Osteoarthritis: everything you need to know about this joint disease

Do you suffer from osteoarthritis and finally want to find reliable information? Updated content next to search? Information on possible causes or treatments for osteoarthritis?

What is osteoarthritis?

Osteoarthritis is a chronic condition that manifests itself as persistent pain in the joints caused by abnormal wear of the cartilage and the entire joint. It is the most common form of arthritis: 1 in 10 Canadians have it.

The most frequently affected joints are the knee, hip, and spine. However, other joints, such as the shoulder, ankle, and wrist, can also be affected. Osteoarthritis of the fingers (digital osteoarthritis) is also very common, especially in women.

Remark. Osteoarthritis of the knee is also called gonarthrosis and osteoarthritis of the hip, coxarthrosis.

What happens when osteoarthritis appears?

In osteoarthritis, the cartilage gradually wears out and loses its original qualities, i.e. its flexibility and elasticity. However, we now know that the entire joint is affected in the case of osteoarthritis: in addition to cartilage, ligaments, bone, muscles, and synovial fluid are altered.

Thus, there is a loss of quality of synovial fluid, a clear, thick liquid similar to egg white that normally lubricates the joint (see diagram above). It is thought that osteoarthritis is the result of an imbalance in the continuous mechanisms of cartilage degradation and reconstruction.

At the beginning of the disease, there are no signs of inflammation. Over time, inflammation may appear. Inflammation is seen more rarely in osteoarthritis than in other forms of arthritis.

The different types of osteoarthritis

Primary osteoarthritis

When the person with osteoarthritis does not have an obvious predisposition, osteoarthritis is called “primary”.

Secondary osteoarthritis

Diseases that affect the joints, such as inflammatory diseases (rheumatoid arthritis, gout, lupus, etc.) and metabolic diseases (diabetes, hemochromatosis), predispose to osteoarthritis. The same is true of injuries and surgeries to a joint.

When there is a predisposition to either of these situations, it is secondary osteoarthritis.

Osteoarthritis: who is affected?

According to Statistics Canada, osteoarthritis affects 10% of the Canadian population, both men and women. After the age of 55, however, women are more affected.

The prevalence of osteoarthritis increases with age. By age 70, the majority of people suffer from osteoarthritis in one or more joints.

Osteoarthritis: what are the causes?

The causes of osteoarthritis are multiple. Mechanical factors are in the foreground, associated with genetic factors, a process of inflammation, etc.

Osteoarthritis is a disease resulting in abnormal degeneration of cartilage. Indeed, the wear and tear of a joint with age should not cause osteoarthritis. However, repetitive movements and repetitive strain injuries to a joint can cause abnormal wear leading to osteoarthritis.

Excess weight and lack of physical activity are 2 other important factors.

Osteoarthritis or osteoarthritis affects each individual differently.

To know all the symptoms, consult our dedicated sheet.

Osteoarthritis: Symptoms

Osteoarthritis or osteoarthritis affects each individual differently. The joints affected and the intensity of the pain varies from one person to another:

  • pain in the affected joint mainly when it is mobilized (for example knee pain when going down the stairs);
  • sensitivity of the joint when gentle pressure is applied;
  • stiffness of the joint, especially upon waking or after a period of immobility Morning stiffness lasts less than 30 minutes;
  • a progressive loss of flexibility in the joint;
  • discomfort in the joint as a result of temperature changes;
  • “crunching”, especially in cases of osteoarthritis of the knee;
  • the gradual appearance of small bony growths (osteophytes) at the joint;
  • More rarely, inflammation (redness, pain, and swelling of the joint).

Some people are at higher risk of developing osteoarthritis. Also, risk factors favor the onset of the disease.

Discover them here.

Osteoarthritis: people at risk

  • People whose joints are on the wrong axis. This is the case, for example, of people who have their knees turned inwards or outwards (genu valgum or varum);
  • people with a hereditary predisposition.

Osteoarthritis: risk factors

  • Age;
  • obesity;
  • repetitive movements caused by work or sport, which over time cause damage to the joints (see the special section Joints (sport and work));
  • the intensive practice of certain sports (rugby, soccer, tennis…);
  • joint trauma (sprains, fractures, dislocations);
  • a lack of physical activity, which decreases muscle tone, reduces blood supply to the muscles, and therefore leads to poor oxygenation of cartilage;
  • wearing high heels (for osteoarthritis of the knee).

