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Osteoarthritis PDF
Osteoarthritis PDF
Osteoarthritis
O N
H A N D O U T
Illustrations
What Areas Does Osteoarthritis Affect? . . . . . . . . . . 3
A Healthy Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A Joint With Severe Osteoarthritis . . . . . . . . . . . . . . 6
Exercises for Osteoarthritis . . . . . . . . . . . . . . . . . . . 28
Information Boxes
Cartilage: The Key to Healthy Joints . . . . . . . . . . . . 7
The Warning Signs of Osteoarthritis . . . . . . . . . . . . . 9
Four Goals of Osteoarthritis Treatment . . . . . . . . . 12
Treatment Approaches to Osteoarthritis . . . . . . . . . 12
On the Move: Fighting Osteoarthritis
with Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Questions to Ask Your Doctor or Pharmacist
About Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Self-Management Programs Do Help . . . . . . . . . . . 26
Enjoy a Good Health Attitude . . . . . . . . . . . . . . . . . 29
Osteoarthritis
This booklet is for people who have osteoarthritis, their
families, and others interested in learning more about
the disorder. It describes osteoarthritis and its symptoms
and contains information about diagnosis and treatment,
as well as current research efforts supported by the
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS) and other components of the
U.S. Department of Health and Human Services National
Institutes of Health (NIH). The booklet also discusses
pain relief, exercise, and quality of life for people with
osteoarthritis. If you have further questions after reading
this booklet, you may wish to discuss them with your doctor.
What Is Osteoarthritis?
1
or cartilage can break off and float inside the joint
space. This causes more pain and damage.
2
What Areas Does Osteoarthritis Affect?
Osteoarthritis most often occurs in the hands (at the ends of the
fingers and thumbs), spine (neck and lower back), knees, and hips.
3
Americans about 72 million people will have passed
their 65th birthday and will be at high risk for the disease.
4
Fortunately, most people with osteoarthritis live
active, productive lives despite these limitations.
They do so by using treatment strategies such as rest
and exercise, pain relief medications, education and
support programs, learning self-care, and having a
good attitude.
5
A Healthy Joint
Medial collateral ligament
Joint capsule
Muscles Synovial membrane
Tendons
Posterior Anterior
cruciate cruciate
ligament ligament
Cartilage Bone
Tendons
Posterior Anterior
cruciate cruciate
ligament ligament
Worn-away Bone
cartilage Cartilage Synovial fluid
Lateral
collateral fragments
ligament in fluid
6
Ligaments, tendons, and muscles are tissues that
surround the bones and joints; they allow the joints
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,
when stimulated by nerves, either relax or contract
to produce movement.
7
How Do You Know if You Have Osteoarthritis?
8
Knees: The knees are among the joints most
commonly affected by osteoarthritis. Symptoms of
knee osteoarthritis include stiffness, swelling, and
pain, which make it hard to walk, climb, and get
in and out of chairs and bathtubs. Osteoarthritis
in the knees can lead to disability.
9
Spine: Osteoarthritis of the spine may show up as
stiffness and pain in the neck or lower back. In some
cases, arthritis-related changes in the spine can cause
pressure on the nerves where they exit the spinal
column, resulting in weakness or numbness of the
arms and legs.
Clinical history
The doctor begins by asking the patient to describe
the symptoms, when and how the condition started,
and how the symptoms have changed over time. The
doctor will also ask about any other medical problems
the patient and close family members have and
about any medications the patient is taking. Accurate
answers to these questions can help the doctor make
a diagnosis and understand the impact the disease has
on the patients life.
Physical examination
The doctor will check the patients reflexes and general
health, including muscle strength. The doctor will also
examine bothersome joints and observe the patients
ability to walk, bend, and carry out activities of
daily living.
10
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 It usually is not
by the x ray and the degree of pain difficult to tell
and disability felt by the patient.
Also, x rays may not show early if a patient has
osteoarthritis damage before much osteoarthritis. It
cartilage loss has taken place.
is more difficult
Magnetic resonance imaging to tell if the
Also known as an MRI, magnetic disease is causing
resonance imaging provides
the patients
high-resolution computerized
images of internal body tissues. This symptoms.
procedure uses a strong magnet that
passes a force through the body
to create these images. Doctors
often use MRI tests if there is pain, if x-ray findings
are minimal, and if the findings suggest damage to
other joint tissues such as a ligament or to the pad of
connective tissue in the knee known as the meniscus.
