Osteoarthritis (OA) is the most common kind of arthritis. It is a joint disease caused by inflammation. Healthy cartilage, the firm, rubbery tissue that cushions bones at joints, lets bones glide over one another while cartilage absorbs energy from the movement. In OA, cartilage breaks down and wears away. As a result, the bones rub together causing pain, swelling, and stiffness.
OA may also limit the range of motion in affected joints. Most often, OA develops in the hands, knees, hips, and spine.
OA affects more women than men. It is a common condition, especially as you get older. Symptoms tend to show up when people are in their 50s and 60s, although an injury to a joint or overuse can cause OA when you are younger. More than 20 million people in the United States have OA.
Signs and Symptoms
Signs and symptoms of OA may include the following:
Most of the time, the cause of OA is unknown. It is associated with aging. However, metabolic, genetic, chemical, and mechanical factors can play a role in getting OA.
Risk factors for OA include:
There is no single test to diagnose OA. Most doctors use a combination of methods to diagnose the disease and rule out other causes. A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness. An x-ray of affected joints will show loss of the joint space and, in advanced cases, wearing down of the ends of the bone and bone spurs.
You may reduce the risk of developing OA by:
While researchers are working on ways to regrow cartilage, those treatments are not yet available. Current goals when treating OA are to relieve pain and improve range of motion of the joint. Specific treatment depends upon which joint is affected. A combination of conventional treatment and complementary and alternative medicine (CAM) may be most effective.
These lifestyle changes may help improve symptoms of OA:
Several studies confirm the benefits of exercise for people with OA. Research also suggests that, in addition to reducing pain and disability, exercise improves strength, range of motion, balance and coordination, endurance, and posture.
Walking is great exercise. If walking is too painful, try warm-water exercise. Water supports your joints and the warmth is soothing. Also, gentle range of motion exercises can increase your flexibility and reduce pain in affected joints. Your doctor may recommend physical therapy for specific joints.
Acetaminophen (Tylenol). Relieves pain, although it does not reduce inflammation. Long-term use or high doses can cause liver damage, especially if you drink alcohol.
Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs relieve pain and reduce inflammation and swelling. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and may raise your risk of heart problems. In April 2005, the U.S. Food and Drug Administration (FDA) asked drug manufacturers of NSAIDs to include warning labels on their products that alert users of an increased risk for stomach bleeding. Over-the-counter NSAIDs include:
Stronger versions are available as prescription drugs.
Celecoxib (Celebrex). Blocks an inflammation-promoting enzyme called COX-2. At first, researchers thought these kinds of drugs worked as well as NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke prompted the FDA to take two similar drugs off the market. Celebrex is still available and labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest amount of time. If you are not getting pain relief from NSAIDs, or cannot take them because of stomach problems, ask your doctor about the benefits and risks of Celebrex.
Corticosteroids (cortisone shot). Injected directly into the joint to reduce inflammation and pain. Too many injections may cause joint damage, so your doctor may limit the number of treatments.
Surgery and Other Procedures
Surgery to replace or repair damaged joints may be needed in severe, debilitating cases. Surgical and other options include:
Nutrition and Dietary Supplements
Eating a balanced, healthy diet can help reduce inflammation in your body, and may also help you lose weight or stay at a proper weight. These diet tips can help:
These specific supplements may help with OA pain:
Glucosamine/chondroitin, for joint health. Results from several well-designed scientific studies suggest that glucosamine supplements may work for OA, particularly OA of the knee or hip. In general, these studies suggest that glucosamine reduces pain, improves function in people with hip or knee OA, reduces joint swelling and stiffness, and provides relief from OA symptoms for up to 3 months after treatment is stopped.
Omega-3 fatty acids, such as fish oil, to help reduce inflammation. Higher doses may be used by health care providers. Omega-3 fatty acids increase the risk of bleeding, especially if you also take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.
SAMe (s-adenosyl-L-methionine). Several studies suggest SAMe can help reduce OA pain. In one study, SAMe relieved pain as well as NSAIDs. In another study of people with knee OA, SAMe worked as well as Celebrex in lessening pain and improving joint function, although it took longer to feel the benefits. SAMe may interact with a number of drugs, including antidepressants, dextromethorphan (found in cough medicine), levodopa, meperidine (Demerol), and tramadol (Ultram). People with bipolar disorder should not take SAMe because of the risk of mania. Ask your doctor before taking SAMe.
Avocado soybean unsaponifiables (ASUs). A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and maybe even slow progression of the disease. More research is needed to know whether ASUs can actually stop joint damage. ASUs increase the risk of bleeding, especially if you also take blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.
Bromelain. This enzyme that comes from pineapples reduces inflammation. Bromelain increases the risk of bleeding, especially if you also take blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin. People with stomach ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.
Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures or liquid extracts (alcohol extraction, unless otherwise noted). Herbs can interact with medications or other herbs. Keep your physician informed about any herbs or supplements you're considering taking. Mix liquid extracts with favorite beverage.
Several controlled clinical trials suggest that the ancient Chinese practice of acupuncture works to treat OA pain. It may also help improve joint function. A few clinical studies have found that people with OA experience better pain relief and improvement in function from acupuncture than from NSAIDs, such as aspiroxicam.