Certain preventive measures can be put in place to prevent the onset of osteoarthritis.

Discover them in this sheet.

Osteoarthritis: basic preventive measures

Maintain a healthy weight

In case of excess weight, it is highly recommended to lose weight and maintain a healthy weight. The causal link between obesity and osteoarthritis of the knee is well demonstrated. Excess weight exerts a very strong mechanical stress on the joint, which wears it out prematurely.

It has been determined that every 8 kg above healthy weight during the twenties increases the risk of developing osteoarthritis of the knee by 70%.2. Obesity also increases the risk of osteoarthritis of the fingers but the mechanisms involved are not yet well explained.

Healthy weight is determined by body mass index (BMI), which gives the ideal weight scale, based on a person’s height. To calculate your BMI, use our What is your body mass index? test.

Engage in regular physical activity

Regular physical activity helps maintain good general health, ensures good oxygenation of the joints, and strengthens muscles. Strong muscles help protect the joints, especially the knee, and therefore limit the risk of osteoarthritis and symptoms.

Taking care of your joints

Protect your joints when playing a sport or work that puts you at risk of injury.

Whenever possible, avoid excessive repetitive movements or overstrain on a joint. However, the link between acute trauma and osteoarthritis is more definitely demonstrated than with chronic or repetitive strain injuries.

Treating joint diseases

In the event of a disease that may contribute to the occurrence of osteoarthritis (such as gout or rheumatoid arthritis), those affected should ensure that their condition is monitored as closely as possible through medical follow-up and appropriate treatment.

There is no cure at the moment, but there are treatments to relieve the pain.

Osteoarthritis: treatments

There is no cure at this time. In addition, no treatment is known to delay cartilage destruction. However, there are both drug and non-drug solutions that aim to relieve the pain and stiffness of the affected joints. They vary according to the intensity of the symptoms.

Non-drug treatments

The latest international recommendations5emphasize the importance of non-pharmacological measures to treat osteoarthritis, especially when it affects the knee or hip:

  • Regular practice of physical exercises, from 15 to 30 minutes, at least 3 times a week: walking, swimming, aerobics, adapted muscle strengthening, etc. The intensity of the exercises can be adapted to variations in the intensity of the pain;
  • weight loss in case of obesity or overweight. Losing 5% to 10% of your weight sometimes eliminates pain in case of osteoarthritis of the knee, by lightening the load on the joint;
  • physiotherapy if necessary;
  • adaptation of the work environment if the work causes joint trauma causing osteoarthritis.

When they are not enough, these measures can be supplemented by taking medication to relieve pain. In more severe cases, the doctor sometimes suggests surgery.

See the Arthritis fact sheet for other ways to soothe the pain.

Analgesic drugs

Acetaminophen (Tylenol®, Tempra®) is the recommended painkiller primarily for osteoarthritis. This medication is very effective, especially if the osteoarthritis is mild. It is important to follow the recommended dosage, as high doses can damage the liver.

More powerful analgesics may be prescribed if the pain is not relieved by acetaminophen or other medications (see below). Some contain a combination of acetaminophen and codeine. However, they can cause nausea, constipation, and drowsiness.

Anti-inflammatory drugs

Like other analgesics, these drugs do not act on the evolution of osteoarthritis, but on its symptoms. Because of their potential side effects, they are only used when acetaminophen at a maximum dose (4 g/day) fails to relieve pain.

Conventional nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation. The NSAID family includes ibuprofen (e.g., Advil and Motrin®), ketoprofen (e.g., Actron® and Orudis®), and naproxen (e.g., Anaprox® and Naproxen®).

Some are obtained over the counter and others, more powerful, are delivered on a doctor’s prescription. Because they can cause potentially serious digestive effects, they are sometimes combined with drugs that protect the stomach lining. They are used for the shortest possible period of time, as needed only.

Alcohol consumption is not recommended during treatment. Common side effects: gastrointestinal discomforts, such as heartburn, ulcers, or sometimes severe digestive bleeding.

Nonsteroidal Cox-2 inhibitor anti-inflammatory drugs (or coxibs)

This generation of anti-inflammatories, selective cyclooxygenase-2 (Cox-2) inhibitors or coxibs, works by inhibiting an enzyme, Cox-2, involved in the inflammatory process. They are less damaging to the stomach than conventional anti-inflammatories. Celecoxib (Celebrex®) is one of them.