Other tests
The doctor may order blood tests to rule out other
causes of symptoms. He or she may also order a
joint aspiration, which involves drawing fluid from
the joint through a needle and examining the fluid
under a microscope.
11
It usually is not difficult to tell if a patient has
osteoarthritis. It is more difficult to tell if the disease is
causing the patients 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 can be influenced greatly by the patients
attitude, anxiety, depression, and daily activity level.
12
How Is Osteoarthritis Treated?
13
On the Move: Fighting Osteoarthritis
withExercise
You can use exercises to keep strong and limber,
improve cardiovascular fitness, extend your
joints range of motion, and reduce your weight.
The following types of exercise are part of a
well-rounded treatment plan for arthritis.
n Strengthening exercises strengthen muscles
that support joints affected by arthritis. They
can be performed with weights or with exercise
bands, inexpensive devices that add resistance.
n Aerobic activities such as walking or low-impact
aerobics, get your heart pumping and can keep
your lungs and circulatory system in shape.
n Range-of-motion activities keep your
joints limber.
n Agility exercises can help you maintain
daily living skills.
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 nonsteroidal anti-inflammatory drugs
(NSAIDs) to make exercising easier, or (2) use
ice afterward.
14
Weight control
Osteoarthritis patients who are overweight or obese
should try to lose weight. Weight loss can reduce
stress on weight-bearing joints, limit further injury,
and increase mobility. A dietitian can help you
develop healthy eating habits. A healthy diet and
regular exercise help reduce weight.
15
Nondrug pain relief
People with osteoarthritis may find many nondrug
ways to relieve pain. Below are some examples:
16
Medications to control pain
Doctors prescribe medicines to eliminate or reduce
pain and to improve functioning. They consider a
number of factors when choosing
medicines for their patients with
osteoarthritis. These factors include
the intensity of pain, potential Most medicines
side effects of the medication, used to treat
your medical history (other health
osteoarthritis
problems you have or are at risk
for), and other medications you have side effects,
are taking. so it is important
Because some medications can for people to
interact with one another and learn about
certain health conditions put you
at increased risk of drug side the medicines
effects, its important to discuss they take.
your medication and health history
with your doctor before you start
taking any new medication and
to see your doctor regularly while you are taking
medication. By working together, you and your
doctor can find the medication that best relieves
your pain with the least risk of side effects.
17
The following types of medicines are commonly used
in treating osteoarthritis:
18
called prostaglandins that contribute to inflammation
and pain. However, each NSAID is a different
chemical, and each has a slightly different effect on
the body.
19
Tramadol (Ultram): A prescription pain reliever
that is sometimes prescribed when over-the-counter
medications dont provide sufficient relief. It
carries risks that dont exist with acetaminophen
and NSAIDs, including the potential for addiction.
20
Because most medicines used to treat osteoarthritis
have side effects, its important to learn as much as
possible about the medications you take, even the
ones available without a prescription. Certain health
problems and lifestyle habits can increase the risk of
side effects from NSAIDs. These include a history of
peptic ulcers or digestive tract bleeding, use of oral
corticosteroids or anticoagulants (blood thinners),
smoking, and alcohol use.
21
Surgery
For many people, surgery helps relieve the pain and
disability of osteoarthritis. Surgery may be performed
to achieve one or more of the following:
n removal of loose pieces of bone and cartilage
from the joint if they are causing symptoms
of buckling or locking
n repositioning of bones
n resurfacing (smoothing out) of bones.
22
Complementary and alternative therapies
When conventional medical treatment doesnt
provide sufficient pain relief, people are more
likely to try complementary and alternative
therapies. The following are some alternative
therapies used to treat osteoarthritis.
23
Who Treats Osteoarthritis?
24
Physiatrists (rehabilitation specialists): medical
doctors who help patients make the most of their
physical potential.
25
1. Get educated: To live well with osteoarthritis, it
pays to learn as much as you can about the disease.
