Osteoarthritis: Symptoms, Causes & Treatment Options

What Is Osteoarthritis?

Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage, the smooth protective tissue covering the ends of bones in joints. As cartilage deteriorates, bones may rub together causing pain, stiffness, and reduced mobility. It is the most common form of arthritis, affecting over 500 million people worldwide.

Osteoarthritis develops when the balance between cartilage breakdown and repair is disrupted. In a healthy joint, cartilage acts as a cushion that allows bones to glide smoothly against each other during movement. The cartilage in joints is hard and smooth, preventing the bone surface from wearing or being damaged while facilitating easy movement.

When osteoarthritis develops, more cartilage is broken down than rebuilt. This causes the cartilage to become thinner, and in some areas, cartilage may be completely absent from the joint surfaces. This can lead to irritation and inflammation within the joint. The soft tissues surrounding the joint, including ligaments and muscles, are also affected by osteoarthritis. Over time, the joint may become stiff, painful, or swollen.

Osteoarthritis can also cause inflammation in the joint, leading to swelling. The severity of symptoms varies greatly between individuals – some people experience minimal discomfort while others have significant pain and disability. The disease typically progresses slowly over years, though symptoms may fluctuate with periods of increased and decreased discomfort.

Understanding osteoarthritis has evolved significantly in recent years. Previously considered simply "wear and tear," researchers now recognize that osteoarthritis involves complex biological processes including inflammation, metabolic changes, and cellular stress responses. This understanding has led to improved treatment approaches and ongoing research into disease-modifying therapies.

How Joints Work

A joint is where two or more bones meet. The surfaces of the bones that meet are called joint surfaces. On these joint surfaces sits cartilage. The cartilage in joints is hard and smooth, allowing the bone surfaces to glide against each other easily, which facilitates movement in the joint.

Joints are surrounded by a joint capsule filled with synovial fluid, which lubricates the joint and provides nutrients to the cartilage. Ligaments connect bones to each other and provide stability, while tendons connect muscles to bones and enable movement. When any of these components are affected, joint function can be compromised.

What Are the Symptoms of Osteoarthritis?

The main symptoms of osteoarthritis include joint pain that worsens with activity, stiffness (especially in the morning or after rest), swelling, decreased range of motion, and crackling or popping sounds during movement. Symptoms typically develop gradually and may come and go in periods.

Osteoarthritis symptoms vary depending on which joints are affected and how advanced the disease has become. The hallmark symptom is joint pain, which typically worsens with activity and improves with rest. However, as the disease progresses, some people experience pain even at rest or during the night. Understanding the pattern of symptoms can help distinguish osteoarthritis from other conditions.

Morning stiffness is characteristic of osteoarthritis, but unlike inflammatory arthritis conditions such as rheumatoid arthritis, the stiffness typically lasts less than 30 minutes. You may also notice stiffness after sitting still for a period of time, which usually eases once you start moving. This phenomenon, sometimes called "gelling," occurs because the joint fluid thickens during rest and becomes more fluid with movement.

The affected joint may become swollen, and you may notice difficulty moving the body part. Some people hear crackling, grinding, or popping sounds from the joint during movement, which doctors call crepitus. This occurs when roughened joint surfaces or bone spurs rub together. While crepitus can be concerning, it doesn't necessarily indicate more severe disease or damage.

Symptoms often fluctuate over time. Many people experience periods of increased symptoms followed by periods of relative comfort. Weather changes, activity levels, and other factors may influence symptom severity. Understanding these patterns can help you manage your condition more effectively.

Knee Osteoarthritis

If you have knee osteoarthritis, the knee feels stiff and painful. The pain is felt primarily in and around the knee and may occur during activity or even at rest. The joint may become swollen and feel warm to the touch. You may have difficulty with movements that require bending the knee, such as climbing stairs or rising from a seated position. The knee may also lock up, and you may hear clicking or grinding sounds. Some people develop a bow-legged or knock-kneed appearance as the disease progresses.

