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Osteoarthritis
National Institutes of HealthNational Institute of Arthritis and
Musculoskeletal and Skin Diseases
This booklet is not copyrighted. Readers are encour-aged to duplicate and distribute as many copies asneeded.
Additional copies of this booklet are available from theNational Institute of Arthritis and Musculoskeletal andSkin Diseases, NIAMS/National Institutes of Health,1 AMS Circle, Bethesda, MD 20892–3675, and on theNIAMS Web site at www.niams.nih.gov.
For Your Information
This publication contains information about medica-tions used to treat the health condition discussed here.When this booklet was printed, we included the mostup-to-date (accurate) information available. Occasion-ally, new information on medication is released.
For updates and for any questions about any medica-tions you are taking, please contact the U.S. Foodand Drug Administration at 1–888–INFO–FDA(1–888–463–6332, a toll-free call) or visit their Website at www.fda.gov.
Table of ContentsWhat Is Osteoarthritis? . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Who Has Osteoarthritis? . . . . . . . . . . . . . . . . . . . . . . . . . 2
How Does Osteoarthritis Affect People? . . . . . . . . . . . . 4
Osteoarthritis Basics: The Joint and Its Parts . . . . . . . . . 5
How Do You Know if You Have Osteoarthritis? . . . . . . 8
How Do Doctors Diagnose Osteoarthritis? . . . . . . . . . . 10
How Is Osteoarthritis Treated? . . . . . . . . . . . . . . . . . . . 13
Who Treats Osteoarthritis? . . . . . . . . . . . . . . . . . . . . . . 24
What You Can Do: the Importance of Self-Care and a Good-Health Attitude . . . . . . . . . . . . . 25
What Research Is Being Done on Osteoarthritis? . . . . . 30
Hope for the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Key Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Illustrations
What Areas Does Osteoarthritis Affect? . . . . . . . . . . . . 3
A Healthy Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A Joint With Severe Osteoarthritis . . . . . . . . . . . . . . . . . 6
Exercises for Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . 28
IInnffoorrmmaattiioonn BBooxxeess
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
1
OsteoarthritisThis booklet is for people who have osteoarthritis, theirfamilies, and others interested in learning more about thedisorder. The booklet describes osteoarthritis and itssymptoms and contains information about diagnosis andtreatment, as well as current research efforts supported bythe National Institute of Arthritis and Musculoskeletal andSkin Diseases (NIAMS) and other components of the U.S.Department of Health and Human Services’ NationalInstitutes of Health (NIH). It also discusses pain relief,exercise, and quality of life for people with osteoarthritis. Ifyou have further questions after reading this booklet, youmay wish to discuss them with your doctor.
What Is Osteoarthritis?
O steoarthritis (AH-stee-oh-ar-THREYE-tis) is the mostcommon type of arthritis, and is seen especially among
older people. Sometimes it is called degenerative joint dis-ease or osteoarthrosis.
Osteoarthritis mostly affects cartilage (KAR-til-uj), the hardbut slippery tissue that covers the ends of bones where theymeet to form a joint. Healthy cartilage allows bones to glideover one another. It also absorbs energy from the shock ofphysical movement. In osteoarthritis, the surface layer ofcartilage breaks down and wears away. This allows bonesunder the cartilage to rub together, causing pain, swelling,and loss of motion of the joint. Over time, the joint maylose its normal shape. Also, small deposits of bone – calledosteophytes or bone spurs – may grow on the edges of thejoint. Bits of bone or cartilage can break off and float insidethe joint space. This causes more pain and damage.
2
People with osteoarthritis usually have joint pain andsome movement limitations. Unlike some other forms ofarthritis, such as rheumatoid arthritis, osteoarthritisaffects only joint function and does not affect skin tissue,the lungs, the eyes, or the blood vessels.
In rheumatoid arthritis, the second most common form ofarthritis, the immune system attacks the tissues of thejoints, leading to pain, inflammation, and eventually jointdamage and malformation. It typically begins at ayounger age than osteoarthritis, causes swelling and red-ness in joints, and may make people feel sick, tired, anduncommonly feverish.
Who Has Osteoarthritis?
O steoarthritis is by far the most common type of arthri-tis, and the percentage of people who have it grows
higher with age. An estimated 12.1 percent of the U.S.population (nearly 21 million Americans) age 25 andolder have osteoarthritis.
Although osteoarthritis is more common in older people,younger people can develop it – usually as the result of ajoint injury, a joint malformation, or a genetic defect injoint cartilage. Both men and women have the disease.Before age 45, more men than women have osteoarthritis;after age 45, it is more common in women. It is also morelikely to occur in people who are overweight and in thosewith jobs that stress particular joints.
