Osteoarthritis hurts people in more than their joints:
their finances and lifestyles also are affected.
Financial effects include
- The cost of treatment
- Wages lost because of disability.
Lifestyle effects include
- Feelings of helplessness
- Limitations on daily activities
- Job limitations
- Trouble participating in everyday personal and family joys and
Despite these challenges, most people with osteoarthritis
can lead active and productive lives. They succeed by using
osteoarthritis treatment strategies, such as the following:
- Pain relief medications
- Rest and exercise
- Patient education and support programs
- Learning self-care and having a "good-health attitude."
Osteoarthritis Basics: The Joint and Its
Most joints--the place where two moving bones come
together--are designed to allow smooth movement between the bones and to
absorb shock from movements like walking or repetitive movements. The
joint is made up of:
- Cartilage: a hard but slippery coating on the end of
each bone. Cartilage, which breaks down and wears away in
osteoarthritis, is described in more detail below.
- Joint capsule:
a tough membrane sac that holds all
the bones and other joint parts together.
- Synovium (sin-O-vee-um): a thin membrane inside the
- Synovial fluid: a fluid that lubricates the joint
and keeps the cartilage smooth and healthy.
- Ligaments, tendons, and muscles: tissues that keep
the bones stable and allow the joint to bend and move. Ligaments are
tough, cord-like tissues that connect one bone to another. Tendons are
tough, fibrous cords that connect muscles to bones. Muscles are
bundles of specialized cells that contract to produce movement when
stimulated by nerves.
How Do You Know if You Have Osteoarthritis?
Usually, osteoarthritis comes on slowly. Early in the
disease, joints may ache after physical work or exercise. Osteoarthritis
can occur in any joint. Most often it occurs at the hands, knees, hips,
Hands: Osteoarthritis of the fingers is one
type of osteoarthritis that seems to have some hereditary
characteristics; that is, it runs in families. More women than men have
it, and they develop it especially after menopause. In osteoarthritis,
small, bony knobs appear on the end joints of the fingers. They are
called Heberden's (HEB-err-denz) nodes. Similar knobs, called Bouchard's
(boo-SHARDZ) nodes, can appear on the middle joints of the fingers.
Fingers can become enlarged and gnarled, and they may ache or be stiff
and numb. The base of the thumb joint also is commonly affected by
osteoarthritis. Osteoarthritis of the hands can be helped by
medications, splints, or heat treatment.
|Cartilage: The Key to Healthy
Cartilage is 65 to 80 percent water. Three other
components make up the rest of cartilage tissue: collagen,
proteoglycans, and chondrocytes.
- Collagen (KAHL-uh-jen): a fibrous protein.
Collagen is also the building block of skin, tendon, bone, and
other connective tissues.
- Proteoglycans (PRO-tee-uh-GLY-kanz): a
combination of proteins and sugars. Strands of proteoglycans and
collagen weave together and form a mesh-like tissue. This allows
cartilage to flex and absorb physical shock.
- Chondrocytes (KAHN-druh-sytz): cells that are
found all through the cartilage. They mainly help cartilage stay
healthy and grow. Sometimes, however, they release substances
called enzymes that destroy collagen and other proteins.
Researchers are trying to learn more about chondrocytes.
Knees: The knees are the body's primary
weight-bearing joints. For this reason, they are among the joints most
commonly affected by osteoarthritis. They may be stiff, swollen, and
painful, making it hard to walk, climb, and get in and out of chairs and
bathtubs. If not treated, osteoarthritis in the knees can lead to
disability. Medications, weight loss, exercise, and walking aids can
reduce pain and disability. In severe cases, knee replacement surgery
may be helpful.
Osteoarthritis in the hip can cause
pain, stiffness, and severe disability. People may feel the pain in
their hips, or in their groin, inner thigh, buttocks, or knees. Walking
aids, such as canes or walkers, can reduce stress on the hip.
Osteoarthritis in the hip may limit moving and bending. This can make
daily activities such as dressing and foot care a challenge. Walking
aids, medication, and exercise can help relieve pain and improve motion.
The doctor may recommend hip replacement if the pain is severe and not
relieved by other methods.
