Discuss all medical advice, diagnosis, and treatment with your healthcare provider.

The Basics

Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritic conditions, osteoarthritis is the most common, affecting over 20 million people in the US. Osteoarthritis occurs more frequently as we age. By age 55, about 80% of people show X-ray evidence of osteoarthritis. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. In the US, all races appear equally affected. Overseas, a higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians, and Southern Chinese have lower rates of the disease.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

Causes of osteoarthritis

Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Repetitive use of the joints over the years irritates and inflames the cartilage, causing joint pain and swelling. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs or osteophytes) to form around the joints. Osteoarthritis occasionally can be found in multiple members of the same family, implying an inherited (genetic) basis for this condition.

Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage. Being overweight is a strong factor for osteoathritis both of the hips and knees. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players. Interestingly, recent studies have not found an increased risk of osteoarthritis in long-distance runners.

Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.

Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth. At any age, quadriceps weakness is also a risk factor.

Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

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Symptoms of osteoarthritis

Osteoarthritis is a disease of the joints. Unlike many other forms of arthritis that are systemic illnesses, such as rheumatoid arthritis and systemic lupus, osteoarthritis does not affect other organs of the body. The most common symptom of osteoarthritis is pain in the affected joint(s) after repetitive use. Joint pain is usually worse later in the day. There can be swelling, warmth, and creaking (or crepitus) of the affected joints. Pain and stiffness of the joints can also occur after long periods of inactivity, for example, sitting in a theater. In severe osteoarthritis, a complete loss of cartilage cushion causes friction between bones, causing pain at rest or pain with limited motion.

Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms. Others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays. Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis of the hands and knees to have years of pain-free intervals between symptoms.

Osteoarthritis of the knees is often associated with obesity or a history of repeated injury and/or joint surgery. Progressive cartilage degeneration of the knee joints can lead to deformity and outward curvature of the knees referred to as "bowlegged." Patients with osteoarthritis of the weight-bearing joints (like the knees) can develop a limp. The limping can worsen as more cartilage degenerates. In some patients, the pain, limping, and joint dysfunction may not respond to medications or other conservative measures. Therefore, severe osteoarthritis of the knees is one of the most common reasons for total knee replacement surgical procedures in the US.

Osteoarthritis of the spine causes pain in the neck or low back. Bony spurs that form along the arthritic spine can irritate spinal nerves, causing severe pain, numbness, and tingling of the affected parts of the body.

Osteoarthritis causes the formation of hard, bony enlargements of the small joints of the fingers. Classic bony enlargement of the small joint at the end of the fingers is called a Heberden's node, named after a very famous British doctor. The bony deformity is a result of the bone spurs from the osteoarthritis in that joint. Another common bony knob (node) occurs at the middle joint of the fingers in many patients with osteoarthritis and is called a Bouchard's node. Bouchard was a famous French doctor who also studied arthritis patients in the late 1800s. Heberden's and Bouchard's nodes may not be painful, but they are often associated with limitation of motion of the joint. The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis. Osteoarthritis of the joint at the base of the big toes leads to the formation of a bunion. Osteoarthritis of the fingers and toes may have a genetic basis and can be found in numerous women members of some families.

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Diagnosis of osteoarthritis

There is no blood test for the diagnosis of osteoarthritis. If your health professional feels it is necessary, blood tests can be performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritic conditions that can mimic osteoarthritis.

X-rays of the affected joints can suggest osteoarthritis. The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation. Simple X-ray testing can be very helpful to exclude other causes of pain in a particular joint as well as assist in the decision making as to when joint surgery should be considered (usually in advanced stages).

Arthrocentesis is often performed in the doctor's office. During arthrocentesis, a sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection, and other causes of arthritis. Removal of joint fluid and injection of corticosteroids into the joints during arthrocentesis can help relieve pain, swelling, and inflammation.

Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope. If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis. Bony enlargement of the joints from spur formations is characteristic of osteoarthritis. Therefore, Heberden's nodes, Bouchard's nodes, and bunions of the feet can help the doctor make a diagnosis of osteoarthritis. In osteoarthritis there is a specific pattern of joints that are typically affected. Osteoarthritis usually involves the hands, toes (especially the big toe), knees, hips, lower back, and neck.

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Women and osteoarthritis

Osteoarthritis affects an estimated 20.7 million Americans, mostly after age 55, the majority of whom are women.


Although osteoarthritis is a degenerative disease that primarily affects women, prior to age 50, the prevalence of osteoarthritis in most joints is higher in men. However, after age 50, more women than men are affected by arthritis of the hand, foot, and knee.

In an 8-year follow-up study on knee osteoarthritis in the elderly, the incidence of disease was 1.7 times higher in women than in men, and progression of the disease occurred slightly more often in women, but rates did not vary by age.

The role of estrogen in osteoarthritis is unclear. Elevated levels of estrogen have been found in arthritic cartilage, suggesting that estrogen is important in the development of arthritis in women. At the same time, the high incidence of osteoarthritis in women just after menopause has suggested that estrogen deficiency plays a role in causing disease. More research is needed on the role that estrogen may play in the incidence of osteoarthritis.

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Ask Your Healthcare Provider

Treatment

Although osteoarthritis cannot be cured, there are many treatment approaches available and these are essentially aimed at controlling pain, reducing swelling, improving function, minimizing disability, and therefore improving overall wellbeing and quality of life. If you find a treatment approach that works well for you, there is no reason why you can't live a relatively normal life with osteoarthritis.

It can be stressful living with osteoarthritis, especially if it limits your activities and causes you distressing pain. When people have severe symptoms they may need to rely on others for help with certain tasks and this dependency can also be stressful. It is reassuring to know that there are many different options available and, of course, your healthcare professional can be a source of psychological support to help you cope with your condition.

Osteoarthritis develops with age and is caused by multiple factors. Therefore, it is difficult to say that any one measure will be successful in preventing or treating this condition. However, there are certain factors which can be modified to reduce the risk of osteoarthritis.

Your healthcare provider can help you form a treatment plan for your osteoarthritis. It is important to discuss with him or her the benefits and risks of different treatments as well as other factors such as cost and insurance.

Prevention

The risk factors for developing osteoarthritis include those that you can and cannot modify. Keep in mind that some of the things you can do to reduce your risk may apply to some joints and not others, for example reducing repetitive trauma to joints can protect against knee and hand osteoarthritis more than it can help prevent osteoarthritis of the hip.

Here is a summary of these risk factors:

Risk factors you can modify	Risk factors you can't modify
Being overweight	Genes
Level of physical activity	Family history
Types of exercise and sports you choose (repetitive and high-impact exercise can put you at risk)	Age
Occupation or job (may be putting excess stress on certain joints)	Gender (females are at a higher risk)
Muscle weakness, such as weakness of the quadriceps muscles	Other medical conditions that predispose to osteoarthritis like inflammatory joint disease and diabetes
Overall risk that you have of injuring yourself	Whether you have any abnormalities of joint alignment, for example, knock-knees or excessive ligament laxity

Listed are some practical steps that may help you modify some of your risk factors to reduce your risk of developing osteoarthritis.