Hip Osteoarthritis

The hip feels stiff and painful if you have hip osteoarthritis. The pain is felt primarily in the groin or on the outer side of the hip and can radiate down toward the knee. Pain may occur when walking and bearing weight on the joint, but hip osteoarthritis can also cause pain at rest. You may experience increased pain when bending the hip joint, such as when tying your shoes or getting in and out of a car.

Hand and Finger Osteoarthritis

With osteoarthritis in the hand joints, you may experience pain, swelling, and stiffness. This can make gripping objects more difficult and may weaken your hand. You may also develop bony nodules around the finger joints (Heberden's nodes on the outer joints, Bouchard's nodes on the middle joints). Osteoarthritis can also affect the wrist joint, causing pain and stiffness.

Spine Osteoarthritis

Osteoarthritis in the spinal joints can cause stiffness and pain in both the neck and lower back (lumbar region). However, back pain is common and can have many other causes. Spinal osteoarthritis is also called spondylosis. In some cases, bone spurs may compress nearby nerves, causing pain, numbness, or weakness in the arms or legs.

What Causes Osteoarthritis?

Osteoarthritis develops when cartilage breakdown exceeds repair. Major risk factors include age over 50, obesity, previous joint injury, genetic predisposition, repetitive joint stress, and muscle weakness. While sometimes called "wear and tear arthritis," it involves complex biological processes beyond simple mechanical damage.

The exact cause of osteoarthritis is not fully understood, but research has identified several factors that increase the risk of developing the condition. Understanding these risk factors can help with prevention strategies and early intervention. Osteoarthritis is likely caused by a combination of genetic susceptibility, mechanical stress, and biological factors that together disrupt the normal balance of cartilage maintenance.

Age is the strongest risk factor for osteoarthritis. As we age, the ability of cartilage to repair itself decreases, making the joint more vulnerable to damage. However, osteoarthritis is not an inevitable part of aging – many older adults never develop significant symptoms. This suggests that other factors play important roles in determining who develops the disease.

Obesity significantly increases the risk of osteoarthritis, particularly in weight-bearing joints like the knees and hips. Excess weight puts additional mechanical stress on joints with every step. However, obesity also increases the risk of hand osteoarthritis, which suggests that metabolic factors associated with obesity – not just mechanical loading – contribute to the disease. Inflammatory substances produced by fat tissue may directly affect cartilage health.

Previous joint injury substantially increases the risk of developing osteoarthritis in that joint, often appearing years or even decades after the original injury. This includes injuries such as ligament tears (like ACL injuries), meniscus damage, and fractures near a joint. The injury may alter joint mechanics or damage the cartilage directly, setting the stage for later degeneration.

Genetic factors play a significant role, particularly in hand osteoarthritis. If osteoarthritis runs in your family, your risk is higher. Researchers have identified numerous genes associated with osteoarthritis risk, affecting factors such as cartilage structure, inflammation, and bone development.

• Obesity: Excess weight places high stress on joints, especially knees and hips
• Heredity: The risk of osteoarthritis is higher if the condition runs in your family
• Joint injury: Previous injuries can lead to osteoarthritis years later, including after ACL tears, meniscus injuries, or fractures near a joint
• Repetitive stress: Occupational or sports activities involving repetitive joint movements, such as heavy lifting
• Muscle weakness: Weak muscles provide less support and stability for joints
• Joint alignment: Abnormal joint mechanics can accelerate cartilage wear

How Can I Reduce My Risk of Osteoarthritis?

You can reduce your risk of osteoarthritis by maintaining a healthy weight, exercising regularly to strengthen muscles around joints, avoiding joint injuries, and addressing any joint problems early. Good examples of preventive activities include strength training, walking, running, or cycling.

While some risk factors for osteoarthritis cannot be changed (such as age and genetics), many modifiable factors can significantly reduce your risk or slow the progression of existing disease. Taking proactive steps to protect your joints can pay dividends throughout your life, maintaining mobility and reducing the likelihood of developing disabling symptoms.