Spine: Stiffness and pain in the neck or in
the lower back can result from osteoarthritis of the spine. Weakness or
numbness of the arms or legs also can result. Some people feel better
when they sleep on a firm mattress or sit using back support pillows.
Others find it helps to use heat treatments or to follow an exercise
program that strengthens the back and abdominal muscles. In severe
cases, the doctor may suggest surgery to reduce pain and help restore
|The Warning Signs of Osteoarthritis|
- Steady or intermittent pain in a joint
- Stiffness in a joint after getting out of bed or
sitting for a long time
- Swelling or tenderness in one or more joints
- A crunching feeling or the sound of bone rubbing on
- Hot, red, or tender? Probably not osteoarthritis.
Check with your doctor about other causes, such as rheumatoid
- Pain? Not always. In fact, only a third of people
whose x rays show evidence of osteoarthritis report pain or
How Do Doctors Diagnose
No single test can diagnose osteoarthritis. Most doctors
use a combination of the following methods to diagnose the disease and
rule out other conditions:
Clinical history: The doctor begins by
asking the patient to describe the symptoms, and when and how the
condition started. Good doctor-patient communication is important. The
doctor can give a better assessment if the patient gives a good
description of pain, stiffness, and joint function, and how they have
changed over time. It also is important for the doctor to know how the
condition affects the patient's work and daily life. Finally, the doctor
also needs to know about other medical conditions and whether the
patient is taking any medicines.
Physical examination: The doctor will check
the patient's general health, including checking reflexes and muscle
strength. Joints bothering the patient will be examined. The doctor will
also observe the patient's ability to walk, bend, and carry out
activities of daily living.
X rays: Doctors take x rays to see how much
joint damage has been done. X rays of the affected joint can show such
things as cartilage loss, bone damage, and bone spurs. But there often
is a big difference between the severity of osteoarthritis as shown by
the x ray and the degree of pain and disability felt by the patient.
Also, x rays may not show early osteoarthritis damage, before much
cartilage loss has taken place.
Other tests: The doctor may order blood
tests to rule out other causes of symptoms. Another common test is
called joint aspiration, which involves drawing fluid from the joint for
It usually is not difficult to tell if a patient has
osteoarthritis. It is more difficult to tell if the disease is causing
the patient's symptoms. Osteoarthritis is so common--especially in older
people--that symptoms seemingly caused by the disease actually may be
due to other medical conditions. The doctor will try to find out what is
causing the symptoms by ruling out other disorders and identifying
conditions that may make the symptoms worse. The severity of symptoms in
osteoarthritis is influenced greatly by the patient's attitude, anxiety,
depression, and daily activity level.
How Is Osteoarthritis Treated?
Most successful treatment programs involve a combination
of treatments tailored to the patient's needs, lifestyle, and health.
Osteoarthritis treatment has four general goals:
- Improve joint care through rest and exercise.
- Maintain an acceptable body weight.
- Control pain with medicine and other measures.
- Achieve a healthy lifestyle.
|Treatment Approaches to Osteoarthritis|
- Weight control
- Rest and joint care
- Pain relief techniques
- Alternative therapies
Osteoarthritis treatment plans often include ways to
manage pain and improve function. Such plans can involve exercise, rest
and joint care, pain relief, weight control, medicines, surgery, and
nontraditional treatment approaches.
Exercise: Research shows that exercise is
one of the best treatments for osteoarthritis. Exercise can improve mood
and outlook, decrease pain, increase flexibility, improve the heart and
blood flow, maintain weight, and promote general physical fitness.
Exercise is also inexpensive and, if done correctly, has few negative
side effects. The amount and form of exercise will depend on which
joints are involved, how stable the joints are, and whether a joint
replacement has already been done.
On the Move: Fighting Osteoarthritis With
You can use exercises to keep strong and limber,
extend your range of movement, and reduce your weight.Some
different types of exercise include the
Strength exercises: These can be
performed with exercise bands, inexpensive devices that add
Aerobic activities: These keep your lungs
and circulation systems in shape.
Range of motion
activities: These keep your joints limber.
exercises: These can help you maintain daily living
Neck and back strength exercises: These can help
you keep your spine strong and limber.