• Maintain a normal body weight. Being overweight is probably the strongest modifiable risk factor for developing osteoarthritis. The more you weigh, the more stress you are putting on your joints, especially your hips, knees, back, and feet.


• Exercise your body. Exercise protects joints by strengthening the muscles around them. Strong quadriceps muscles will help protect against knee osteoarthritis. Make sure you stick to low-impact exercise as much as possible.


• Be careful when lifting and carrying to avoid injury and strain on your joints. If necessary, ask someone to help you when moving heavy items.


• During periods of intense activity, get plenty of rest so you can balance the strain on your joints with recovery and healing. Repetitive stress on joints for long periods of time can accelerate the wear and tear that may contribute to the development of osteoarthritis.


• Don't ignore symptoms of joint pain as this may indicate you have put excess stress on your joints.


• Warm up and stretch properly before intense physical exercise. It may help reduce the risk of injury to your joints.


• Try to avoid certain repetitive movements such as repetitive knee bending.


• Wear proper safety equipment, such as wrist pads when you are playing sports, to avoid injury

Accepted Treatments

Accepted treatment for osteoarthritis varies from over-the-counter products to prescription medications to physical therapies. A combination of these approaches is usually the most effective approach for the majority of people; however, this will depend on certain factors including your treatment goals.

The treatment goals of osteoarthritis will vary from individual to individual depending on various factors including:

• The severity of your symptoms, the amount of pain
• How well you are able to move your affected joints
• How well you can function in your day-to-day activities
• What kind of work you do (your job or occupation)
• The specific joints affected by arthritis
• Whether you have any other coexisting medical conditions
• Your thoughts and perspectives on different types of treatment
• How well your symptoms respond to different types of treatment
• Whether you experience side effects from some treatments
• Cost and insurance issues

Your healthcare provider will discuss options, and together you can decide what treatment is right for you. It is important to have an open mind to different treatment approaches, as it is often a process of trial and assessment before finding the best and most effective treatment.

Lifestyle Options

Risk and benefit should be assessed prior to selecting any treatment for a condition or disease. As the first approach to treatment, experts recommend the use of nonmedication measures, such as lifestyle changes, to control symptoms. Medication can be provided if nonmedication measures alone are not meeting treatment goals.
The following nonmedication based treatments have been shown in research studies to be beneficial in reducing the symptoms of osteoarthritis:

• Exercise programs
  
  Regular exercise is extremely important to improving your osteoarthritis and your overall health. Exercise usually does not aggravate osteoarthritis when performed at levels that do not cause joint pain.
  
  Exercise programs can be designed for each individual with the help of a healthcare professional, such as a physical therapist. An exercise program means that you will be given a stepwise exercise plan to adhere to over a period of time. It is important that the program be realistic and based on your individual goals. Before you start any exercise program, you should be assessed by a healthcare professional to determine the severity of your osteoarthritis and to make sure that you don't have other medical problems, such as a heart condition, that may be adversely affected.
  
  Unlike running, low-impact exercises such as walking, swimming, bicycling, and Tai Chi are ideal as they do not cause excess strain on healthy joints. Hydrotherapy is a form of exercise in water that is also recommended. Warming up and stretching are very important elements of any exercise program.
  
  Exercise enhances flexibility, strengthens muscles, and improves overall fitness, all of which can help reduce pain and improve functioning in people with osteoarthritis. Other benefits of exercise include enhanced feelings of wellbeing, and reduced levels of stress and symptoms of depression.
  Applying local heat before and cold packs after exercise can also help relieve pain and inflammation of a painful joint like the knee, wrist, ankle, or shoulder.

• Weight loss
  
  Weight loss can reduce osteoarthritis symptoms. Loosing 1 pound of weight will lead to a 4-fold reduction of stress on knee joints, and a loss of 10 pounds translates into a 40-fold reduction of stress on the knees. The large weight-bearing joints of the hips will also benefit from weight loss.
  
  Your healthcare professional will be able to advise you on how you can best go about losing weight; this will usually involve a combination of a tailored diet and an exercise program.

• Orthoses
  
  Orthoses are devices that you can wear to help your joints function better and reduce symptoms of pain. Examples include shoe inserts and leg splints.

• Aids
  
  There are various devices that can be used to help you perform everyday activities, including walking and bathing, such as canes, walkers, and bars for the bath tub. Your healthcare professional can refer you to an occupational therapist to determine aids that are available to improve your everyday life.

• Transcutaneous electrical nerve stimulation
  
  This is a machine that sends a minor electrical current through your skin to alter the nerves that are contributing to the joint pain of osteoarthritis. This approach to pain relief may not work for everyone, however, it may be worth trying as the side effects are limited.

• Dietary supplements
  
  Dietary supplements are available in pharmacies and health food stores without a prescription, although there is no certainty of the purity of the products or the amount of active ingredients, because they are not monitored by the FDA.
  
  Glucosamine and chondroitin, which can be used in combination, are dietary supplements that have been researched for the treatment of osteoarthritis and may be useful in relieving pain. There is also a possibility that glucosamine used long-term may slow the progression of joint damage in osteoarthritis. You should not take glucosamine if you are allergic to shellfish.
  
  Another dietary supplement that may be useful for reducing osteoarthritis symptoms is S-adenosyl-L-methionine (SAMe); however, more research is needed to determine the effects of this supplement.
  
  Fish oil supplements have been shown to have some anti-inflammatory properties; eating more fish and/or taking fish oil (omega 3) capsules can reduce the inflammation of arthritis in some cases. It is an area that needs more research.
  
  One scientific trial found that avacado-soy unsaponifiables (a combination of one-third avocado oil extract and two-thirds soybean oil extract) can help patients with osteoarthritis, providing both pain relief and improvements in movement. This is another area that needs further research.

• Massage
  
  Massage can reduce pain and stiffness in the body, improving a person's overall functioning for a short period of time.

• Acupuncture
  
  Acupuncture is an ancient Chinese technique that involves using fine needles to place pressure on points on the skin. These pressure points represent channels where energy flows and are known as meridians of energy. The goal of acupuncture is to correct imbalances of energy that are contributing to pain. Acupuncture is a common technique in the US for relieving pain.
  
  Many people find their neck and back pain is helped with complementary and alternative treatments, such as massage, acupuncture, and relaxation techniques.

• Physical therapy
  
  Physical therapists can provide support devices, such as splints, canes, walkers, and braces. These devices can be helpful in reducing stress on the joints and therefore help with movement. Your healthcare professional can refer you to a physical therapist.

• Occupational therapy
  
  Occupational therapists can assess daily activities and determine additional devices that may help patients at work or home. Your healthcare professional can refer you to an occupational therapist.

• Counseling
  
  Living with the pain and disability of osteoarthritis can be stressful. Sometimes the experience of arthritic pain is heightened by other stresses in a person's life. The chronic pain, use of painkillers, dependency on others, and limitation of activities can also be depression.cfm?portalid=0&layoutID=0" target="blank_">depressing for many people with osteoarthritis. Seeking counseling to help you cope with your illness is beneficial and may help you manage your condition over time.

