The term “arthritis” refers to more than 100 conditions that affect your joints, including the most common form: osteoarthritis.
Osteoarthritis has commonly been considered degenerative arthritis, based on what we’ve known about the disease’s effects on joint cartilage. However, ongoing scientific investigations have revealed that osteoarthritis goes deeper than cartilage and that other factors combine to mold the osteoarthritis symptomatology. Consequently, our broadening understanding of the disease has prompted a shift in the osteoarthritis management paradigm.
“We used to talk about osteoarthritis as only wear and tear of cartilage,” says M. Elaine Husni, MD, a Cleveland Clinic rheumatologist. “Now, the new way of thinking is that there are a lot of different things happening in the whole joint with osteoarthritis.”
What Is Osteoarthritis?
Arthritis can develop anywhere two bones come together to form one of the approximately 350 joints in your body. The ends of many of these bones are covered by cartilage, a fibrous tissue that provides a smooth surface against which the bones glide against each other. Lining the joint capsule is the synovium, which produces a viscous fluid that lubricates the cartilage.
Without cartilage acting as a shock absorber for the joints, friction generated by the movement of bone rubbing against bone would cause them to wear away. In osteoarthritis, the cartilage becomes damaged, thereby losing its protective effects and depriving the bone of its cushioning.
Osteoarthritis was once believed to be no more than the byproduct of long-term joint use and overuse that causes the cartilage to become more likely to tear, whereas other forms of arthritis, such as rheumatoid arthritis, primarily were due to inflammation triggered by a wayward immune system. While the latter remains true, researchers have learned that osteoarthritis is more than just wear and tear, and that localized inflammation plays a more significant role in the osteoarthritis disease process than was once believed.
Today, we also understand that it’s not just eroded cartilage but also problems with the subchondral bone underneath it, the tissues supporting the joint, and the nerves that supply sensation to it that contribute to the osteoarthritis experience.
“Now we know that it’s a whole-joint disease and that it doesn’t just involve cartilage loss,” Dr. Husni says. “We now have a better understanding that it’s really the entire joint that works all together that can cause osteoarthritis, so the muscles, the bone, the ligaments, the cartilage, the synovium, and these pain pathways are all involved.”
Common Symptoms of Osteoarthritis
Osteoarthritis causes joint pain that typically worsens with activity, along with joint stiffness and loss of mobility, structural integrity, and smooth movement in the joint. You also can experience localized swelling and inflammation, as well as clicking, popping, or grinding sounds (crepitus), in the affected joint.
Over time, an osteoarthritic joint can become unstable due to deterioration of cartilage, poor alignment, or stretching of the ligaments that support the joint. Eventually, if you become more sedentary in response to osteoarthritis pain and stiffness, you can lose strength in the muscles around the joint.
Osteoarthritis symptoms may vary somewhat, depending on the joint. For instance, because of its larger joint space and weight-bearing responsibilities, your knee may be more likely to develop swelling in osteoarthritis (and other arthritis types), whereas you’re less likely to notice swelling in deeper joints, like the hip. In the hands, osteoarthritis can produce hard, bony growths, known as Bouchard’s and Heberden’s nodes, in the joints at the end of the fingers.
Causes and Risk Factors
Osteoarthritis becomes more common as you get older, largely because of longer-term use of your joints and age-related declines in the lubricating fluid in the joints. Similarly, the genes you inherit from your parents can influence your risk of osteoarthritis.
Other osteoarthritis risk factors are preventable or manageable. For instance, that old football injury may place you at higher risk of developing post-traumatic osteoarthritis later in life, even if the injury was treated correctly at the time. Heavy repetitive movement of a joint in your occupation or other activities also can lead to osteoarthritis, as can anatomical abnormalities, such as unequal leg lengths, bowlegs, flat feet, and weakness in your leg muscles.
One of the most significant modifiable osteoarthritis risk factors is overweight and obesity. On a structural level, added weight places greater stress on your weight-bearing joints, including the hips, knees, ankles, and spine. It’s estimated that each additional pound of body weight places four extra pounds of stress on your knees when you walk.
Obesity also can affect your joints on a metabolic level. Scientists have found that increased fat mass results in greater joint inflammation, as fat cells function as tiny inflammation-producing factories that damage the joint cartilage. This process may explain why people with obesity face a greater risk of osteoarthritis even in non-weight-bearing joints, like the fingers and hands.
“So, it’s not only the weight, but it’s also the active component of the fat tissue,” Dr. Husni says. “That’s something new and important for people to understand. So, if you’re overweight, you should lose weight not just for cosmetic reasons or to lessen the impact of weight on the joints, but also to lower the systemic inflammation from having excess fat cells that is important to curb.”
How Osteoarthritis Is Diagnosed
Unlike rheumatoid arthritis and certain other types of arthritis, there’s no blood test available to diagnose osteoarthritis. Instead, your doctor will review your medical history and symptoms and perform a physical exam.
He or she may order conventional x-rays to show the positioning of the bones and the amount of space between them, which indicates how much healthy cartilage remains. To gain a more detailed look at the joint structures, your physician may order more sophisticated studies, such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans, Dr. Husni says.
Treatment Options
To ease pain from osteoarthritis, your physician may recommend oral over-the-counter medications such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Advil, Motrin) and naproxen (Aleve).