Regular physical activity is one of the most important protective factors for joint health. Exercise strengthens the muscles that support and stabilize joints, maintains joint flexibility, and helps control weight. Contrary to what some people believe, regular moderate exercise does not cause osteoarthritis and is actually protective. Activities like walking, swimming, cycling, and strength training are particularly beneficial.

Maintaining a healthy weight is crucial for joint health, especially for weight-bearing joints. Every pound of body weight creates approximately four pounds of force across the knee during walking. Losing even a modest amount of weight can significantly reduce joint stress and symptom severity. Weight management also reduces the systemic inflammation associated with obesity that may contribute to cartilage damage.

Preventing joint injuries is another important strategy. Using proper techniques during sports and exercise, wearing appropriate protective equipment, and avoiding activities that place excessive stress on joints can help prevent the injuries that often lead to later osteoarthritis. If you do sustain a joint injury, proper treatment and rehabilitation are essential to minimize long-term consequences.

How Is Osteoarthritis Diagnosed?

Osteoarthritis is diagnosed primarily through physical examination and patient history. X-rays may be used to confirm the diagnosis but are often not necessary. Diagnosis focuses on your symptoms, joint examination findings, and ruling out other conditions. X-ray changes may not appear until the disease has progressed.

When you visit a healthcare provider for suspected osteoarthritis, they will examine you and ask about your symptoms. You will describe what bothers you, how symptoms affect your daily life, and whether you have any history of other illnesses or injuries. A physical therapist or occupational therapist may also evaluate you, particularly if you have hand problems.

The physical examination assesses your joint for pain, swelling, tenderness, range of motion, and any deformity. Your provider may also test the strength of muscles around the affected joint and observe how you move. These clinical findings, combined with your symptom history, are usually sufficient to diagnose osteoarthritis without additional testing.

X-rays are not required to diagnose osteoarthritis. The diagnosis is made primarily based on your symptoms and the examination findings. Sometimes X-rays are performed, but it can take a long time before changes in the cartilage become visible on X-ray images. Furthermore, the severity of X-ray changes often does not correlate well with symptom severity – some people with significant X-ray changes have minimal symptoms, while others with mild changes have considerable pain.

Additional tests such as MRI may be ordered in certain situations, such as when the diagnosis is unclear or when surgery is being considered. Blood tests may be performed to rule out inflammatory types of arthritis but are not necessary for diagnosing osteoarthritis itself.

How Is Osteoarthritis Treated?

The core treatments for osteoarthritis are patient education, exercise therapy, and weight management if needed. Regular exercise is more effective than pain medication for most people and should be the foundation of treatment. Medication and surgery are options for those who need additional help.

Treatment for osteoarthritis follows a stepped approach, starting with the most effective and least invasive options. For the vast majority of people, a combination of education, exercise, and weight management provides excellent symptom control without the need for medication or surgery. Understanding this is important because it empowers you to take an active role in managing your condition.

All major international guidelines emphasize that exercise and self-management education should be the first-line treatment for osteoarthritis. These approaches are more effective than pain medication for most people and have no negative side effects. In fact, regular exercise has numerous additional health benefits beyond joint health.

Education and Self-Management

As part of treatment, you will learn more about osteoarthritis and what it means to have the condition. You will learn about self-care and how to manage daily activities to reduce symptoms. This education is often called an "arthritis school" and may be provided individually, in groups, or through online resources. Understanding your condition helps you make informed decisions about treatment and lifestyle modifications.

Exercise Therapy – The Foundation of Treatment

Movement is beneficial for joints and for overall well-being. Regular exercise typically reduces osteoarthritis symptoms and decreases pain. For the vast majority of people with osteoarthritis, exercise is sufficient treatment. It is more effective than pain medication, which can also have side effects. Exercise maintains your strength and mobility and keeps your joints functioning well, thereby reducing the risk of recurrent pain.