Ask your doctor or physical therapist what exercises
are best for you. Ask for guidelines on exercising when a joint is
sore or if swelling is present. Also, check if you should (1) use
pain-relieving drugs, such as analgesics or anti-inflammatories
(also called NSAIDs), to make exercising easier, or (2) use ice
Rest and joint care: Treatment plans include
regularly scheduled rest. Patients must learn to recognize the body's
signals, and know when to stop or slow down, which prevents pain caused
by overexertion. Some patients find that relaxation techniques, stress
reduction, and biofeedback help. Some use canes and splints to protect
joints and take pressure off them. Splints or braces provide extra
support for weakened joints. They also keep the joint in proper position
during sleep or activity. Splints should be used only for limited
periods because joints and muscles need to be exercised to prevent
stiffness and weakness. An occupational therapist or a doctor can help
the patient get a properly fitting splint.
Nondrug pain relief: People with
osteoarthritis may find nondrug ways to relieve pain. Warm towels, hot
packs, or a warm bath or shower to apply moist heat to the joint can
relieve pain and stiffness. In some cases, cold packs (a bag of ice or
frozen vegetables wrapped in a towel can relieve pain or numb the sore
area. (Check with a doctor or physical therapist to find out if heat or
cold is the best treatment.) Water therapy in a heated pool or whirlpool
also may relieve pain and stiffness. For osteoarthritis in the knee,
patients may wear insoles or cushioned shoes to redistribute weight and
reduce joint stress.
Weight control: Osteoarthritis patients who
are overweight or obese need to lose weight. Weight loss can reduce
stress on weight-bearing joints and limit further injury. A dietitian
can help patients develop healthy eating habits. A healthy diet and
regular exercise help reduce weight.
Medicines: Doctors prescribe medicines to
eliminate or reduce pain and to improve functioning. Doctors consider a
number of factors when choosing medicines for their patients with
osteoarthritis. Two important factors are the intensity of the pain and
the potential side effects of the medicine. Patients must use medicines
carefully and tell their doctors about any changes that occur.
The following types of medicines are commonly used in
- Acetaminophen: Acetaminophen is a pain reliever (for
example, Tylenol* that does not reduce swelling. Acetaminophen does not irritate the
stomach and is less likely than nonsteroidal anti-inflammatory drugs
(NSAIDs) to cause long-term side effects. Research has shown that
acetaminophen relieves pain as effectively as NSAIDs for many patients
Warning: People with liver disease,
people who drink alcohol heavily, and those taking blood- thinning
medicines or NSAIDs should use acetaminophen with caution.
* Note: Brand names included in this
booklet are provided as examples only. Their inclusion does not mean
they are endorsed by the National Institutes of Health or any other
Government agency. Also, if a certain brand name is not mentioned,
this does not mean or imply that the product is unsatisfactory.
- NSAIDs (nonsteroidal anti-inflammatory drugs): Many
NSAIDs are used to treat osteoarthritis. Patients can buy some over
the counter (for example, aspirin, Advil, Motrin IB, Aleve,
ketoprofen). Others require a prescription. All NSAIDs work similarly:
they fight inflammation and relieve pain. However, each NSAID is a
different chemical, and each has a slightly different effect on the
Side effects: NSAIDs can cause stomach irritation
or, less often, they can affect kidney function. The longer a person
uses NSAIDs, the more likely he or she is to have side effects,
ranging from mild to serious. Many other drugs cannot be taken when a
patient is being treated with NSAIDs because NSAIDs alter the way the
body uses or eliminates these other drugs. Check with your health care
provider or pharmacist before you take NSAIDs in addition to another
medication. Also, NSAIDs sometimes are associated with serious
gastrointestinal problems, including ulcers, bleeding, and perforation
of the stomach or intestine. People over age 65 and those with any
history of ulcers or gastrointestinal bleeding should use NSAIDs with
COX-2 inhibitors: Several new NSAIDs--valdecoxib
(Bextra) and celecoxib (Celebrex)--from a class of drugs known as
COX-2 inhibitors are now being used to treat osteoarthritis. These
medicines reduce inflammation similarly to traditional NSAIDs, but
they cause fewer gastrointestinal side effects. However, these
medications occasionally are associated with harmful reactions ranging
from mild to severe.