As the population ages, the number of people withosteoarthritis will only grow. By 2030, 20 percent ofAmericans – about 72 million people – will have passedtheir 65th birthday and will be at high risk for the disease.
3
What Areas Does Osteoarthritis Affect?
Osteoarthritis most often occurs in the hands (at the ends of thefingers and thumbs), spine (neck and lower back), knees, and hips.
4
How Does Osteoarthritis Affect People?
P eople with osteoarthritis usually experience joint painand stiffness. The most commonly affected joints are
those at the ends of the fingers (closest to the nail),thumbs, neck, lower back, knees, and hips.
Osteoarthritis affects different people differently.Although in some people it progresses quickly, in mostindividuals joint damage develops gradually over years.In some people, osteoarthritis is relatively mild and inter-feres little with day-to-day-life; in others, it causes signif-icant pain and disability.
While osteoarthritis is a disease of the joints, its effectsare not just physical. In many people with osteoarthritis,lifestyle and finances also decline.
Lifestyle effects include
n depression
n anxiety
n feelings of helplessness
n limitations on daily activities
n job limitations
n difficulty participating in everyday personal andfamily joys and responsibilities.
Financial effects include
n the cost of treatment
n wages lost because of disability.
5
Fortunately, most people with osteoarthritis live active,productive lives despite these limitations. They do so byusing treatment strategies such rest and exercise, painrelief medications, education and support programs,learning self-care, and having a “good attitude.”
Osteoarthritis Basics: The Joint and Its Parts
A joint is the point where two or more bones are con-nected. With a few exceptions (in the skull and pelvis,
for example), joints are designed toallow movement between the bonesand to absorb shock from movementslike walking or repetitive motions.These movable joints are made up ofthe following parts:
Cartilage: a hard but slippery coatingon the end of each bone. Cartilage,which breaks down and wears away inosteoarthritis, is described in moredetail on the next page.
Joint capsule: a tough membrane sacthat encloses all the bones and otherjoint parts.
Synovium (sin-O-vee-um): a thin membrane inside thejoint capsule that secretes synovial fluid.
Synovial fluid: a fluid that lubricates the joint and keepsthe cartilage smooth and healthy.
Osteoarthritis
hurts people in
more than their
joints: their
finances and
lifestyles also
are affected.
6
Worn-away cartilage
Synovial membrane
Synovial fluidCartilagefragments
in fluid
Bone
Muscles
Tendons
Bone spurs
Posterior cruciate ligament
Anterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
With osteoarthritis, the cartilage becomes worn away. Spurs growout from the edge of the bone, and synovial fluid increases. Alto-gether, the joint feels stiff and sore.
Cartilage
Synovial membrane
Synovial fluid
Bone
Muscles
Tendons
Posterior cruciate ligament
Anterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
Joint capsule
A Healthy Joint
In a healthy joint, the ends of bones are encased in smooth cartilage.Together, they are protected by a joint capsule lined with a synovialmembrane that produces synovial fluid. The capsule and fluid protectthe cartilage, muscles, and connective tissues.
A Joint With Severe Osteoarthritis
7
Ligaments, tendons, and muscles are tissues that surroundthe bones and joints, and allow the joints to bend andmove. Ligaments are tough, cord-like tissues that connectone bone to another. Tendons are tough, fibrous cords thatconnect muscles to bones. Muscles are bundles of spe-cialized cells that, when stimulated by nerves, either relaxor contract to produce movement.
Cartilage: The Key to Healthy Joints
Cartilage is 65 to 80 percent water. The remainingthree components – collagen, proteoglycans, andchondrocytes – are described below.
n collagen (KAHL-uh-jen): A family of fibrousproteins, collagens are the building blocks ofskin, tendon, bone, and other connective tissues.
n proteoglycans (PRO-tee-uh-GLY-kanz): Made upof proteins and sugars, strands of proteoglycansinterweave with collagens and form a mesh-liketissue. This allows cartilage to flex and absorbphysical shock.
n chondrocytes (KAHN-druh-sytz): Found through-out the cartilage, chondrocytes are cells that pro-duce cartilage and help it stay healthy as itgrows. Sometimes, however, they release sub-stances called enzymes that destroy collagen andother proteins. Researchers are trying to learnmore about chondrocytes.
8
How Do You Know if You Have Osteoarthritis?