Since prolonged use of oral NSAIDs may increase the risk of adverse kidney, gastrointestinal (GI), and cardiovascular side effects, a topical NSAID, diclofenac gel (Voltaren Arthritis Pain) can provide relief for arthritic joints amenable to treatment: the knees, ankles, feet, elbows, hands and wrists. “I like the topical NSAIDs because you don’t get the systemic side effects,” Dr. Husni says. “I think these topical options an underutilized treatment.”
Another topical option is capsaicin cream, a chili pepper extract that, with continued use, has been show to provide some osteoarthritis relief.
For more chronic pain management, your physician may prescribe a medication like celecoxib (Celebrex, a special type of NSAID that’s less likely to affect your GI tract), duloxetine (Cymbalta, a type of antidepressant that is indicated for chronic pain) or corticosteroid injections.
For an arthritic knee, injections of hyaluronic acid (viscosupplementation), anesthetic nerve blocks, or ablation procedures that target the nerves around the knee may be necessary if your pain persists. Some people gain some osteoarthritis pain relief and augment other treatments through complementary therapies like acupuncture, therapeutic massage, and meditation practices.
A cornerstone of osteoarthritis management is keeping your joints in motion. So, your provider may work with you directly or refer you to a physical therapist to formulate an exercise program that can strengthen the muscles supporting your arthritic joints and improve/maintain their range of motion.
“It’s counterintuitive because when your knee or your hip hurts, you don’t want to move,” Dr. Husni says. “But finding ways to keep moving to maintain your strength and stretching are critical. Motion is not bad; loss of motion is. So, we tell our patients to keep moving however they can, but not when it hurts a lot. I would use intense pain as a marker that you’re doing too much and you should slow down.”
For many people, another vital component of osteoarthritis management is weight optimization. If you have overweight or obesity, your health-care provider can guide you on an appropriate diet and exercise plan to help you lose weight.
Or, if necessary, you may be prescribed a GLP-1 medication—liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound)—that promote weight loss and also may benefit your arthritic joints. In the Step 9 trial, involving 407 people with obesity and moderate knee osteoarthritis, once-weekly injections of semaglutide produced greater reductions in weight and knee osteoarthritis pain, compared with placebo, when added to a reduced-calorie diet (New England Journal of Medicine, Oct. 30, 2024).
“In this study, adding the GLP-1 in patients with knee osteoarthritis was able to reduce pain and improve function, compared with diet and physical activity counseling alone,” Dr. Husni says. “These drugs not only help you lose weight, but they also probably reduce some kind of inflammatory response, as well.”
Furthermore, your doctor or therapist can recommend braces to support your joints and instruct you on the use of canes, walkers, or other assistive devices to help you function better with osteoarthritis. Your physician may prescribe a simple heel lift to correct leg-length discrepancies or a shoe insert (orthotic) to address flatfeet, as these persistent mechanical changes can worsen osteoarthritis.
If your osteoarthritis pain and loss of function occur daily, persist despite nonsurgical management and you have advanced joint damage visible on x-rays or other imaging, it’s time to consider a surgical solution, such as joint replacement, Dr. Husni says. Carefully weigh the benefits and potential risks of surgery with your surgeon so you can make an educated decision.
“We used to not recommend surgery until the bitter end,” Dr. Husni says. “But if you wait too long to replace a joint and you lose function and your ligaments and muscles become weak, you’re never going to get the benefits of that joint replacement, so we have to find a sweet spot. Now, we tend to refer to our surgical colleagues a little sooner so that shared decision-making can be done between the patient and surgeon.”
Practical Tips for Living with Osteoarthritis
Depending on the severity of your symptoms, you might need to adjust your daily activities to protect your joints and help you live better and easier with osteoarthritis. For instance, you may have to reduce certain repetitive motions that affect the arthritic joint and can worsen osteoarthritis.
If you have difficulty performing everyday tasks, seek a referral to an occupational therapist, who can advise you about the use of adaptive equipment and offer tips to help you accomplish your daily activities, overcome any osteoarthritis-related challenges, and help you stay active safely.
Prevention and Long-Term Management
Adopting a number of healthy lifestyle habits can help reduce your risk of osteoarthritis and help you and your health-care team manage it over the long term. Consider these recommendations:
- Consult a physical therapist to develop and maintain an exercise program that includes strength-training and range-of-motion (stretching) exercises, tailored to your individual capabilities, that can help preserve your mobility and joint function.
- Work with your health-care providers to optimize your weight through a healthful diet, physical activity and, if necessary, newer weight-loss medications.
- If you smoke, discuss cessation strategies with your physician. Smoking has been linked to cartilage loss and increased pain in people with osteoarthritis.
- Undergo periodic checkups with your primary care doctor and/or a rheumatologist to monitor your symptoms and make any adjustments to your osteoarthritis treatment regimen.
When to See a Doctor
Everyone has occasional aches and pains, especially as they get older. When pain, stiffness, and other symptoms persist more than a few days, begin to keep you from performing your daily activities or detract from your quality of life, seek a medical evaluation.
“Even though you have joint pain and you think you have osteoarthritis, there is some value in meeting with a rheumatologist to get diagnosed properly and making sure that there’s nothing else going on,” Dr. Husni says. “I feel really bad if somebody thinks they have osteoarthritis, but they really have rheumatoid arthritis or something else. So, at least having a checkup by your primary care physician or a rheumatologist would be helpful.”