- Other medications: Doctors may prescribe several
other medicines for osteoarthritis, including the following:
Topical pain-relieving creams, rubs, and sprays
(for example, capsaicin cream), which are applied directly to the
Mild narcotic painkillers, which--although very
effective--may be addictive and are not commonly used.
Corticosteroids, powerful anti-inflammatory
hormones made naturally in the body or manmade for use as medicine.
Corticosteroids may be injected into the affected joints to
temporarily relieve pain. This is a short-term measure, generally not
recommended for more than two or three treatments per year. Oral
corticosteroids should not be used to treat osteoarthritis.
Hyaluronic acid, a medicine for joint injection,
used to treat osteoarthritis of the knee. This substance is a normal
component of the joint, involved in joint lubrication and
|Questions To Ask Your Doctor or Pharmacist About
- How often should I take this medicine?
- Should I take this medicine with food or between meals?
- What side effects can I expect?
- Should I take this medicine with the other prescription
medicines I take?
- Should I take this medicine with the over-the-counter
medicines I take?
Most medicines used to treat osteoarthritis have side
effects, so it is important for people to learn about the medicines they
take. Even nonprescription drugs should be checked. Several groups of
patients are at high risk for side effects from NSAIDs, such as people
with a history of peptic ulcers or digestive tract bleeding, people
taking oral corticosteroids or anticoagulants (blood thinners), smokers,
and people who consume alcohol. Some patients may be able to help reduce
side effects by taking some medicines with food. Others should avoid
stomach irritants such as alcohol, tobacco, and caffeine. Some patients
try to protect their stomachs by taking other medicines that coat the
stomach or block stomach acids. These measures help, but they are not
always completely effective.
Surgery: For many
people, surgery helps relieve the pain and disability of osteoarthritis.
Surgery may be performed to:
Remove loose pieces of bone and cartilage from the joint if they
are causing mechanical symptoms of buckling or locking
Resurface (smooth out) bones
Surgeons may replace affected joints with artificial
joints called prostheses. These joints can be made from metal alloys,
high-density plastic, and ceramic material. They can be joined to bone
surfaces by special cements. Artificial joints can last 10 to 15 years
or longer. About 10 percent of artificial joints may need revision.
Surgeons choose the design and components of prostheses according to
their patient's weight, sex, age, activity level, and other medical
The decision to use surgery depends on several things.
Both the surgeon and the patient consider the patient's level of
disability, the intensity of pain, the interference with the patient's
lifestyle, the patient's age, and occupation. Currently, more than 80
percent of osteoarthritis surgery cases involve replacing the hip or
knee joint. After surgery and rehabilitation, the patient usually feels
less pain and swelling, and can move more easily.
Nontraditional Approaches: Among the
alternative therapies used to treat osteoarthritis are the
- Acupuncture: Some people have found pain relief using
acupuncture (the use of fine needles inserted at specific points on
the skin). Preliminary research shows that acupuncture may be a useful
component in an osteoarthritis treatment plan for some patients.
- Folk remedies: Some patients seek alternative therapies for
their pain and disability. Some of these alternative therapies have
included wearing copper bracelets, drinking herbal teas, and taking
mud baths. While these practices are not harmful, some can be
expensive. They also cause delays in seeking medical treatment. To
date, no scientific research shows these approaches to be helpful in
- Nutritional supplements: Nutrients such as glucosamine and
chondroitin sulfate have been reported to improve the symptoms of
people with osteoarthritis, as have certain vitamins. Additional
studies are being carried out to further evaluate these claims.
|Health Professionals Who Treat
Many types of health professionals care
for people with osteoarthritis:
- Primary care physicians. Doctors who treat patients
before they are referred to other specialists in the health care
- Rheumatologists. Medical doctors who specialize in
treating arthritis and related conditions that affect joints,
muscles, and bones.
- Orthopaedists. Doctors who specialize in treatment of
and surgery for bone and joint diseases.
- Physical therapists. Health professionals who work
with patients to improve joint function.
- Occupational therapists. Health professionals who
teach ways to protect joints, minimize pain, and conserve
- Dietitians. Health professionals who teach ways to
use a good diet to improve health and maintain a healthy weight.