U sually, osteoarthritis comes on slowly. Early in thedisease, your joints may ache after physical work or
exercise. Later on, joint pain may become more persis-tent. You may also experience joint stiffness, particularlywhen you first wake up in the morning or have been inone position for a long time.
Although osteoarthritis can occur in any joint, most oftenit affects the hands, knees, hips, and spine (either at theneck or lower back). Different characteristics of the dis-ease can depend on the specific joint(s) affected. For gen-eral warning signs of osteoarthritis, see the box on thenext page. For information on the joints most oftenaffected by osteoarthritis, please see the followingdescriptions below:
Hands: Osteoarthritis of the hands seems to have somehereditary characteristics; that is, it runs in families. Ifyour mother or grandmother has or had osteoarthritis intheir hands, you’re at greater-than-average risk of havingit too. Women are more likely than men to have handinvolvement and, for most, it develops after menopause.
When osteoarthritis involves the hands, small, bonyknobs may appear on the end joints (those closest to thenails) of the fingers. They are called Heberden’s (HEB-err-denz) nodes. Similar knobs, called Bouchard’s (boo-SHARDZ) nodes, can appear on the middle joints of thefingers. Fingers can become enlarged and gnarled, andthey may ache or be stiff and numb. The base of thethumb joint also is commonly affected by osteoarthritis.
9
Knees: The knees are among the joints most commonlyaffected by osteoarthritis. Symptoms of knee osteoarthri-tis include stiffness, swelling, and pain, which make ithard to walk, climb, and get in and out of chairs and bath-tubs. Osteoarthritis in the knees can lead to disability.
Hips: The hips are also common sites of osteoarthritis. Aswith knee osteoarthritis, symptoms of hip osteoarthritisinclude pain and stiffness of the joint itself. But some-times pain is felt in the groin, inner thigh, buttocks, oreven the knees. Osteoarthritis of the hip may limit mov-ing and bending, making daily activities such as dressingand putting on shoes a challenge.
The Warning Signs of Osteoarthritis
n stiffness in a joint after getting out of bed orsitting for a long time
n swelling in one or more joints
n a crunching feeling or the sound of bonerubbing on bone
About a third of people whose x rays show evidenceof osteoarthritis report pain or other symptoms.For those who experience steady or intermittentpain, it is typically aggravated by activity andrelieved by rest.
If you feel hot or your skin turns red, you probablydo not have osteoarthritis. Check with your doctorabout other causes, such as rheumatoid arthritis.
10
Spine: Osteoarthritis of the spine may show up as stiff-ness and pain in the neck or lower back. In some cases,arthritis-related changes in the spine can cause pressureon the nerves where they exit the spinal column, resultingin weakness or numbness of the arms and legs.
How Do Doctors Diagnose Osteoarthritis?
N o single test can diagnose osteoarthritis. Most doctorsuse a combination of the following methods to diag-
nose the disease and rule out other conditions:
Clinical history
The doctor begins by asking the patient to describe thesymptoms, and when and how the condition started, aswell as how the symptoms have changed over time. Thedoctor will also ask about any other medical problems thepatient and close family members have and about anymedications the patient is taking. Accurate answers tothese questions can help the doctor make a diagnosis andunderstand the impact the disease has on your life.
Physical examination
The doctor will check the patient’s reflexes and generalhealth, including muscle strength. The doctor will alsoexamine bothersome joints and observe the patient’s abil-ity to walk, bend, and carry out activities of daily living.
X rays
Doctors take x rays to see how much joint damage hasbeen done. X rays of the affected joint can show suchthings as cartilage loss, bone damage,and bone spurs. But there often is abig difference between the severity ofosteoarthritis as shown by the x rayand the degree of pain and disabilityfelt by the patient. Also, x rays maynot show early osteoarthritis damagebefore much cartilage loss has takenplace.
Magnetic resonance imaging
Also known as an MRI, magnetic res-onance imaging provides high-resolu-tion computerized images of internalbody tissues. This procedure uses astrong magnet that passes a forcethrough the body to create theseimages. Doctors often use MRI testsif there is pain; if x-ray findings are minimal; and if thefindings suggest damage to other joint tissues such as aligament, or the pad of connective tissue in the kneeknown as the meniscus.
Other tests
The doctor may order blood tests to rule out other causesof symptoms. He or she may also order a joint aspiration,which involves drawing fluid from the joint through aneedle 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 patient’s
symptoms.
It usually is not difficult to tell if a patient has osteoarthritis.It is more difficult to tell if the disease is causing thepatient’s symptoms. Osteoarthritis is so common – espe-cially in older people – that symptoms seemingly caused bythe disease actually may be due to other medical conditions.The doctor will try to find out what is causing the symptomsby ruling out other disorders and identifying conditions thatmay make the symptoms worse. The severity of symptomsin osteoarthritis can be influenced greatly by the patient’sattitude, anxiety, depression, and daily activity level.