Three kinds of programs help people understand
osteoarthritis, learn self-care, and improve their
good health attitude. They are:
n patient education programs
n arthritis self-management programs
n arthritis support groups.
26
2. Stay active: Regular physical activity plays a key
role in self-care and wellness. Three types of exercise
are important in osteoarthritis management.
Strengthening exercises help keep or increase muscle
strength. Strong muscles help support and protect
joints affected by arthritis. Aerobic conditioning exercises
improve cardiovascular fitness, help control weight,
and improve overall function. Range-of-motion
exercises help reduce stiffness and maintain or
increase proper joint movement and flexibility.
27
Exercises for Osteoarthritis
Strengthening
Aerobic conditioning
Range of motion
People with osteoarthritis should do different kinds of exercise
for different benefits to the body. Consult your health
professional before starting.
28
4. Get plenty of sleep: Getting a good nights sleep on a
regular basis can minimize pain and help you cope better
with the effects of your disease. If arthritis pain makes
it difficult to sleep at night, speak with your doctor or
physical therapist about the best mattress, the most
comfortable sleeping positions, or the possibility of
timing medications to provide more pain relief at night.
You may also improve your sleep by getting enough
exercise early in the day; avoiding caffeine or alcoholic
beverages at night; keeping your bedroom dark, quiet,
and cool; and taking a warm bath to relax and soothe
sore muscles at bedtime.
Diagnostic tools
Scientists are searching for ways to detect
osteoarthritis at earlier stages so they can treat it
sooner. Abnormalities in the blood, joint fluid, or
urine of people with osteoarthritis may provide clues.
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. Many studies now involve
the development of a rapid MRI procedure that
doctors use to evaluate joint cartilage quickly and
noninvasively. The procedure could potentially be
used to diagnose the disease. More important, it may
be an effective method to study disease progression.
31
Genetics studies
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. For example,
scientists have identified a mutation
(a gene defect) affecting collagen, an
Osteoarthritis important part of cartilage, in patients
with an inherited kind of osteoarthritis
in all its various
that starts at an early age. The
forms appears mutation weakens collagen protein,
to have a which may break or tear more easily
under stress. Scientists are looking for
strong genetic other gene mutations in osteoarthritis.
connection. Researchers have also 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(s)
could help people reduce their risk for osteoarthritis
by making 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 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 NIAMS are exploring three types of
tissue engineering. The two most common methods
32
being studied today include cartilage cell replacement
and stem cell transplantation. The third method is
gene therapy.
33
Gene therapy: Scientists are working to genetically
engineer cells that would inhibit certain 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 reside in the joint and secrete
substances that inhibit the damaging enzymes.
Patient education
Effective treatment for osteoarthritis takes more
than medicine or surgery. Getting help from a variety
of health care professionals often can improve
patient treatment and self-care. (See Who Treats
Osteoarthritis?on page 24.) 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. One NIAMS-funded
project involves developing and testing an interactive
Web site by which health professionals and patients
could communicate concerning appointments and
treatment instructions, thus giving patients a greater
role in, and control of, their care.
34
n People with knee osteoarthritis who are active
in an exercise program feel less pain. They also
function better.
Treatment
Researchers are studying the effectiveness of a variety
of different types of treatment. These include:
35
n risedronate, a bisphosphonate drug. In a recent
British study of several hundred people with
mild to moderate osteoarthritis of the knee,
those treated with risedronate showed a clear
trend toward reduced symptoms and improved
joint structure.
36
Complementary and alternative therapies:
n acupuncture: One of the most popular alternative
pain-relief methods is acupuncture, an ancient
Chinese practice in which fine needles are
inserted at specific points in the body. According
to research funded by the National Center for
Complementary and Alternative Medicine,
acupuncture may help reduce pain and improve
function for individuals with knee osteoarthritis
when used as an adjunct to medication.
One study under way compares the benefits
of acupuncture with physical therapy to the
benefits of physical therapy alone. The hope
is that acupuncture will help relieve pain that
makes exercise difficult and, therefore, will
improve the effectiveness of traditional exercise
and physical therapy.
n glucosamine and chondroitin sulfate: In
recent years, the nutritional supplement pair
glucosamine and chondroitin has shown some
potential for reducing the pain of osteoarthritis,
although no conclusive proof has emerged to
date. Both of these nutrients are found in
small quantities in food and are components
of normal cartilage.