- Nurse educators. Nurses who specialize in helping patients
understand their overall condition and implement their treatment
- Physiatrists (rehabilitation specialists). Doctors
who help patients make the most of their physical potential.
- Licensed acupuncture therapists. Health professionals
who reduce pain and improve physical functioning by inserting
fine needles into the skin at various points on the body.
- Psychologists. Health professionals who help patients
cope with difficulties in the home and workplace resulting from
their medical conditions.
- Social workers. Professionals who assist patients
with social challenges caused by disability, unemployment,
financial hardships, home health care, and other needs resulting
from their medical conditions.
Be a Winner! Practice Self-Care and Keep a
People with osteoarthritis can enjoy good health despite
having the disease. How? By learning self-care skills and developing a
Self-care is central to successfully managing the pain and
disability of osteoarthritis. People have a much better chance of having
a rewarding lifestyle when they educate themselves about the disease and
take part in their own care. Working actively with a team of health care
providers enables people with the disease to minimize pain, share in
decisionmaking about treatment, and feel a sense of control over their
lives. Research shows that people with osteoarthritis who take part in
their own care report less pain and make fewer doctor visits. They also
enjoy a better quality of life.
|Self-Management Programs Do
People with osteoarthritis find that
self-management programs help them
- Understand the disease
- Reduce pain while remaining active
- Cope physically, emotionally, and mentally
- Have greater control over the disease
- Build confidence in their ability to live an active,
Self-Help and Education Programs: Three
kinds of programs help people learn about osteoarthritis, learn
self-care, and improve their good-health attitude. These programs
- Patient education programs
- Arthritis self-management programs
- Arthritis support groups.
These programs teach people about osteoarthritis, its
treatments, exercise and relaxation, patient and health care provider
communication, and problem solving. Research has shown that these
programs have clear and long-lasting benefits.
Exercise: Regular physical activity plays a
key role in self-care and wellness. Two types of exercise are important
in osteoarthritis management. The first type, therapeutic exercises,
keep joints working as well as possible. The other type, aerobic
conditioning exercises, improve strength and fitness, and control
weight. Patients should be realistic when they start exercising. They
should learn how to exercise correctly, because exercising incorrectly
can cause problems.
Most people with osteoarthritis exercise best when their
pain is least severe. Start with an adequate warmup and begin exercising
slowly. Resting frequently ensures a good workout. It also reduces the
risk of injury. A physical therapist can evaluate how a patient's
muscles are working. This information helps the therapist develop a
safe, personalized exercise program to increase strength and
Many people enjoy sports or other activities in their
exercise program. Good activities include swimming and aquatic exercise,
walking, running, biking, cross-country skiing, and using exercise
machines and exercise videotapes.
People with osteoarthritis should check with their doctor
or physical therapist before starting an exercise program. Health care
providers will suggest what exercises are best for you, how to warm up
safely, and when to avoid exercising a joint affected by arthritis. Pain
medications and applying ice after exercising may make exercising
Exercises for Osteoarthritis
People with osteoarthritis should do different kinds
of exercise for different benefits to the
Body, Mind, Spirit: Making the most of good
health requires careful attention to the body, mind, and spirit. People
with osteoarthritis must plan and develop daily routines that maximize
their quality of life and minimize disability. They also need to
evaluate these routines periodically to make sure they are working
Good health also requires a positive attitude. People must
decide to make the most of things when faced with the challenges of
osteoarthritis. This attitude--a good-health mindset--doesn't just
happen. It takes work, every day. And with the right attitude, you will
|Enjoy a "Good-Health Attitude"|
- Focus on your abilities instead of disabilities.
- Focus on your strengths instead of weaknesses.
- Break down activities into small tasks that you can manage.
- Incorporate fitness and nutrition into daily routines.
- Develop methods to minimize and manage stress.
- Balance rest with activity.