Mind-body approaches such as cognitive-behavioral therapy can sometimes be very effective as added therapy in the pain management of osteoarthritis.

Medication

Medication is available to help reduce the pain of osteoarthritis and improve functioning. Appropriate medications are recommended as an addition to the lifestyle options described above and should not be used before trying other approaches first.

There are many different types of medication available for the treatment of osteoarthritis, and your healthcare professional will be able to advise you. At the end of this section, there is a description of how to take these medications and precautions you should know.

The main groups of medication used in the treatment of osteoarthritis are

• Painkiller tablets for mild pain
  
  • Acetaminophen (paracetamol)
    Tylenol
    Anacin-3
    Panadal
    Phenaphen
    
• Painkiller and anti-inflammatory medication (nonsteroidal anti-inflammatory drugs) for mild, moderate, and severe pain
  
  • Traditional nonsteroidal anti-inflammatory drugs
    
    Over-the-counter tablets
    Aspirin
    Ibuprofen (Advil, Nuprin, Motrin, Rufen)
    Naproxen (Aleve)
    Ketoprofen (Actron, Orudis KT)
    
    Prescription tablets
    Naproxen (Naprosyn, Anaprox)
    Etodolac (Lodine)
    Piroxicam (Feldene)
    Sulindac (Clinoril)
    Flurbiprofen (Ansaid)
    Diclofenac (Voltaren)
    Tolmetin (Tolectin)
    Ketoprofen (Orudis, Oruvail)
    Nabumetone (Relafen)
    Dexibuprofen (Seractil)
    Indomethacin (Indocin)
    Meloxicam (Mobic)
  
  
  • COX-2 inhibitors
    
    Celecoxib (Celebrex)
    
    The FDA has withdrawn rofecoxib (Vioxx), and valdecoxib (Bextra) was withdrawn from the market by Pfizer, Inc, the manufacture.
    Nonsteroidal anti-inflammatory drugs (NSAIDs) usually need to be taken for 2 to 4 weeks before their true effectiveness is known and should be taken at the lowest dose to both relieve your symptoms and minimize the risk of side effects.
    
    All nonsteroidal anti-inflammatory drugs carry the risk of gastrointestinal side effects, including bleeding from the stomach or intestines. Your healthcare provider can assess whether you are at high risk of this side effect.
    
    When choosing to take nonsteroidal anti-inflammatory drugs, particular caution should be exercised by people with the following:
    
    
    • Cardiovascular disease
    • Ulcer of the stomach or intestines
    • Bleeding in the esophagus, stomach, or intestines
    • Age over 65 years
    • Kidney disease
    • High blood pressure
    • Use of diuretics, angiotensin-converting enzyme (ACE) inhibitors, aspirin, steroids, or anticoagulants such as (Coumadin^®)
    • Allergy to aspirin
    COX-2 inhibitors are thought to be as effective as traditional nonsteroidal anti-inflammatory drugs, however, research shows that they may be less likely to cause gastrointestinal bleeding. The risk of gastrointestinal bleeding may be reduced by taking an anti-ulcer medication at the same time that a nonsteroidal anti-inflammatory medication is taken or by taking a cox-2 inhibitor instead. Examples of anti-ulcer medications include famotidine (Pepcid^®), omeprazole (Prilosec^®), lansoprazole (Prevacid^®) and misoprostol (Cytotec^®).
    


• Painkiller and anti-inflammatory injections for moderate-to-severe symptoms
  
  • Intra-articular glucocorticoids and other injectable treatments
    
    Hyaluronic acid
    Sodium hyalurante (Hyalgan^®)
    Sodium hyalurante (Supartz^®)
    Sodium hyalurante (Nuflexxa^®)
    Hylan G-F (Synvisc^®)
    
    Human joints contain hyaluronic acid in the fluid between the surfaces of the joints and this helps to create joint lubrication, which is necessary for ongoing movement of joints. Injections of synthetic hyaluronic acid can be injected into joints to help relieve symptoms of osteoarthritis including pain and impaired joint movement.
    
    Corticosteroids
    Triamcinolone acetonide (Kenalog^®-40)
    Triamcinolone hexacetonide (Aristospan^®)
    Microcrystalline methylprednisolone. (Depo-medrol^®)
    Betamethasone acetate (Celestone™)
    
    Corticosteroids can be injected into osteoarthritis joints to reduce inflammation, if other treatments such as oral anti-inflammatory tablets (traditional nonsteroidal anti-inflammatory drugs or cox-2 inhibitors) are causing side effects. These injections are very effective at improving pain and functioning of a joint for several weeks or a few months.
    
    Joint injections can cause damage in large joints if they are used too often, so it is best to limit their use to 3 or 4 times per year. The main side effects are flare-ups in pain after injection, bleeding from the injection site, and the risk of introducing infection into the joint.
    
• Painkiller tablets for moderate-to-severe pain
  
  • Opiods or narcotics
    
    Codeine (often combined with Tylenol, called Tylenol with codeine)
    Oxycodone (Percodan, Percocet, Roxicodone, Oxycontin, OxyIR, Percolone)
    Hydrocodone (Vicodin, Lorcet, Lortab, Norco)
    Oxymorphone (Numorphan^®)
    
    Narcotics are medications that treat moderate and severe pain. These medications carry the risk of physical dependence and psychological addiction and have other side effects such as constipation, confusion, and drowsiness, thus they should be avoided for long-term use and used only to treat intermittent severe pain that is not responding to other medications.
  
  
  • Tramadol (Ultram^®)
    
    This medication is used to relieve moderate-to-severe pain if anti-inflammatory drugs are not working or have intolerable side effects. It can be used instead of or in combination with anti-inflammatory drugs and is especially effective with acetaminophen.
    
    This is a pain reliever that can be used instead of narcotics because it works in a similar way to reduce pain but is not as addictive. Side effects include nausea and itching.
    
• Others
  
  • Capsaicin (Zostrix^®, Arthricare^®)
    
    Capsaicin comes from hot red peppers and is available as a skin cream to be applied topically. Always wear gloves when applying capsaicin.

How to take medications for osteoarthritis

Some medications for osteoathritis are available over-the-counter and some are available by prescription only. Even if you take medication that is sold over-the-counter and without a prescription, you should discuss the treatment with your healthcare professional.

As mentioned previously, deciding on which treatment is right for you involves weighing the benefit and safety (or side effects) of each. Some people may not be able to take one or more of these medications because of other preexisting medical problems. However, even if there is a medication you cannot use, there are a variety of other medications available; you can discuss with your healthcare professional which medication is safe for you.

For mild pain that is not controlled adequately with nonmedication-based therapies like exercise or physical therapy, it might be helpful to take a course of acetaminophen under the guidance of your healthcare professional. If you suffer from liver or renal disease or if you drink alcohol excessively, you should discuss this with your healthcare professional as severe side effects may result with acetaminophen.