The recently concluded Glucosamine/Chondroitin
Arthritis Intervention Trial (GAIT), which
was cosponsored by the National Center for
Complementary and Alternative Medicine
and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, assessed the
effectiveness and safety of these supplements,
when taken together or separately.
37
The trial found that the
combination of glucosamine
The GAIT trial and chondroitin sulfate did not
assessed the provide significant relief from
osteoarthritis pain among all
effectiveness
participants. However, a smaller
and safety of subgroup of study participants
the supplements with moderate to severe pain
showed significant relief with
glucosamine the combined supplements.
and chondroitin The 4-year trial was conducted at
sulfate. 16 sites across the United States.
The results were published in the
February 23, 2006, edition of the
New England Journal of Medicine.
38
n green tea: Many studies have shown that green
tea has anti-inflammatory properties. One
recent study showed that mice predisposed to a
condition similar to human osteoarthritis had
mild arthritis and little evidence of cartilage
damage and bone erosion when green tea
polyphenols were added to their drinking
water. Another study showed that when added
to human cartilage cell cultures, the active
ingredients in green tea inhibited chemicals
and enzymes that lead to cartilage damage
and breakdown. Further studies are looking
at the effects of green tea compounds on
human cartilage.
39
Hope for the Future
Additional Resources
National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 3014954484 or
87722NIAMS (2264267) (free of charge)
TTY: 3015652966
Fax: 3017186366
E-mail: [email protected]
www.niams.nih.gov
40
NIH Osteoporosis and Related Bone Diseases ~
National Resource Center (NIH ORBD~NRC)
2 AMS Circle
Bethesda, MD 20892-3676
Phone: 2022230344 or
800624BONE (2663) (free of charge)
TTY: 2024664315
Fax: 2022932356
www.niams.nih.gov/bone
41
American Academy of Orthopaedic Surgeons (AAOS)
P.O. Box 1998
Des Plaines, IL 60017
Phone: 8478237186 or
800824BONE (2663) (free of charge)
Fax: 8478238125
www.aaos.org
Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357-0669
Phone: 4048727100 or
8002837800 (free of charge)
Fax: 7036847343
www.arthritis.org
44
Chondroitin sulfate a naturally existing substance in
joint cartilage that is believed to draw fluid into the
cartilage. Chondroitin is often taken in supplement form
along with glucosamine as a treatment for osteoarthritis.
(For more information, see the glucosamine and
chondroitin sulfate section under Complementary
and alternative therapies on page 37.)
45
Heberdens nodes small, bony knobs associated with
osteoarthritis of the hand that can occur on the joints
of the fingers closest to the nail.
46
Osteoarthritis the most common form of arthritis. It
is characterized by the breakdown of joint cartilage,
leading to pain, stiffness, and disability.
47
Synovial fluid a fluid secreted by the synovium that
lubricates the joint and keeps the cartilage smooth
and healthy.
48
Acknowledgments
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., Arthritis Foundation, Atlanta; and
Roland Moskowitz, M.D., Case Western Reserve
University, Cleveland, in the preparation and review
of this publication. Special thanks also go to the
patients who reviewed this publication and provided
valuable input.
49
The mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of
theU.S. Department of Health and Human Services
National Institutes of Health (NIH), is to support
research into thecauses, treatment, and prevention
of arthritis and musculoskeletal and skin diseases;
training of basic and clinical scientists to carry out this
research; and dissemination of information on research
progress in thesediseases. The NIAMS Information
Clearinghouse is a public service sponsored by the
Institute that provides health information and
information sources. Additional information can be
found on the NIAMS Website at www.niams.nih.
gov. Information on bone and its disorders can be
obtained from the NIH Osteoporosis and Related
Bone Diseases ~ National Resource Center by calling
(toll free) 800624BONE (2663) or by visiting its
Web site at www.niams.nih.gov/bone.
U.S. Department of Health and
Human Services
Public Health Service
National Institutes of Health
National Institute of Arthritis and
Musculoskeletal and Skin Diseases