- Develop a support system of family, friends, and health
The leading role in osteoarthritis research is played by
the National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS), within the National Institutes of Health (NIH). The
NIAMS funds many researchers across the United States to study
osteoarthritis. It has established a Specialized Center of Research
devoted to osteoarthritis. Also, many researchers study arthritis at
NIAMS Multipurpose Arthritis and Musculoskeletal Diseases Centers and
Multidisciplinary Clinical Research Centers. These centers conduct
basic, laboratory, and clinical research aimed at understanding the
causes, treatment options, and prevention of arthritis and
musculoskeletal diseases. Center researchers also study epidemiology,
health services, and professional, patient, and public education. The
NIAMS also supports multidisciplinary clinical research centers that
expand clinical studies for diseases like osteoarthritis.
For years, scientists thought that osteoarthritis was
simply a disease of "wear and tear" that occurred in joints as people
got older. In the last decade, however, research has shown that there is
more to the disorder than aging alone. The production, maintenance, and
breakdown of cartilage, as well as bone changes in osteoarthritis, are
now seen as a series or cascade of events. Many researchers are trying
to discover where in that cascade of events things go wrong. By
understanding what goes wrong, they hope to find new ways to prevent or
treat osteoarthritis. Some key areas of research are described
Animal Models: Animals help researchers
understand how diseases work and why they occur. Animal models help
researchers learn many things about osteoarthritis, such as what happens
to cartilage, how treatment strategies might work, and what might
prevent the disease. Animal models also help scientists study
osteoarthritis in very early stages before it causes detectable joint
Diagnostic Tools: Some scientists want to
find ways to detect osteoarthritis at earlier stages so that they can
treat it earlier. They seek specific abnormalities in the blood, joint
fluid, or urine of people with the disease. Other scientists use new
technologies to analyze the differences between the cartilage from
different joints. For example, many people have osteoarthritis in the
knees or hips, but few have it in the ankles. Can ankle cartilage be
different? Does it age differently? Answering these questions will help
us understand the disease better.
Genetics Studies: Researchers suspect that
inheritance plays a role in 25 to 30 percent of osteoarthritis cases.
Researchers have found that genetics may play a role in approximately 40
to 65 percent of hand and knee osteoarthritis cases. They suspect
inheritance might play a role in other types of osteoarthritis, as well.
Scientists have identified a mutation (a gene defect) affecting
collagen, an important part of cartilage, in patients with an inherited
kind of osteoarthritis that starts at an early age. The mutation weakens
collagen protein, which may break or tear more easily under stress.
Scientists are looking for other gene mutations in osteoarthritis.
Recently, researchers found that the daughters of women who have knee
osteoarthritis have a significant increase in cartilage breakdown, thus
making them more susceptible to disease. In the future, a test to
determine who carries the genetic defect (or defects) could help people
reduce their risk for osteoarthritis with lifestyle adjustments.
Tissue Engineering: This technology involves
removing cells from a healthy part of the body and placing them in an
area of diseased or damaged tissue in order to improve certain body
functions. Currently, it is used to treat small traumatic injuries or
defects in cartilage, and, if successful, could eventually help treat
osteoarthritis. Researchers at the NIAMS are exploring three types of
tissue engineering. The two most common methods being studied today
include cartilage cell replacement and stem cell transplantation. The
third method is gene therapy.
- Cartilage cell replacement: In this procedure, researchers
remove cartilage cells from the patient's own joint and then clone or
grow new cells using tissue culture and other laboratory techniques.
They then inject the newly grown cells into the patient's joint.
Patients with cartilage cell replacement have fewer symptoms of
osteoarthritis. Actual cartilage repair is limited, however.
- Stem cell transplantation: Stem cells are primitive cells
that can transform into other kinds of cells, such as muscle or bone
cells. They usually are taken from bone marrow. In the future,
researchers hope to insert stem cells into cartilage, where the cells
will make new cartilage. If successful, this process could be used to
repair damaged cartilage and avoid the need for surgical joint
replacements with metal or plastics.
- Gene therapy: Scientists are working to genetically
engineer cells that would inhibit the body chemicals, called enzymes,
that may help break down cartilage and cause joint damage. In gene
therapy, cells are removed from the body, genetically changed, and
then injected back into the affected joint. They live in the joint and
protect it from damaging enzymes.
Comprehensive Treatment Strategies:
Effective treatment for osteoarthritis takes more than medicine or
surgery. Getting help from a variety of care professionals often can
improve patient treatment and self-care. Research shows that adding
patient education and social support is a low-cost, effective way to
decrease pain and reduce the amount of medicine used.