For pain that is more severe, or for pain not controlled by acetaminophen and nonmedication-based therapies, it may be worth trying a course of traditional nonsteroidal anti-inflammatory drugs or a cox-2 inhibitor. These medications can sometimes have side effects that affect the stomach and intestines, although the risk of this may be lower with cox-2 inhibitors than with traditional nonsteroidal anti-inflammatory drugs. If you are over age 65, have a previous history of gastrointestinal problems (such as ulcers or bleeding), or take other medications such as steroids (glucocorticoids) or anti-coagulants (medications that thin the blood such as aspirin or warfarin) then you have to be especially cautious when taking these medications. You should discuss this with your healthcare professional who will be able to advise you on the risk of serious side effects, such as gastrointestinal bleeding. If you are taking one of these medications and experience any abnormal gastrointestinal symptoms like stomach discomfort or nausea, even if minor, you should stop taking the medication and contact your healthcare professional immediately.

Traditional nonsteroidal anti-inflammatory drugs and cox-2 inhibitors can also have side effects involving the heart, blood pressure, and kidneys—although this is usually more of a problem for people who are already at risk of heart disease, blood pressure, and/or kidney problems or for people who are taking other medications such as diuretics and angiotensin-converting enzyme (ACE) inhibitors, which can also affect the kidneys.

For more troublesome pain or limitation of movement that does not respond to the use of medications (either acetaminophen or nonsteroidal anti-inflammatory drugs or both) or nonmedication-based therapies, there are treatments available involving the injection of medication into the problem joint. Medication that is able to be injected into your joints includes hyaluronic acid and corticosteroids. Not all joints can be injected and the number of times a year you can have injections is limited because of potential side effects.

For troublesome pain, using stronger painkillers temporarily and intermittently may be an option, under the guidance and supervision of your healthcare professional. Stronger painkillers such as opiods or narcotics are potentially addictive, which is one reason for avoiding their use long-term.

A cream called capsaicin can be rubbed over painful joints, and some people find this very helpful.

Following is a summary of therapies that can be used to treat osteoarthritis, the correct order for their use, and precautious to be aware of when trying these therapies. We give you this summary in a stepwise fashion.

Step	Symptom	Medication	Main precautions
1	Pain, limitation of movement or difficulty with activities	Nonmedication based-therapies	Seek advice from your healthcare professional about therapies. Get a checkup before starting an exercise program and seek help if you are experiencing stress and/or depression.
2	Symptoms in step 1 that are persistent	Acetaminophen and/or nonsteroidal anti-inflammatory drug, including cox-2 inhibitors	Acetaminophen can potentially affect the heart, liver, and kidneys. With nonsteroidal anti-inflammatory drugs, everyone is at risk of gastrointestinal side effects, some people more than others. Also, there is a risk of heart, kidney and blood pressure problems. Your healthcare professional can advise you on whether these are safe for you and whether you should be prescribed a cox-2 inhibitor.
3	Symptoms that persist even after fulfilling steps 1 and 2	Joint injection with hyaluronic acid or corticosteroids	Injection should only be performed 3 to 4 times per year. There is a small risk of bleeding and joint infection when medications are injected into joints.
4	Symptoms that persist after steps 1 thru 3	Opiods or narcotics	These agents may be beneficial for short-term use for patients with acute and/or severe pain.
5	Symptoms that persist after fulfilling steps 1 thru 4	Capsaicin cream	Apply 4 times a day to your painful joint. It may cause a burning feeling on the skin after use.

Other Treatments

Surgery

Surgery to replace or repair damaged joints is available for cases of severe osteoarthritis in which someone is debilitated or other treatments have failed. Your healthcare professional can refer you to an orthopedic surgeon to discuss whether you are a candidate to receive this treatment and what type of surgery may be an option for you.

Surgical options for the treatment of osteoarthritis include the following:

• Surgery to replace damaged joints
  
  This is also known as joint replacement surgery or athroplasty. Your affected joint can be replaced with a plastic or metal prosthesis. Generally, artificial joints can wear out rapidly but when placed in the knee or hip they last from 10 to 20 years.


• Surgery to wash out joints and to remove torn tissues within the joint
  
  Joint wash (lavage) and removal of torn tissue (debridement) is performed by inserting a small instrument with a camera (called an athroscope) into the joint. The procedure is called arthroscopy.


• Surgery to reposition the bones
  
  This helps to correct deformities due to arthritis of bone and other joint structures like ligaments.


• Surgery to join or fuse bones together
  
  This is known as arthrodesis and helps to increase joint stability and reduce pain at the expense of reducing joint flexibility. Commonly, this surgery is used to fuse together bones of the spine as well as the ankles, wrists, and small bones of the hands and feet.

Alternative treatments

Some people use herbs, oils, and special diets to treat their osteoarthritis symptoms. Their efficacy of most of these treatments is not supported by research and not FDA approved. If you are thinking about using an herb or special dietary supplement to treat your osteoarthritis, you should discuss it with your healthcare professional.

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Emerging therapies

Preventing progression of joint damage in osteoarthritis

• Medications
  
  At present, there are no medications that will definitely reduce the progression of joint damage in osteoarthritis. There is a lot of ongoing research in this area, and certain promising medications include the following:
  
  
  • Topical anti-inflammatory medications in the form of creams or gels that can be applied to the affected joint. These topical products, creams, and gels may have less risk of side effects compared with nonsteroidal oral anti-inflammatory drug tablets. Currently, some are being evaluated for possible approval in the US, however, they may be available now in other countries. One example of this is topical diclofenac (Pennsaid^®).
  • Antibiotics such as doxycycline
  • Medications that interfere with cytokines such as interleukin-1 can affect the immune system helping to reduce inflammation. Examples include diacerein, anakinera (Kineret^®) (already used in rheumatoid arthritis), and orthokine.
  • Bisphosphonates such as alendronate (Fosamax^®) and risedronate (Actonel^®) are used in the treatment of osteoporosis and are being researched for the treatment of osteoarthritis.
  • A patch form of lidocaine (Lidoderm^®), a local anesthetic is being researched as it may provide pain relief for people with osteoarthritis.
  • Licofelone is a new painkiller and anti-inflammatory medication in research.
  • Nitric oxide in combination with nonsteroidal anti-inflammatory medications may reduce the usual risk of gastrointestinal side effects. This is being researched.
• Surgery
  
  Surgery to graft new cartilage into regions of damaged cartilage.


• Gene therapy
  
  Research is underway to find genes that are involved in the inflammation and joint damage that occurs in osteoarthritis.

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Frequently asked questions

Is osteoarthritis just the result of aging?
Osteoarthritis was previously considered primarily a progressive degenerative disorder and a natural occurrence of “wear-and-tear” on joints. However, we now know there are many other factors associated with it, including race, genetic factors, and metabolic and endocrine diseases such as diabetes and thyroid disorders.