Its use is generally reserved for people whose risk of gastrointestinal complications is considered high and whose risk of cardiovascular disease is low. Meloxicam (Mobicox®) also has an inhibitory effect on Cox-2, but less strongly than celecoxib.

Rofecoxib (Vioxx®), valdecoxib (Bextra®), and lumiracoxib (Prexige®) were withdrawn from the market by Health Canada between 2004 and 2007 because of the risk of serious side effects.6,7.

These drugs do not eliminate the risk of gastrointestinal symptoms and should be subjected to the same moderation as other anti-inflammatory drugs.

Topical anti-inflammatories

This type of anti-inflammatory gel or cream is applied directly to the painful joint (for example, Pennsaid® or Voltaren emulgel®, diclofenac topical solution). They are a good alternative to oral anti-inflammatories, as they do not cause digestive side effects.

However, in osteoarthritis of the hip or spine, it is not known whether the drug can penetrate deep enough (to the joints) to be effective.

Corticosteroid injections

In more severe cases, when the person has difficulty moving and the pain is not relieved by oral analgesics, the doctor will prescribe corticosteroid injections directly into the affected joint. People taking this treatment should expect relief that sets in gradually rather than immediately.

Only 2 to 4 corticosteroid injections can be given each year, to limit side effects, such as loss of bone minerals.

Hyaluronic acid injections

In cases of osteoarthritis of the hip or knee, hyaluronic acid injections can also relieve pain, but with a slower effect than corticosteroid injections.

This procedure is also called “viscosupplementation” because hyaluronic acid is a kind of gel that lubricates the joint, relieves pain, and provides better mobility.

However, studies conducted so far indicate that the beneficial effect of this treatment is relatively small. Several studies have not demonstrated a superior effect to a placebo.

Remark. Other drugs such as glucosamine or chondroitin are effective and frequently prescribed by doctors against osteoarthritis. See Complementary approaches.

Surgery

In case of failure of medical treatment and too much functional discomfort, surgical operations may be suggested. Arthroscopy removes cartilage and bone debris from the joint.

Other procedures can correct bone growths and deformities, weld joints, or rebuild part of the joint. As a last resort, replacement surgery will be performed. The affected joint (often the hip) is then replaced by an artificial joint (a metal or plastic prosthesis).

Tips

Take care of your joints. After doing an activity that puts more strain on a joint, give yourself a break. In case of severe pain, avoid straining the joint.

Moderate your physical efforts. Start exercise or physical exertion quietly and safely to avoid injury. Don’t engage in activities that are beyond your capabilities.

Have good posture. When standing, stand up straight to protect the joints in your neck, spine, hips, and knees.

Lift objects carefully. To pick up a heavy object, squat and bend your knees. When standing up, keep your back straight while keeping the object as close to your body as possible.

Avoid standing still for too long. Change position regularly to reduce stiffness in your muscles and joints.

Wear good shoes. If you have osteoarthritis in the knee or hip, wear comfortable shoes with good soles that cushion shocks and allow adequate weight distribution on the feet.

Use specialized devices. Supports can help you support your joints and thus facilitate movement. Consulting a doctor or occupational therapist helps you choose the right devices: canes, walkers, carts, and other supports.

Adapt the house as needed. For example, a faucet adapted to not twist the wrist and fingers, grab bars to move or stand, adapted covers, etc. An occupational therapist will be able to advise you.

In the case of osteoarthritis, some complementary approaches make it possible to treat it in a more natural way.

Check out the full and detailed list below.

Osteoarthritis: effective complementary approaches

Cayenne (Capsicum frutescens)

The U.S. Food and Drug Administration (FDA) has approved the use of creams, lotions, and ointments based on capsaicin (or capsaicin), the active compound in cayenne, to relieve pain caused by osteoarthritis.

International recommendations recommend the local use of capsaicin5, especially for osteoarthritis of the knee.

Dosage: Apply to affected areas, up to 4 times daily, a cream, lotion, or ointment containing 0.025% to 0.075% capsaicin. It often takes up to 14 days of treatment before the full therapeutic effect is felt. Be careful, a burning sensation may be perceived during application.

Glucosamine

Glucosamine plays an important role in maintaining the integrity of the cartilage of all joints. The body produces it naturally. The vast majority of studies were conducted with glucosamine sulfate.