Exercise plays a key part in comprehensive treatment.
Researchers are studying exercise in greater detail and finding out just
how to use it in treating or preventing osteoarthritis. For example,
several scientists have studied knee osteoarthritis and exercise. Their
results included the following:
- Strengthening the thigh muscle (quadriceps) can relieve symptoms
of knee osteoarthritis and prevent more damage.
- Walking can result in better functioning, and the more you walk,
the farther you will be able to walk.
- People with knee osteoarthritis who were active in an exercise
program feel less pain. They also function better.
Research has shown that losing extra weight can help
people who already have osteoarthritis. Moreover, overweight or obese
people who do not have osteoarthritis may reduce their risk of
developing the disease by losing weight.
Using NSAIDs: Many people who have
osteoarthritis have persistent pain despite taking simple pain relievers
such as acetaminophen. Some of these patients take NSAIDs instead.
Health care providers are concerned about long-term NSAID use because it
can lead to an upset stomach, heartburn, nausea, and more dangerous side
effects, such as ulcers.
Scientists are working to design and test new, safer
NSAIDs. One example currently available is a class of selective NSAIDs
called COX-2 inhibitors. Traditional NSAIDs prevent inflammation by
blocking two related enzymes in the body called COX-1 and COX-2. The
gastrointestinal side effects associated with traditional NSAIDs seems
to be associated mainly with blocking the COX-1 enzyme, which helps
protect the stomach lining. The new selective COX-2 inhibitors, however,
primarily block the COX-2 enzyme, which helps control inflammation in
the body. As a result, COX-2 inhibitors reduce pain and inflammation but
are less likely than traditional NSAIDs to cause gastrointestinal ulcers
and bleeding. However, research shows that some COX-2 inhibitors may not
protect against heart disease as well as traditional NSAIDs, so check
with your doctor if you have concerns.
Drugs to Prevent Joint Damage: No treatment
actually prevents osteoarthritis or reverses or blocks the disease
process once it begins. Present treatments just relieve the symptoms.
Researchers are looking for drugs that would prevent, slow down, or
reverse joint damage. One experimental antibiotic drug, doxycycline, may
stop certain enzymes from damaging cartilage. The drug has shown some
promise in clinical studies, but more studies are needed. Researchers
also are studying growth factors and other natural chemical messengers.
These potential medicines may be able to stimulate cartilage growth or
Acupuncture: During an acupuncture
treatment, a licensed acupuncture therapist inserts very fine needles
into the skin at various points on the body. Scientists think the
needles stimulate the release of natural, pain-relieving chemicals
produced by the brain or the nervous system. Researchers are studying
acupuncture treatment of patients who have knee osteoarthritis. Early
findings suggest that traditional Chinese acupuncture is effective for
some patients as an additional therapy for osteoarthritis, reducing pain
and improving function.
Nutritional Supplements: Nutritional
supplements are often reported as helpful in treating osteoarthritis.
Such reports should be viewed with caution, however, since very few
studies have carefully evaluated the role of nutritional supplements in
- Glucosamine and chondroitin sulfate: Both of these
nutrients are found in small quantities in food and are components of
normal cartilage. Scientific studies on these two nutritional
supplements have not yet shown that they affect the disease. They may
relieve symptoms and reduce joint damage in some patients, however.
The National Center for Complementary and Alternative Medicine at the
NIH is supporting a clinical trial to test whether glucosamine,
chondroitin sulfate, or the two nutrients in combination reduce pain
and improve function. Patients using this therapy should do so only
under the supervision of their doctor, as part of an overall treatment
program with exercise, relaxation, and pain relief.
- Vitamins D, C, E, and beta carotene: The progression of
osteoarthritis may be slower in people who take higher levels of
vitamin D, C, E, or beta carotene. More studies are needed to confirm
Hyaluronic Acid: Injecting this substance
into the knee joint provides long-term pain relief for some people with
osteoarthritis. Hyaluronic acid is a natural component of cartilage and
joint fluid. It lubricates and absorbs shock in the joint. The Food and
Drug Administration (FDA) approved this therapy for patients with
osteoarthritis of the knee who do not get relief from exercise, physical
therapy, or simple analgesics. Researchers are presently studying the
benefits of using hyaluronic acid to treat osteoarthritis.