It is important that you get an exercise program tailored to your specific needs. You may work with a physical therapist (or occupational therapist for hand problems) who can help you adapt and plan your training for the best results. For osteoarthritis, it is good to strengthen the muscles around the joint and train joint mobility through activities like walking, cycling, and strength training.

Having regular contact with a physical therapist can be valuable because your exercise program may need to be updated as your condition changes over time. You get the best results by making exercise a regular part of life. Find an exercise form that suits you and that you enjoy doing. A physical therapist can help you vary your training to maintain motivation.

Weight Management

Obesity can increase the load on your joints and worsen osteoarthritis symptoms. You may experience less pain and better mobility by losing weight. If needed, you can receive support and guidance on how to achieve a healthy weight. Even modest weight loss of 5-10% of body weight can produce meaningful improvements in symptoms.

Assistive Devices and Aids

You may receive additional treatment from a physical therapist or occupational therapist if exercise alone has not helped and you still have joint pain. Examples of treatments that some people find helpful include pain relief with TENS (transcutaneous electrical nerve stimulation), acupuncture for knee osteoarthritis, and supportive braces. You may also try various walking aids such as canes, crutches, walking poles, or walkers. An occupational therapist can help you try assistive devices if you have reduced hand strength, such as wrist supports or gripping tools.

Pain Medication

You may need to take pain medication with paracetamol (acetaminophen) or anti-inflammatory medications (NSAIDs). Talk to your doctor about which medication is best for you. Medications come in various forms including tablets, creams, and gels. If you have not been helped by other treatments, a corticosteroid injection may sometimes be considered, for example if you have knee osteoarthritis or finger osteoarthritis.

It is important to understand that while medication can provide temporary relief, it does not address the underlying problem and cannot replace exercise therapy. Pain medication should be used as a supplement to exercise and self-management, not as the primary treatment.

Surgery

Only a small proportion of people with osteoarthritis need surgery. You will be offered surgery only under certain circumstances, such as if you still have significant pain despite regular exercise and pain medication. Surgery may also be appropriate if you have severe pain even at rest and at night despite medication.

The most common surgery for osteoarthritis is joint replacement (arthroplasty), where an artificial joint replaces the damaged joint. This can be performed in the knee, hip, and other joints including fingers. Joint replacement is highly effective for appropriately selected patients, with most experiencing significant pain relief and improved function.

Recovery from joint replacement surgery typically involves physical therapy to regain strength and mobility. The length of sick leave depends on which joint was operated on, the type of work you do, and how quickly you can begin rehabilitation. The more you have exercised before surgery, the faster you typically recover afterward.

What Is It Like to Live with Osteoarthritis?

Living with osteoarthritis varies greatly depending on which joints are affected and how severe your symptoms are. Your quality of life is also influenced by how you manage the condition. Regular exercise and maintaining an active lifestyle are key to living well with osteoarthritis.

Osteoarthritis can affect life differently depending on which joint you have the condition in and how severe your symptoms are. Your quality of life is also influenced by what you do about your symptoms. A sedentary lifestyle often leads to increased osteoarthritis symptoms and increases the risk of complications such as diabetes and high blood pressure.

The most important thing is that you learn more about osteoarthritis and begin regular physical exercise. Stronger muscles often mean less pain and improved mobility. It is also good to work on your joint flexibility and cardiovascular fitness. Symptoms may come and go in periods, and you can view exercise as a lifelong treatment without side effects.

It is good to find a form of exercise that you enjoy and that gives you motivation to continue. It is not harmful to have some pain during or after exercise. A physical therapist can give you instructions and help you find different ways to exercise. Making changes in daily activities can also be very helpful, such as breaking up tasks into smaller portions rather than doing everything at once.

Many people with osteoarthritis find that they can live full, active lives with proper management. The key is taking an active role in your care, staying physically active, and working with healthcare providers to find the treatment approach that works best for you.