What are the differences between a joint that has osteoarthritis and a normal, aging joint?
There are several differences between an osteoarthritis joint and an aging joint. The water content of cartilage in an aging joint does not change significantly. In a joint with osteoarthritis, the water content increases early in the disease process. The biological changes in the cell that occur with osteoarthritis cause physical, chemical, and other changes that are not seen in the aging joint. Osteoarthritis causes changes in the bone below the cartilage (subchondral bone) that do not occur in an aging joint. In an aging joint, fibrillation (fine, rapid contractions or twists of small groups of fibers) occurs on joint surfaces that don’t bear weight. Osteoarthritis occurs primarily in weightbearing joints, like the knees and hips.

What is the major impact of osteoarthritis?
The primary effect of osteoarthritis is pain that can lead to disability. The cause of the pain is generally an inflammation or joint incongruity. However, individuals who have the same degree of osteoarthritis can experience different levels of pain.

How many people in the US have osteoarthritis?
In the US, estimates of arthritis range from as low as 6% of the adult population to as high as 90% of adults over 40 years old. According to a 2000 report from the National Center for Health Statistics, up to 32.9 million Americans (about 23% of the adult population) reported that their physicians diagnosed them with some type of arthritis.

Is osteoarthritis one disease or many?
It’s still not clear whether osteoarthritis is a single disease or many disorders with a similar final outcome. Several areas of study seem to indicate that osteoarthritis is many distinct entities and research is continuing to identify several types of risk factors that may contribute to osteoarthritis.

How large a role does heredity play in the development of osteoarthritis?
Osteoarthritis in all its various forms appears to have a strong genetic connection. Gene mutations may be a factor in predisposing individuals to develop osteoarthritis. But there are other risk factors as well that can increase a person's risk of developing osteoarthritis. These include

• Obesity. Generally, the more weight a person carries, the greater the pressure on the weightbearing joints of the body.
• Aging. As people age, cartilage normally is less able to repair itself.
• Nutrition. Calcium and vitamins C and D are needed to build strong bones. Investigators are researching whether an insufficiency of these vitamins may contribute to developing osteoarthritis in later life.
• Other diseases and hereditary conditions that affect bones and connective tissues. Among the conditions are Ehlers-Danlos syndrome, bone dysplasias, and Charcot joints.
• Injury or deformity in a joint. There is an increased risk of developing osteoarthritis in a joint that is not properly aligned or in one that has been injured.
• Occupational factors. Repetitive tasks, overworking the joints and overtiring the muscles that protect a joint, increase the risk for osteoarthritis in that joint.

How will having osteoarthritis affect my life?
Osteoarthritis affects each person differently. In some people, it progresses quickly and can cause chronic pain and disability such as difficulty walking and doing everyday tasks. In others, the symptoms can remain mild or may fluctuate and the disease may never progress to disability. It is important to remember that no matter how mild or severe the symptoms are, there are always options that may help.

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Empower Yourself

Dealing with osteoarthritis

Arthritis is the leading cause of disability in the US. In 2003, arthritis and other rheumatic conditions affected 70 million people—a number that is expected to climb as the baby boom generation ages—almost 33 percent of the population.

Arthritis conditions are not fatal, but they do worsen the health-related quality of life. Arthritis is the leading cause of disability in the US, limiting the everyday activities of more than 7 million Americans. Arthritis results in nearly 32 million physician visits (Source: National Center for Health Statistics; Centers for Disease Control and Prevention (CDC); 2003 Ambulatory Medical Care Survey) and more than 1 million hospitalizations each year (Source: National Center for Health Statistics; Centers for Disease Control and Prevention; 2003 National Hospital Discharge Survey).

Prevailing myths have portrayed arthritis as an inevitable part of aging that can only be endured. The CDC (Centers for Disease Control and Prevention) maintains that there are effective interventions that are available to prevent or reduce arthritis-related pain and disability. Among them early diagnosis and appropriate management, including weight control, physical activity, physical and occupational therapy, and joint replacement, when necessary. Self-management activities can also help people with arthritis decrease their symptoms and improve their function. Self-management for osteoarthritis involves taking an active role in caring for yourself in partnership with your healthcare professional. Your health professional can assist you in finding the right self-management program for you. Self management will include:

• Pain-management techniques for mild and severe pain
• Individualized exercise program
• Dealing with stress and fatigue
• Learning how to take medications safely (for example, painkillers)
• Learning how to overcome disability and limitations placed on you because of your arthritis

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Glossary of osteoarthritis terms

Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer).

Acetaminophen: A pain reliever and fever reducer (one brand name: Tylenol). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold (that is, by requiring a greater amount of pain to develop before it is felt by a person). Acetaminophen reduces fever through its action on the heat-regulating center (the “thermostat”) of the brain. Generic is available.

Acupuncture: A form of traditional Chinese medicine in which needles are inserted into specific points on the body to restore health and wellbeing.

Aleve: See Naproxen.

Anticoagulants: Medications used to thin the blood to reduce the blood clots.

Arthritis: Inflammation of a joint. When joints are inflamed they can develop stiffness, warmth, swelling, redness, and pain. There are over 100 types of arthritis.

Arthrocentesis: Joint aspiration, a procedure whereby a sterile needle and syringe are used to drain fluid from a joint. This is usually done as an office procedure or at the bedside in the hospital.  

Arthrodesis: Bone or joint fusion surgery, where the ends of two bones are fused and the joint is eliminated.  

Arthroscope: A thin, flexible fiberoptic scope that is introduced into a joint space through a small incision to carry out diagnostic and treatment procedures within the joint. An arthroscope is about the diameter of a drinking straw. It is fitted with a miniature camera, a light source, and precision tools at the end of flexible tubes. An arthroscope can be used not only for diagnostic procedures but a wide range of surgical repairs, such as debridement, or cleaning of a joint to remove bits of torn cartilage, ligament reconstruction, and synovectomy (removal of the joint lining). All are done without a major, invasive operation, and since arthroscopy requires only tiny incisions, many procedures can be done on an outpatient basis with local anesthetic.

Arthroscopic: Refers to a surgical technique whereby a doctor inserts a tube-like instrument into a joint to inspect, diagnose and repair tissues. It is most commonly performed in patients with diseases of the knees or shoulders. The word arthroscopic is often confused with orthoscopic. Orthoscopic means having correct vision or producing it. Orthoscopic, in other words, means free from optical distortion or designed to correct distorted vision. This fits with the prefix “ortho-,” meaning straight or erect, and with “-scopic” from the Greek “skopein”, to see. Orthoscopic literally is to see straight. Knee surgery performed with a small scope is arthroscopic knee surgery, not orthoscopic knee surgery.

Arthroscopy: A surgical technique whereby a tube-like instrument is inserted into a joint to inspect, diagnose and repair tissues. Arthroscopy is most commonly performed in patients with diseases of the knees or shoulders. The adjective “arthroscopic” is often confused with “orthoscopic.” Orthoscopic means having correct vision or producing it; and free from optical distortion or designed to correct distorted vision. This fits with the prefix “ortho-,” meaning straight or erect, and “-scopic” from the Greek “skopein,” to see. Orthoscopic literally is to see straight. Knee surgery performed with a small scope is arthroscopic knee surgery, not orthoscopic knee surgery.