Although there is no evidence that chiropractic care can stop joint damage from OA, some studies indicate that spinal manipulation may:
A review of the scientific literature suggests that chiropractic, especially when combined with glucosamine supplements and stretches and exercise, helps treat OA. Chiropractors will avoid using direct thrusts or pressure on red, swollen joints.
Physical therapy can improve muscle strength and motion at stiff joints. Physical therapists have many techniques for treating OA.
Manual therapy and supervised exercise may help you put off joint replacement surgery for a time or even avoid it. In one study of people with OA of the knee, those who got manual therapy to the lumbar spine, hip, ankle, and knees showed the following improvements:
Balneotherapy (Hydrotherapy or spa therapy)
Balneotherapy is one of the oldest forms of therapy for pain relief for people with arthritis. The term "balneo" comes from the Latin word for bath (balneum) and refers to bathing in thermal or mineral waters. Sulfur-containing mud baths, for example, have been shown to relieve symptoms of arthritis. However, hydrotherapy, which can be performed under the guidance of certain physical therapists, is sometimes referred to with the word balneotherapy. The goals of balneotherapy for arthritis include:
Although balneotherapy is most often used for psoriatic or rheumatoid arthritis, some medical experts believe that it may help people with OA as well. However, one large review of clinical trials found little evidence to support its use.
Ice Massage, Transcutaneous Nerve Stimulation (TENS), and Electroacupuncture
In a well-designed trial comparing the effectiveness of TENS, electroacupuncture, and ice massage for the treatment of knee OA, each of these methods were found to:
Many physical therapists use TENS. When the nerve stimulation of TENS is applied to acupuncture points, it is called electroacupuncture.
Mechanical Aids (braces, splints)
Many mechanical devices, called orthoses, are available for people with OA to help support and protect joints. Made from lightweight metal leather, elastic, foam, and plastic, they allow some movement of the affected joint while not restricting nearby joints. For example, splints or braces help align joints and properly distribute weight. Shock-absorbing soles in shoes can help in daily activities and during exercise. Physical therapists use these mechanical aids most often to treat hands, wrists, knees, ankles, and feet. Orthoses should be custom-fitted by a physical or occupational therapist.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following treatments to alleviate symptoms of OA based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Although people with OA are best treated with an individualized homeopathic remedy chosen by a professional homeopath, several trials have found that some common homeopathic combinations may be at least as effective as conventional medications for OA. Potential remedies include:
Other Common Homeopathic Remedies for OA Include:
Chronic pain and disability can make daily life difficult. Treating the whole person and paying attention to the mind as well as the body can improve quality of life. Many people say that relaxation techniques, such as guided imagery and meditation, are an important part of their care, and help to reduce pain and other symptoms of OA.
This ancient Indian practice is well known for its physical, psychological, emotional, and spiritual benefits. In the West, it is often recommended to relieve musculoskeletal symptoms, and some studies have found it can help relieve OA pain. In one clinical trial among people with OA of the hand, the group practicing yoga showed less pain and better range of motion compared to those participating in non-yoga stretching and strengthening sessions. Some yoga "asanas" (postures) strengthen the quadriceps and emphasize stretching, both of which help people with OA of the knee. People with arthritis should begin asanas slowly and make sure they warm up first. Look for a reputable instructor who knows how to modify postures for people with arthritis.
This ancient form of classical conditioning has been practiced in China for centuries. Like yoga, it is sometimes recommended to help relieve arthritis pain. Clinical studies have found the following benefits of tai chi:
In a clinical trial of people with OA of the knee or hip (ranging in age from 49 to 81), those who practiced tai chi twice a week for 3 months showed improvement compared to those in the control group. Improvement was seen in the following areas:
Many of the herbs used to treat OA have not been tested on pregnant women, and some are known to be unsafe in pregnancy. DO NOT take any medication, herb, or supplement when you are pregnant without first talking to your obstetrician.
Prognosis and Complications
Complications of OA include:
Many people are able to control OA and prevent the condition from getting worse over time. Knee OA is still the number one cause of disability in the United States. In the most advanced stages, OA can cause complete cartilage loss. In some cases, joint replacement may be needed. While OA can be a debilitating condition, current treatments have shown great promise in reducing pain and improving mobility.
Bijlsma JW, Knahr K. Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Pract Res Clin Rheumatol. 2007;21(1):59-76.
Blain EJ, Ali AY, Duance VC. Boswellia frereana (frankincense) suppresses cytokine-induced matrix metalloproteinase expression and production of pro-inflammatory molecules in articular cartilage. Phytother Res. 2009 Nov 26. [Epub ahead of print]
Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2013;5:CD010538.
Cameron M, Gagnier JJ, Little CV, Parsons TJ, Blümle A, Chrubasik S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother Res. 2009 Nov;23(11):1497-515.
Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. 2007;21(7):675-83.
Clark KL. Nutritional considerations in joint health. Clin Sports Med. 2007;26(1):101-18.