Relieve joint pain (mild or moderate osteoarthritis)

Despite some controversies, the majority of research conducted to date shows that glucosamine relieves, at least slightly, the symptoms of mild or moderate osteoarthritis (see our glucosamine sheet). The vast majority of studies have focused on osteoarthritis of the knee, a few on osteoarthritis of the hip.

Slowing the progression of osteoarthritis

The conclusions of 2 long-term clinical trials (3 years each, 414 subjects in all)13-16 indicate that the action of glucosamine, in addition to its effects on symptoms, may contribute to slowing the progression of the disease. An advantage over NSAIDs, which tend to accelerate the progression of osteoarthritis.

Dosage: Take 1,500 mg glucosamine sulfate, in one or more doses, with food. Allow 2 to 6 weeks before the effects of the supplement are fully manifested.

Chondroitin

Like glucosamine, chondroitin is an essential constituent of cartilage and is naturally produced by the body. Most studies have been done with highly purified patented products (e.g. Condrosulf®, Structum®). Several meta-analyses, syntheses, and clinical trials conclude that it is effective in relieving the symptoms of mild to moderate osteoarthritis and slowing its progression.

As with glucosamine, this is an advantage over NSAIDs, which tend to accelerate the progression of osteoarthritis. Chondritin is also the subject of some controversy.

Consult our Chondroitin fact sheet to learn more about the studies conducted and the choice between glucosamine and chondroitin.

Dosage: Take chondroitin from 800 mg to 1,200 mg daily in one or more doses. It takes 2 to 8 weeks for the effect to be fully felt.

Sami

SAMe (for S-Adenosyl-L-Methionine) is synthesized by the body from proteins in food. Used in supplement form, it has proven itself in the treatment of osteoarthritis27. The results of the studies revealed that it was as effective as conventional anti-inflammatory drugs without adverse effects and is safe.

However, a meta-analysis provides a downside to the efficacy and safety of S-adenosylmethionine. According to its authors, several studies have methodological weaknesses and an insufficient number of participants. They conclude that the analgesic effect of SAMe (1,200 mg per day) is modest.

Dosage: Take 400 mg 3 times a day, for 3 weeks then reduce the daily dose to 200 mg, 2 times a day.

Remark. Although beneficial effects can be felt after only a few days, it can take up to 5 weeks for the treatment to take full effect. See our SAMe fact sheet for more details.

Devil’s claw (Harpagophytum procumbens)

Devil’s claw root has demonstrated an ability to reduce inflammation. Despite reservations about the methodology of some studies, the results of several clinical trials, with or without placebo groups, indicate that devil’s claw root can improve mobility and significantly relieve pain.

Dosage: dosages may vary depending on the type of extract. Follow the manufacturer’s instructions. It is recommended to follow the treatment for at least 2 or 3 months in order to take full advantage of its effects.

Phytodolor®

This standardized phytotherapeutic product, marketed in Europe as a tincture to be taken internally, consists of trembling aspen (Populus tremula), European ash (Fraxinus excelsior), and goldenrod (Solidago virgaurea) with a ratio of 3:1:1.

This product would be more effective than a placebo in reducing pain, increasing mobility, and reducing the consumption of nonsteroidal anti-inflammatory drugs.

Acupuncture

Several clinical trials have evaluated the effectiveness of acupuncture on osteoarthritis-related pain. A meta-analysis of more than 1,300 people concluded that acupuncture could reduce osteoarthritis-related pain and disability.

However, some trials have shown that sham acupuncture can also be effective. In any case, international recommendations on the management of osteoarthritis of the knee and hip5recognize acupuncture as a potentially effective means of pain relief.

Hydrotherapy

The results of various clinical trials show that hydrotherapy treatments in different forms (spa, baths using different kinds of water, etc.) could improve the quality of life of people with osteoarthritis, by increasing the range of motion and decreasing pain.

A systematic review, including 9 trials and nearly 500 patients, concludes that balneotherapy is effective in the short and long term on pain related to osteoarthritis of the knee.

Homeopathy

A few studies have been published on the effectiveness of homeopathy in reducing the pain and symptoms of osteoarthritis. The authors of a systematic review believe that homeopathy may be a useful treatment for osteoarthritis but that more studies are needed to ensure this.

See the Homeopathy sheet.

Unsaponifiable avocado and soybean

Substances extracted from avocado and soy – the unsaponifiable fraction of their oils – could be beneficial for people with osteoarthritis of the knee or hip.