Aspirin: A good example of a tradename that entered into the language, Aspirin was once the Bayer trademark for acetylsalicylic acid.

Attention: The ability to focus selectively on a selected stimulus, sustaining that focus and shifting it at will. The ability to concentrate.

Blood: The familiar red fluid in the body that contains white and red blood cells, platelets, proteins, and other elements. The blood is transported throughout the body by the circulatory system. Blood functions in two directions: arterial and venous. Arterial blood is the means by which oxygen and nutrients are transported to tissues, whereas venous blood is the means by which carbon dioxide and metabolic byproducts are transported to the lungs and kidneys, respectively, for removal from the body.

Bone: Bone is the substance that forms the skeleton of the body. It is composed chiefly of calcium phosphate and calcium carbonate. It also serves as a storage area for calcium, playing a large role in calcium balance in the blood.

Bunion: A bunion is a localized painful swelling at the base of the big toe (the great toe). The joint is enlarged (due to new bone formation) and the toe is often misaligned. It is frequently associated with inflammation. It can be related to inflammation of the nearby bursa (bursitis) or degenerative joint disease (osteoarthritis).

Calcium: A mineral found mainly in the hard part of bones, where it is stored. Calcium is added to bones by cells called osteoblasts and is removed from bones by cells called osteoclasts. Calcium is essential for healthy bones. It is also important for muscle contraction, heart action, nervous system maintenance, and normal blood clotting. Food sources of calcium include dairy foods, some leafy green vegetables such as broccoli and collards, canned salmon, clams, oysters, calcium-fortified foods, and tofu. According to the National Academy of Sciences, adequate intake of calcium is 1200 milligrams a day (four glasses of milk) for men and women 51 and older, 1000 milligrams a day for adults 19 through 50, and 1300 milligrams a day for children 9 through 18. The upper limit for calcium intake is 2.5 grams daily.

Capsaicin: A component of certain plants, including cayenne and red pepper, used topically to relieve minor arthritis pain and nerve pain. Capsaicin is in creams such as Arthricare and Zostrix that are applied to the skin. It appears to work by reducing a chemical substance found at nerve endings that is involved in transmitting pain signals to the brain.

Cardiovascular disease: Disease of the heart or blood vessels (arteries and/or veins).

Cartilage: Firm, rubbery tissue that cushions bones at joints. A more flexible kind of cartilage connects muscles with bones and makes up other parts of the body, such as the larynx and the outside parts of the ears.

Charcot joints: A joint that lacks the ability to respond via reflexes to abnormal stress and movement. As a result, the bone adjoining the cartilage in the joint disintegrates, leading to joint collapse and joint deformity. People with diabetes who have reduced sensation in their lower legs are at risk of developing charcot joints in their feet and ankles.

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.

Cognitive behavioral therapy (CBT): A type of psychotherapy that focuses on modifying a person’s thoughts and behaviors wtih the aim of influencing emotions. It can help produce positive emotions and break a pattern of negative thinking.

Condition: The term “condition” has a number of biomedical meanings including the following:

• An unhealthy state, such as in “this is a progressive condition.”
• A state of fitness, such as “getting into condition.”
• Something that is essential to the occurrence of something else; essentially a “precondition.”
• As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.

Congenital: Present at birth. A condition that is congenital is one that is present at birth. There are numerous uses of “congenital” in medicine. There are, for example, congenital abnormalities. (For more examples, see below.)

Constipation: A condition in which a person experiences harder than usual feces and finds it difficult to pass the feces from the bowel, often resulting in straining.

Cortisone: An adrenocorticoid hormone, a naturally occurring hormone made by and secreted by the adrenal cortex, the outer part (the cortex) of the adrenal gland.

Cox-2: Cyclooxygenase-2, a protein acts as an enzyme and specifically catalyzes (speeds) the production of certain chemical messengers called prostaglandins. Some of these messengers are responsible for promoting inflammation. When Cox-2 activity is blocked, inflammation is reduced. Unlike cox-1, cox-2 is active only at the site of inflammation, not in the stomach.

Crepitus: Crackling or grinding noise heard during joint movement.

Degenerative arthritis: Also known as osteoarthritis, this type of arthritis is caused by inflammation, breakdown, and eventual loss of the cartilage of the joints. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting usually the hands, feet, spine, and large weightbearing joints, such as the hips and knees. Also called degenerative joint disease.

Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus. Diabetes mellitus and diabetes insipidus share the name “diabetes” because they are both conditions characterized by excessive urination (polyuria).

Diagnosis: 1. The nature of a disease, for example, the identification of an illness. 2. A conclusion or decision reached by diagnosis, for example, the diagnosis is rabies. 3. The identification of any problem, eg, the diagnosis was a plugged IV.

Diarrhea: Unusually frequent or unusually liquid bowel movements, excessive watery evacuations of fecal material. The opposite of constipation. The word “diarrhea” with its odd spelling is similar to the Greek “diarrhoia” meaning “a flowing through.” Plato and Aristotle may have had diarrhoia whereas today we have diarrhea. There are myriad infectious and noninfectious causes of diarrhea.

Dietary supplements: A supplement like a herb, vitamin, or enzyme supplies nutrients that are missing or deficient in a person's diet. Some people take them to treat or prevent certain health conditions.

Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs).

Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent, such as the rubella (German measles) virus.

Doxycycline: Brand name: Vibramycin. A synthetic broad-spectrum antibiotic derived from tetracycline. Doxycycline is used to treat many different types of infections, including respiratory tract infections due to Hemophilus influenzae, Streptococcus pneumoniae, or Mycoplasma pneumoniae. It is also used for the treatment of nongonococcal urethritis (due to Ureaplasma), Rocky Mountain spotted fever, typhus, chancroid, cholera, brucellosis, syphilis, and acne.

Dysfunction: Difficult function or abnormal function.

Ehlers-Danlos syndrome: A group of inherited diseases in which the connective tissue of the skin, joints, and blood vessel walls becomes fragile and weak.

Esophagus: The passageway through which food passes from the mouth to the stomach.

Family: 1. A group of individuals related by blood or marriage or by a feeling of closeness. 2. A biological classification of related plants or animals that is a division below the order and above the genus. 3. A group of genes related in structure and in function that descended from an ancestral gene. 4. A group of gene products similarly related in structure and function and of shared genetic descent. 5. Parents and their children. The most fundamental social group in humans.

FDA: The Food and Drug Administration, an agency within the US Public Health Service, that is a part of the Department of Health and Human Services.

Feet: The plural of foot, both an anatomic structure and a unit of measure.

Fissure: A cleft or groove, that can be normal or abnormal.

Gastrointestinal: Adjective referring collectively to the stomach and small and large intestines.

Genetic: Having to do with genes and genetic information.