Connelly AE, Tucker AJ, Tulk H, et al. High-rosmarinic acid spearmint tea in the management of knee osteoarthritis symptoms. J Med Food. 2014;17(12):1361-7.
Ferri: Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier; 2016.
Fraenkel L, Bogardus ST, Concato J, Wittink DR. Treatment options in knee osteoarthritis: the patient's perspective. Arch Intern Med. 2004 Jun;164(12):1299-304.
Frech TM, Clegg DO. The utility of nutraceuticals in the treatment of osteoarthritis. Curr Rheumatol Rep. 2007;9(1):25-30.
Gorsline RT, Kaeding CC. The use of NSAIDs and nutritional supplements in athletes with osteoarthritis: prevalence, benefits and consequences. Clin Sports Med. 2005 Jan;24(1):71-82.
Henrotin Y, Clutterbuck AL, Allaway D, Lodwig EM, Harris P, Mathy-Hartert M, Shakibaei M, Mobasheri A. Biological actions of curcumin on articular chondrocytes. Osteoarthritis Cartilage. 2009 Oct 8. [Epub ahead of print]
Kolasinski SL, Garfinkel M, Tsai AG, Matz W, Dyke AV, Schumacher HR. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005 Aug;11(4):689-93.
Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, Wattanamongkonsil L, Thamlikitkul V. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009 Aug;15(8):891-7.
Laufer S. Osteoarthritis therapy -- are there still unmet needs? Rheumatology. 2004 Feb;43;Suppl 1:i9-15.
Lee C, Straus WL, Balshaw R, Barlas S, Vogel S, Schnitzer TJ. A comparison of the efficacy and safety of nonsteroidal anti-inflammatory agents versus acetaminophen in the treatment of osteoarthritis: a meta-analysis. Arthritis Rheum. 2004 Oct;51(5)746-54.
Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology. 2012;20(2):53-8.
Leeb BF, Schweitzer KM, Smolen JS. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27(1):205-11.
Lin J, Zhang W, Jones A, Doherty M. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomized controlled trials. BMJ. 2004 Aug;329(7461):324.
Loeser RF. Agin processes and the development of osteoarthritis. Curr Opin Rheumatol. 2013;25(1):108-13.
Long L, Ernst E. Homeopathic remedies for the treatment of osteoarthritis: A systematic review. Br Homeopath J. 2001;90:37-43.
Mehta K, Gala J, Bhasale S, et al. Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]. BMC Complement Altern Med. 2007;7(1):34 [Epub ahead of print].
Misra D, Booth SL, Tolstykh I, et al. Vitamin K deficiency is associated with incident knee osteoarthritis. Am J Med. 2013;126(3):243-8.
Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician. 2003 Jan;67(2):339-44.
Mork PJ, Holtermann A, Nilsen TI. Effect of body mass index and physical exercise on risk of knee and hip osteoarthritis: longitudinal data from the Norwegian HUNT Study. J Epidemiol Community Health. 2012;66(8):678-83.
National Center for Complimentary and Alternative Medicine. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). J Pain Palliat Care Pharmacother. 2008;22(1):39-43.
Neogi T, Zhang Y. Epidemiology of Osteoarthritis. Rheumatic Diseases Clinics of North America. Philadelphia, PA: Elsevier Saunders. 2013;39(1).
Neugebauer V, Han JS, Adwanikar H, Fu Y, Ji G. Techniques for assessing knee joint pain in arthritis. Mol Pain. 2007;3:8.
Owens S, Wagner P, Vangsness CT. Recent advances in glucosamine and chondroitin supplementation. J Knee Surg. 2004 Oct;17(4):185-93.
Piscoya J, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJ, Sandoval M. Efficacy and safety of freeze-dried cat's claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis. Inflamm Res. 2001;50(9):442-8.
Reginster JY, Bruyere O, Neuprez A. Current role of glucosamine in the treatment of osteoarthritis. Rheumatology. 2007;46(5):731-5.
Richmond J, Hunter D, Irrgang J, et al; American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009 Sep;17(9):591-600.
Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008 Oct;58(10):3183-91.
Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Annals of the Rheumatic Diseases. August 2010.
Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary therapies for osteoarthristis: are they effective? Pain Manag Nurs. 2013;14(4):e274-88.
Sun BH, Wu CW, Kalunian KC. New developments in osteoarthritis. Rheum Dis Clin North Am. 2007;33(1):135-48.
Taylor NF, Dodd KJ, Shields N, Bruder A. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother. 2007;53(1):7-16.
Towheed TE, Anastassiades T. Glucosamine therapy for osteoarthritis: an update. J Rheumatol. 2007;34(9):1787-90.
Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, McAlindon T. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009 Nov 15;61(11):1545-53.
Wise CM. Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 2007;33(1):33-55.
Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomized trial. Lancet. 2005 Jul;366(9480):136-43.
Yazmalar L, Ediz L, Alpayci M, Hiz O, Toprak M, Tekeoglu I. Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis. Afr Health Sci. 2013;13(1):47-55.
Zhang FF, Driban JB, Lo GH, et al. Vitamin D deficiency is associated with progression of knee osteoarthritis. J Nutr. 2014;144(12):2002-8.
Review Date: 2/3/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.