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Four Goals of Osteoarthritis Treatment
n to control pain
n to improve joint function
n to maintain normal body weight
n to achieve a healthy lifestyle
Treatment Approaches to Osteoarthritis
n exercise
n weight control
n rest and relief from stress on joints
n nondrug pain relief techniques
n medications to control pain
n surgery
n complementary and alternative therapies
How Is Osteoarthritis Treated?
M ost successful treatment programs involve a combi-nation of treatments tailored to the patient’s needs,
lifestyle, and health. Most pro-grams include ways to managepain and improve function.These can involve exercise,weight control, rest and relieffrom stress on joints, pain relieftechniques, medications,surgery, and complementary andalternative therapies. Theseapproaches are described below.
Exercise
Research shows that exercise isone of the best treatments forosteoarthritis. Exercise can improve mood and outlook,decrease pain, increase flexibility, strengthen the heartand improve blood flow, maintain weight, and promotegeneral physical fitness. Exercise is also inexpensive and,if done correctly, has few negative side effects. Theamount and form of exercise prescribed will depend onwhich joints are involved, how stable the joints are, andwhether a joint replacement has already been done. Walk-ing, swimming, and water aerobics are a few populartypes of exercise for people with osteoarthritis. Your doc-tor and/or physical therapist can recommend specifictypes of exercise depending on your particular situation.(See What You Can Do: the Importance of Self-Care anda Good-Health Attitude).
13
Patients must
learn to recognize
the body’s
signals, and know
when to stop or
slow down.
14
On the Move: Fighting Osteoarthritiswith Exercise
You can use exercises to keep strong and limber,improve cardiovascular fitness, extend your joints’range of motion, and reduce your weight. The fol-lowing types of exercise are part of a well-roundedarthritis treatment plan.
n strengthening exercises: These exercisesstrengthen muscles that support joints affectedby arthritis. They can be performed with weightsor with exercise bands, inexpensive devices thatadd resistance.
n aerobic activities: These are exercises, such aswalking or low-impact aerobics, that get yourheart pumping and can keep your lungs and cir-culatory system in shape.
n range-of-motion activities: These keep yourjoints limber.
n agility exercises: These can help you maintaindaily living skills.
Ask your doctor or physical therapist what exer-cises are best for you. Ask for guidelines on exer-cising when a joint is sore or if swelling is present.Also, check if you should (1) use pain-relievingdrugs, such as analgesics or anti-inflammatories(also called NSAIDs or nonsteroidal anti-inflam-matory drugs) to make exercising easier, or (2) useice afterward.
15
Weight control
Osteoarthritis patients who are overweight or obeseshould try to lose weight. Weight loss can reduce stresson weight-bearing joints, limit further injury, andincrease mobility. A dietitian can help you develophealthy eating habits. A healthy diet and regular exercisehelp reduce weight.
Rest and relief from stress on joints
Treatment plans include regularly scheduled rest. Patientsmust learn to recognize the body’s signals, and knowwhen to stop or slow down. This will prevent the paincaused by overexertion. Although pain can make it diffi-cult to sleep, getting proper sleep is important for manag-ing arthritis pain. If you have trouble sleeping, you mayfind that relaxation techniques, stress reduction, andbiofeedback can help, as can timing medications to pro-vide maximum pain relief through the night.
Some people use canes to take pressure off painful joints.They may use splints or braces to provide extra supportfor joints and/or keep them in proper position duringsleep or activity. Splints should be used only for limitedperiods of time because joints and muscles need to beexercised to prevent stiffness and weakness. If you need asplint, an occupational therapist or a doctor can help youget a properly fitted one.
If joint pain interferes with your ability to sleep or rest,consult your doctor.
16
Nondrug pain relief
People with osteoarthritis may find many nondrug waysto relieve pain. Below are some examples:
Heat and cold: Heat or cold (or a combination of thetwo) can be useful for joint pain. Heat can be applied in anumber of different ways – with warm towels, hot packs,or a warm bath or shower – to increase blood flow andease pain and stiffness. In some cases, cold packs (bagsof ice or frozen vegetables wrapped in a towel), whichreduce inflammation, can relieve pain or numb the sorearea. (Check with a doctor or physical therapist to findout if heat or cold is the best treatment.)