Glucosamine: A molecule derived from the sugar glucose by the addition of an amino (NH2) group, glucosamine is a component of a number of structures, including the blood group substances and cartilage.

Gout: Condition characterized by abnormally elevated levels of uric acid in the blood, recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints, and decreased kidney function and kidney stones. Uric acid is a breakdown product of purines, a part of many foods we eat. The tendency to develop gout and elevated blood uric acid level (hyperuricemia) is often inherited and can be promoted by obesity, weight gain, alcohol intake, high blood pressure, abnormal kidney function, and drugs. The most reliable diagnostic test for gout is the identification of crystals in joints, body fluids, and tissues.

Growth hormone: A hormone made in the anterior pituitary gland that stimulates the release of another hormone, called somatomedin, by the liver, thereby causing growth. Also known as somatotropin. It is a polypeptide that consists of 191 amino acids. Growth hormone is given to children with pituitary dwarfism (short stature due to underfunction of the anterior pituitary) to help them grow. Excessive growth hormone production in children can lead to gigantism and in adults it can lead to acromegaly, or progressive enlargement of peripheral parts of the body.

Health: As officially defined by the World Health Organization, a state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity.

Heredity: Genetic transmission from parent to child.

Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs.

Hyaluronic acid: A viscous slippery substance that lubricates the joints, maintains the shape of the eyeballs, and is a key component of connective tissue. On a more technical level, hyaluric acid is an glycosaminoglycan (formerly called a mucopolysaccharide), a long, unbranched polysaccharide (complex sugar), composed of repeating dimeric units of glucuronic acid and N acetyl glucosamine.

Hypermobility syndrome: A benign condition where joints move easily beyond the normal range expected for that joint. Joint hypermobility is also a symptom of Ehlers-Danlos syndrome.

Ibuprofen: A nonsteroidal anti-inflammatory drug (NSAID), commonly used to treat pain, swelling, and fever. Common brand names for Ibuprofen include Advil, Motrin, and Nuprin.

Incidence: The frequency with which something, such as a disease, appears in a particular population or area. In disease epidemiology, the incidence is the number of newly diagnosed cases during a specific time period. Incidence is distinct from the prevalence of disease, which refers to the number of cases alive on a certain date.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a “germ”) growing within him, drawing its nourishment from the person.

Inflammation: A basic way in which the body reacts to infection, irritation or other injury. The key feature is redness, warmth, swelling, and pain. Inflammation is now recognized as a type of nonspecific immune response.

Injury: Harm or hurt. The term “injury” may be applied in medicine to damage inflicted upon oneself, as in a hamstring injury, or by an external agent, as in a cold injury. The injury may be accidental or deliberate, as with a needlestick injury. The term injury may be synonymous (depending on the context) with a wound or trauma.

Intervention: The act of intervening, interfering, or interceding with the intent of modifying the outcome. In medicine, an intervention is usually undertaken to help treat or cure a condition. For example, early intervention may help children with autism to speak. “Acupuncture as a therapeutic intervention is widely practiced in the US," according to the National Institutes of Health.

Joint: A joint is the area where two bones are attached for the purpose of motion of body parts. A joint is usually formed of fibrous connective tissue and cartilage. An articulation or an arthrosis is the same as a joint.

Knee: The knee is a joint that has three parts. The thigh bone (the femur) meets the large shin bone (the tibia) to form the main knee joint. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (the patella) joins the femur to form a third joint, called the patellofemoral joint. The patella protects the front of the knee joint.

Knock Knees: A condition of the lower legs in which they are positioned at an outward angle, so that the ankles tend to be separated much more than usual when the knees are placed close together.

Lumbar: Referring to the five lumbar vertebrae that are situated below the thoracic vertebrae and above the sacral vertebrae in the spinal column. The five lumbar vertebrae are represented by the symbols L1 through L5. There are correspondingly five lumbar nerves.

Lupus: A chronic inflammatory condition caused by an autoimmune disease in which the body’s tissues are attacked by its own immune system. Patients with lupus have unusual antibodies in their blood that are targeted against their own body tissues.

Medication: 1. A drug or medicine. 2. The administration of a drug or medicine.

Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.

Muscular: Having to do with the muscles. Also, endowed with above average muscle development. Muscular system refers to all of the muscles of the body collectively.

Naprosyn: See: Naproxen.

Naproxen: A nonsteroidal anti-inflammatory drug (NSAID) used for the management of mild to moderate pain, fever, and inflammation. Naproxen blocks the enzyme cyclooxygenase that makes prostaglandins, resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain, and fever are reduced. Brand names for naproxen include Anaprox, Naprelan, Naprosyn, and Aleve.

Narcotic: Refers to medication derived from opium and otherwise known as opioids. They are used as prescription painkillers but also are often abused and used as recreational drugs.

Nausea: A sensation of wanting to vomit.

Neck: The part of the body joining the head to the shoulders. Also, any narrow or constricted part of a bone or organ that joins its parts as, for example, the neck of the femur bone.

Node: Literally a knot. A node is a collection of tissue, for example, a lymph node is a collection of lymphoid tissue. A nodule is a small node, a little collection of tissue.

Obesity: The state of being well above one’s normal weight, defined as a body mass index above 25.

Organ: A relatively independent part of the body that carries out one or more special functions. For example, the eye, ear, heart, lungs, and liver.

Orthoses: An orthosis is a device that can be worn on the outside of the body in order to support a body part and reduce symptoms like pain and disability in that part of the body.

Osteoarthritis: A type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also known as degenerative arthritis.

Osteophytes: Commonly known as bone spurs, they are protrusions of bone and cartilage in areas of a degenerating joint.

Osteoporosis: A condition of reduced bone strength that increases the risk of bone fracture with minimal trauma especially to the wrist, hips, and spinal bones.

Osteotomy: Taking out part or all of a bone or cutting into or through bone.

Overweight: The term overweight is used in two different ways. In one sense it is a way of saying imprecisely that someone is heavy. The other sense of “overweight” is more precise and designates a state between normal weight and obesity.

Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be in a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.

Prescription: A physician’s order for the preparation and administration of a drug or device for a patient. A prescription has several parts, including the superscription or heading with the symbol “R” or “Rx,” which stands for the word recipe (meaning, in Latin, to take); the inscription, which contains the names and quantities of the ingredients; the subscription or directions for compounding the drug; and the signature which is often preceded by the sign “s” standing for signa (Latin for mark), giving the directions to be marked on the container.

Primary: First or foremost in time or development. The primary teeth (the baby teeth) are those that come first. Primary may also refer to symptoms or a disease to which others are secondary.

Progressive: Increasing or advancing in scope or severity. Advancing. Going forward. In medicine, a disease that is progressive is going from bad to worse.

Protein: A large molecule composed of one or more chains of amino acids in a specific order determined by the base sequence of nucleotides in its DNA coding.

Pseudogout: Inflammation of the joints caused by deposits of calcium pyrophosphate crystals, resulting in arthritis, most commonly of the knees, wrists, shoulders, hips, and ankles, usually affecting only one or a few joints at a time. True gout is due to a different type of crystal formed by the precipitation of uric acid.