Estrogen: In studies of older women,
scientists found a lower risk of osteoarthritis in women who had used
oral estrogens for hormone replacement therapy. The researchers suspect
having low levels of estrogen could increase the risk of developing
osteoarthritis. Additional studies are needed to answer this
Hope for the Future
Research is opening up new avenues of treatment for people
with osteoarthritis. A balanced, comprehensive approach is still the key
to staying active and healthy with the disease. People with
osteoarthritis should combine exercise, relaxation education, social
support, and medicines in their treatment strategies. Meanwhile, as
scientists unravel the complexities of the disease, new treatments and
prevention methods should appear. They will improve the quality of life
for people with osteoarthritis and their families.
National Institute of Arthritis and Musculoskeletal and
National Institutes of Health
Bethesda, MD 20892-3675
(301) 495-4484 or (877) 22-NIAMS
(free of charge)
TTY: (301) 565-2966
Fax: (301) 718-6366
NIAMS provides information about various forms of
arthritis and rheumatic diseases. It distributes patient and
professional education materials and also refers people to other sources
American College of Rheumatology
1800 Century Place,
Atlanta, GA 30345
This association provides referrals to rheumatologists and
physical and occupational therapists who have experience working with
people who have osteoarthritis. The organization also provides
educational materials and guidelines.
American Academy of Orthopaedic Surgeons
Des Plaines, IL 60017
(800) 824-BONE (2663) (free of
The academy provides education and practice management
services for orthopaedic surgeons and allied health professionals. It
also serves as an advocate for improved patient care and informs the
public about the science of orthopaedics. The orthopaedist's scope of
practice includes disorders of the body's bones, joints, ligaments,
muscles, and tendons. For a single copy of an AAOS brochure, send a
self-addressed stamped envelope to the address above or visit the AAOS
1330 West Peachtree
Atlanta, GA 30309
Call your local chapter (listed in the
or (800) 283-7800 (free of
The foundation is a major voluntary organization devoted
to supporting research on arthritis and other rheumatic diseases. The
foundation publishes a free pamphlet on osteoarthritis and a magazine
for members on arthritis and related conditions. It also provides
up-to-date information on treatments, nutrition, alternative therapies,
and self-management strategies. Chapters nationwide offer exercise
programs, classes, support groups, physician referral services, and free
The NIAMS gratefully acknowledges the assistance of Gayle
Lester, Ph.D., Joan McGowan, Ph.D., James Panagis, M.D., Susana
Serrate-Sztein, M.D., and Bernadette Tyree, Ph.D., NIAMS, NIH; Kenneth
D. Brandt, M.D., Indiana University School of Medicine, Indianapolis;
Victor M. Goldberg, M.D., University Hospitals of Cleveland; Marc C.
Hochberg, M.D., M.P.H., University of Maryland, Baltimore; John Klippel,
M.D., the Arthritis Foundation, Atlanta; and Roland Moskowitz, M.D.,
Case Western Reserve University, Cleveland, in preparation and review of
this publication. Special thanks also go to the patients who reviewed
this publication and provided valuable input. Debbie Novak of Johnson,
Bassin, and Shaw, Inc. wrote this booklet.
About NIAMS and Its Clearinghouse:
The mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of the National
Institutes of Health (NIH), is to support research into the causes,
treatment, and prevention of arthritis and musculoskeletal and skin
diseases, the training of basic and clinical scientists to carry out
this research, and the dissemination of information on research progress
in these diseases. The National Institute of Arthritis and
Musculoskeletal and Skin Diseases Information Clearinghouse is a public
service sponsored by the NIAMS that provides health information and
information sources. Additional information can be found on the NIAMS
Web site at http://www.niams.nih.gov/index.htm.
This booklet is not copyrighted. Readers are encouraged to
duplicate and distribute as many copies as needed. Additional copies of
this booklet are available from
National Institute of
Arthritis and Musculoskeletal and Skin Diseases
Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
NIH Publication No.
Publication Date: July 2002