen

Glucosamine & chondroitin

The clinical studies are ongoning, and the results of different studies differ or have conflicting results because chondroitin quality, concentration and origin is variable and sometimes it is used in combination with glucosamine which adds a confounding element to the studies' outcomes.

The largest clinical trial (5), the Glucosamine⁄Chondroitin Arthritis Intervention Trial (GAIT) of 2006 found some benefits in pain reduction among those patients with moderate-to-severe pain: "For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared with placebo, about 79% had a 20% or greater reduction in pain versus about 54% for placebo."

Omega-3 fatty acids

A scientific review conducted in 2022 (6) reported that the "evidence provides credible proof of human trials in the use of omega-3 PUFAs as a possible treatment option in OA, while human evidence shows that omega-3s may be efficacious but requires further research to determine optimal treatment protocols."

The most common types of omega-3 fatty acids are the plant-based ALA (alpha-linolenic acid), and the animal-based DHA (docosahexaenoic acid), and EPA (eicosapentaenoic acid). Fatty fish like salmon, anchovies or sardines and algal oil have DHA and EPA, walnuts, flax and chia seeds have ALA.

Bromelian

An enzyme obtained from pineapples has proven effective for treating OA, but further studies are required to evaluate its effects and dosage (15).

Herbal Nutriceuticals

These are plant-derived products that are available as teas, pills, extracts or tinctures. The fact that they are natural and botanical don't mean that they are harmless. They have adverse effects, and pregnant or nursing women, or those taking medications should consult with their physician before taking them.

Turmeric

Turmeric (Curcuma longa) has a long history in tradigtional medicine, it has bioactive curcuminoids that are antioxidants and anti-inflammatory.
Hewlings & Kalman, (2017) (7) reported a six-week-long double-blind trial involving 40 subjects with knee osteoarthritis. They found that those treated with 500 mg per day of a curcuminoid (plus 5 mg of piperine -an active component of black pepper) showed significant improvements when compared to the placebo group: less pain, better physical function scores, but not in the stiffness score.

Turmeric extracts and curcumin can be recommended for alleviating the symptoms of arthritis, especially osteoarthritis. Hewlings SJ, Kalman DS., (2017) (7)

Hewlings and Kalman also revealed that doses of 1,000 mg⁄day of curcumin reduced symptoms of arthritis such as inflammation and pain as effectively as ibuprofen or diclofenac sodium.

Another study (8) found that curcumin's efficacy in treating rheumatoid arthritis was similar to that of the drug phenylbutazone.

A study by Paultre et al., (2021) found that "Compared with placebo, there appears to be a benefit of turmeric on knee OA pain and function" (9).

Cat's claw

Cat's claw (Uncaria tomentosa) is an Amazonian vine that relieves pain associated with in osteoarthritis. Piscoya et al., (2001) reported that: "Pain associated with activity, medical and patient assessment scores were all significantly reduced, with benefits occurring within the first week of therapy. Knee pain at rest or at night, and knee circumference were not significantly reduced by cat's claw during this brief trial... Conclusion: Cat's claw is an effective treatment for osteoarthritis" (10).

Ginger

This oriental spice (Zingiber officinale) helps to reduce pain and disability when ingested according to a meta analysis by Bartels (2015): "Following ginger intake, a statistically significant pain reduction ... and a statistically significant reduction in disability ... were seen, both in favor of ginger" (11).

Willow bark

The bark of the willow tree (Salix alba) has been used for for thousands of years as a pain killer, anti-inflammatory, and to lower fever. In 1897, a scientist working for Bayer, Felix Hoffmann, searching for a medicine to ease his father's rheumatic pains selected salicylic acid, a chemical found in willow bark and managed to modify it so that it was safe to use, he discovered aspirin, acetylated salicylic acid.

Willow bark also contains bioactive plant chemicals such as polyphenols, and flavonoids that may also play prominent roles in its therapeutic actions.

Studies involving willow bark involve a small number of subjects and should be taken with caution as you can see below, they had mixed results.

These studies reported that the willow bark extract (WBE) group "received significantly less physical therapy and reported decreased pain" than the placebo group and that "the estimation of pain... decreased for the willow bark group, but not significantly" ... "the results showed a tendency of decreased pain scores in the willow bark-treated patients, but the change was not significant"... "The group treated with WBE reported a moderate relief with a 14% reduction in WOMAC [Western Ontario and McMaster Universities] score Osteoarthritis Index versus 2% increase in the placebo, thus a significant... reduction in pain compared with placebo" (12).

Capsaicin

The capsicum genus is native to the Americas and best known for their fruits: the spicy chili pepper and bell pepper. One of the capsicum species, Capsicum frutescens produces a substance that gives the hot, painful kick to chili peppers, capsaicin. This substance has an effect on neurochemicals that transmit pain to the brain causing relief after a few days of application: "topical NSAIDs and capsaicin in licensed doses may be equally effective for pain relief in OA" (13).

Vitamin D

You should get tested for vitamin D deficiency. Studies have suggested that vitamin D deficiency may increase the risk of OA. The conclusion was that "vitamin D supplementation may alleviate joint pain in OA patients with low vitamin D status (<50 nmol/L)" (13).

Collagen

A statistical analysis of randomized trials involving patients with osteoarthritis (OA) found that oral supplementation of "collagen is effective in improving OA symptoms (16).
Despite its anti-inflammatory properties, there is no definitive results showing that collagen may be effective as a treatment for rheumatoid arthritis.

Detailed Information on each type of Arthritis

We have written pages for each of the most common types of arthritis with in depth information on their symptoms, causes and treatment. Click below to learn all about them.