Quadriceps muscles: Muscles located at the front of the thighs. These muscles enable you to extend your knee.

Radioactive: Emitting energy waves due to decaying atomic nuclei. Radioactive substances are used in medicine as tracers for diagnosis and in treatment to kill cancerous cells.

Range of motion: The range through which a joint can be moved, usually its range of flexion and extension. Due to an injury, the knee may, for example, lack 10 degrees of full extension.

Rheumatoid arthritis: A chronic disease of joints in which the joints become painful, swollen, and over time damaged by a process caused by inflammation driven by a person's immune system. The condition can lead to disability. There are many treatments available for rheumatoid arthritis.

Rheumatologist: A specialist in the nonsurgical treatment of rheumatic illnesses, especially arthritis.

Risk factor: Something that increases a person's chances of developing a disease.

Side effects: Problems that occur when treatment exceeds the desired therapeutic effect or problems that occur in addition to the desired therapeutic effect.

Spasm: A brief, automatic jerking movement. A muscle spasm can be quite painful, with the muscle clenching tightly. A spasm of the coronary artery can cause angina. Spasms in various types of tissue may be caused by stress, medication, overexercising, or other factors.

Spine: The column of bone known as the vertebral column that surrounds and protects the spinal cord. The spine can be categorized according to level of the body, for example, cervical spine (neck), thoracic spine (upper and middle back), and lumbar spine (lower back).

Splint: A devise that helps support the body by holding joints in place so they do not move. Often they are used for people who have broken bones as it helps to allow healing while immobilizing the bone area.

Steroids: A type of medication that has anti-inflammatory properties. Also known as corticosteroids.

Stomach: The sac-shaped digestive organ that is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine.

Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.

Surgery: The word surgery has multiple meanings. It is the branch of medicine concerned with diseases and conditions that require or are amenable to operative procedures. Surgery is the work done by a surgeon.

Symptom: Any subjective evidence of disease. Anxiety, lower back pain, and fatigue are all symptoms. They are sensations only the patient can perceive. In contrast, a sign is objective evidence of disease. A bloody nose is a sign. It is evident to the patient, doctor, nurse, and other observers.

Systemic: Affecting the entire body. A systemic disease, such as diabetes, can affect the whole body. Systemic chemotherapy employs drugs that travel through the bloodstream and reach and affect cells throughout the body.

Tetracycline: A family of broad-spectrum antibiotics effective against a remarkably wide variety of organisms. Bacteria susceptible to tetracycline include H. flu (Hemophilus influenzae), strep (Streptococcus pneumoniae), Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, and Neisseria gonorrhoeae (the cause of gonorrhea). Tetracycline is also used to treat nongonococcal urethritis (due to Ureaplasma), Rocky mountain spotted fever, typhus, chancroid, cholera, brucellosis, anthrax, and syphilis. It is used in combination with other medications to treat Helicobacter pylori, the bacteria associated with ulcers of the stomach and duodenum.

Therapy: The treatment of disease.

Tissue: A tissue is a broad term that is applied to any group of cells, not necessarily in a layer, that perform specific functions. Thus, the bone marrow is a tissue; connective tissue consists of cells that make up fibers in the framework supporting other body tissues; and lymphoid tissue is the part of the body's immune system that helps protect it from bacteria and other foreign entities.

Topical: Pertaining to a particular surface area. A topical agent is applied to a certain area of the skin and is intended to affect only the area to which it is applied. Whether its effects are indeed limited to that area depends upon whether the agent stays where it is applied or is absorbed into the bloodstream.

Total hip replacement: Surgery in which the diseased ball and socket of the hip joint are completely removed and replaced with artificial materials. A metal ball with a stem (a prosthesis) is inserted into the femur (thigh bone) and an artificial plastic cup socket is placed in the acetabulum (a “cup-shaped” part of the pelvis).

Toxicity: The degree to which a substance can harm humans or animals.

Transcutaneous electrical nerve stimulation (TENS): A way of decreasing the sensation of pain by application of electrode patches to the skin through which painless electrical currents are sent to specific nerves.

Trauma: Any injury, whether physically or emotionally inflicted. “Trauma” has both a medical and a psychiatric definition. Medically, “trauma” refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry, “trauma” has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.

Ulcer: An area of tissue erosion, for example, of the skin or lining of the gastrointestinal (GI) tract. Because of the erosion, an ulcer is concave. It is always depressed below the level of the surrounding tissue.

Uric acid: A breakdown product of purines that are part of many foods. In gout, there are frequently, but not always, elevated levels of uric acid in the blood (hyperuricemia). However, only a small proportion of people with hyperuricemia will develop gout.

X-ray: High-energy radiation with waves shorter than those of visible light. X-rays possess the properties of penetrating most substances (to varying extents), of acting on a photographic film or plate (permitting radiography), and of causing a fluorescent screen to give off light (permitting fluoroscopy). In low doses, X-rays are used for making images that help to diagnose disease; high doses are used to treat cancer.

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Osteoarthritis Resources

Government Organizations

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Bldg. 31 Room 4C02
31 Center Drive MSC 2350
Bethesda, MD 20892-2350  
Phone: 301-496-8190
Fax: 301-480-2814
http://www.niams.nih.gov/


Private Organizations

American College of Rheumatology
1800 Century Place
Suite 250
Atlanta, GA 30345  
Phone: 404-633-3777
Fax: 404-633-1870
http://www.rheumatology.org

American Osteopathic Association
142 E. Ontario St
Chicago, IL 60611  
Phone: 312-202-8000
Fax: 312-202-8200
Hotline: 800-621-1773
http://www.osteopathic.org/

American Society for Bone and Mineral Research (ASBMR)
2025 M Street, NW
Suite 800
Washington, DC 20036-3309  
Phone: 202-367-1161
Fax: 202-367-1161
http://www.asbmr.org

Orthopaedic Research and Education Foundation (OREF)
6300 N River Rd., Ste 700
Rosemont, IL 60018-4261  
Phone: 847-698-9980
Fax: 847-698-7806
http://www.oref.org


Osteoarthritis Tools

Osteoarthritis Quiz
Detailed information on osteoarthritis, including statistics, causes, diagnosis, treatment, and management of osteoarthritis.
http://www.muschealth.com/gs/InteractiveToolList.aspx?mapid=2

Arthritis pain quiz: Are you controlling your arthritis symptoms? (MayoClinic)
http://www.mayoclinic.com/health/arthritis/QZ00060

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References

1. Hochberg MC. Epidemiologic considerations in the primary prevention of osteoarthritis. J Rheum. 1991;18:1438-1440. [Evidence Level B]

2. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000:43:1905-1915. [Evidence Level C]

3. Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine. 2003;28:292-297.

4. Fang MA, Taylor CE, Nouvong A, Masih S, Kao KC, Perell KL. Effects of footwear on medial compartment knee osteoarthritis. J Rehabil Res Dev. 2006;43:427-434. [Evidence Level B]

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