According to 4 clinical studies with a placebo, these substances help improve joint function and reduce pain and the need for anti-inflammatory drugs, without adverse effects.

Magnetotherapy

Several studies have evaluated the effects of magnetotherapy, applied using static magnets or devices emitting electromagnetic fields (EMFs), in the treatment of osteoarthritis, particularly that of the knee.

Magnetotherapy would reduce pain modestly. In 2009, a synthesis including 9 studies and 483 patients with osteoarthritis of the knee concluded that magnetotherapy was an interesting complementary approach to improve functional capacity and facilitate daily activities…

Leeches

A pilot study55 and 2 randomized clinical trials56,57 conducted in Germany indicate that applying leeches to a knee with osteoarthritis can relieve pain, counteract stiffness and reduce other symptoms.

Leeches have been traditionally used in the treatment of pain since ancient times and then abandoned in the mid-nineteenth century. However, they are still commonly used in traditional medicines from Asia, Africa, and Arab countries.

White Willow (Salix alba)

White willow bark extracts would be more effective than a placebo in reducing joint pain caused by osteoarthritis. However, in a trial of 127 participants with osteoarthritis of the knee or hip, these extracts were significantly less effective than an anti-inflammatory drug (diclofenac).

Yoga

The results of clinical trials conducted in healthy subjects and people with various musculoskeletal disorders reveal that the practice of yoga can help improve many aspects of these conditions, including osteoarthritis of the hands and knees and rheumatoid arthritis.

Transcutaneous electrical stimulation (TENS)

This technique uses a device that generates a low-intensity electric current, transmitted to the nerves by electrodes placed on the skin.

A review of studies suggested that transcutaneous electrical nerve stimulation may lead to decreased pain in knee osteoarthritis… However, an update published by the same group of researchers, including new trials, concluded that the effectiveness of this technique for osteoarthritis of the knee could not be confirmed.

Boron

Epidemiological data indicate that in locations where boron intake is 1 mg or less per day, the frequency of arthritis problems is significantly higher (20% to 70%) than in areas where daily intake is between 3 mg and 10 mg per day (0% to 10%).

Only one clinical study involving 20 subjects was published on the effect of boron on osteoarthritis: participants noted a slight improvement in their condition after taking 6 mg per day of boron for 8 weeks.

Boswellia (Boswellia serrata)

Boswellia, whose anti-inflammatory properties have been demonstrated in vitro and on animals, could help in the treatment of osteoarthritis. Indeed, several studies of patients with osteoarthritis of the knee have shown positive results42,43,61.

However, there is still too little data to suggest a dosage.

Collagen

Collagen ensures the cohesion, elasticity, and regeneration of several tissues (tendons, connective tissues, ligaments, etc.). Studies that have evaluated the effectiveness of collagen supplements in relieving osteoarthritis have been inconclusive.

The most recent study found a slight reduction in pain. In vitro data suggest that taking such supplements may help the affected joint by stimulating collagen production.

Note. Most researchers used a dosage of 10 g of collagen hydrolyzate per day. Commercially available capsules and tablets offer 1 g to 2 g per day.

Tai chi

A clinical trial was conducted in 43 women over 55 years of age with osteoarthritis63. They practiced tai chi weekly for 12 weeks or were part of the control group. There have been positive changes in the perception of pain, joint stiffness, balance, and strength of the abdominal muscles in women practicing tai chi.

Results are promising, but more clinical trials are needed to verify the effectiveness of tai chi.

Blackcurrant (Ribes nigrum)

ESCOP recognizes the medicinal use of blackcurrant leaves (PSN) as an adjuvant treatment for rheumatic disorders. The organization has identified a large enough number of in vivo studies reporting the anti-inflammatory properties of the leaves to officially recognize this tradition of use.

Dosage: infuse 5 g to 12 g of dried leaves in 250 ml of boiling water for 15 minutes. Take 2 cups a day of this infusion, or take 5 ml of fluid extract (1:1), 2 times a day, before meals.

Various plants have been traditionally used to treat people with osteoarthritis: turmeric (psn) (Curcuma longa), ginger rhizomes (psn) (Zingiber Officinalis), and feverfew (Tanacetum parthenium).

Massage therapy

Massage therapy sessions contribute to the general state of well-being and muscle and nerve relaxation. It also promotes blood and lymphatic circulation. This is why some specialists recommend its use by people who suffer from osteoarthritis.

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