Transcutaneous electrical nerve stimulation (TENS):TENS is a technique that uses a small electronic device todirect mild electric pulses to nerve endings that liebeneath the skin in the painful area. TENS may relievesome arthritis pain. It seems to work by blocking painmessages to the brain and by modifying pain perception.
Massage: In this pain-relief approach, a massage thera-pist will lightly stroke and/or knead the painful muscles.This may increase blood flow and bring warmth to astressed area. However, arthritis-stressed joints are sensi-tive, so the therapist must be familiar with the problemsof the disease.
17
Medications to control pain
Doctors prescribe medicines to eliminate or reducepain and to improve functioning. Doctors consider anumber of factors when choosingmedicines for their patients withosteoarthritis. These include the inten-sity of pain, potential side effects ofthe medication, your medical history(other health problems you have or areat risk for), and other medications youare taking.
Because some medications can inter-act with one another and certain healthconditions put you at increased risk ofdrug side effects, it’s important to dis-cuss your medication, and health his-tory with your doctor before you starttaking any new medication, and to seeyour doctor regularly while you aretaking medication. By workingtogether, you and your doctor can find the medicationthat best relieves your pain with the least risk of sideeffects.
Most medicines
used to treat
osteoarthritis
have side effects,
so it is important
for people to
learn about the
medicines they
take.
18
1 Brand names included in this booklet are provided as examples only,and their inclusion does not mean that these products are endorsed by theNational Institutes of Health or any other Government agency. Also, if aparticular brand name is not mentioned, this does not mean or imply thatthe product is unsatisfactory.
The following types of medicines are commonly used intreating osteoarthritis:
Acetaminophen: A medication commonly used to relievepain, acetaminophen (for example, Tylenol1) is available
without a prescription. It is often the firstmedication doctors recommend forosteoarthritis patients because of itssafety relative to some other drugs and itseffectiveness against pain.
NSAIDs (nonsteroidal anti-inflamma-tory drugs): A large class of medica-tions useful against both pain andinflammation, NSAIDs are staples inarthritis treatment. A number ofNSAIDs – ibuprofen (Advil, Motrin),naproxen sodium (Aleve) and ketopro-fen (Orudis, Oruvail) – are availableover the counter. More than a dozenothers, including a subclass of NSAIDs
called COX-2 inhibitors, are available only with a pre-scription.
All NSAIDs work similarly: by blocking substancescalled prostaglandins that contribute to inflammationand pain. However, each NSAID is a different chemical,and each has a slightly different effect on the body2.
Check with your
health care
provider or
pharmacist
before you take
NSAIDs in addition
to another
medication.
19
The U.S Food and Drug Administration has warned thatlong-term use of NSAIDs, or use by people who haveheart disease, may increase the chance of a heart attackor stroke. So it’s important to work with your doctor tochoose the one that’s safest and most effective for you.Side effects can also include stomach upset and stomachulcers, heartburn, diarrhea, and fluid retention. Forunknown reasons, some people seem to respond better toone NSAID than another.
Other medications: Doctors may prescribe several othermedicines for osteoarthritis. They include the following:
Topical pain-relieving creams, rubs, and sprays:These products, which are applied directly to the skinover painful joints, contain ingredients that work inone of three different ways: by stimulating the nerveendings to distract the brain’s attention from the jointpain; by depleting the amount of a neurotransmittercalled substance P that sends pain messages to thebrain; or by blocking chemicals called prostaglandinsthat cause pain and inflammation. Examples of topi-cal medications are Zostrix, Icy Hot, TherapeuticMineral Ice, Aspercreme, and Ben Gay.
2 Warning: NSAIDs can cause stomach irritation or, less often, they canaffect kidney function. The longer a person uses NSAIDs, the morelikely he or she is to have side effects, ranging from mild to serious.Many other drugs cannot be taken when a patient is being treated withNSAIDs because NSAIDs alter the way the body uses or eliminates theseother drugs. Check with your health-care provider or pharmacist beforeyou take NSAIDs. Also, NSAIDs sometimes are associated with seriousgastrointestinal problems, including ulcers, bleeding, and perforation ofthe stomach or intestine. People over age 65 and those with any historyof ulcers or gastrointestinal bleeding should use NSAIDs with caution.
20
Tramadol (Ultram): A prescription pain reliever thatis sometimes prescribed when over-the-counter med-ications don’t provide sufficient relief. It carries risksthat don’t exist with acetaminophen and NSAIDs,including the potential for addiction.
Mild narcotic painkillers: Medications containingnarcotic analgesics such as codeine or hydrocodoneare often effective against osteoarthritis pain. Butbecause of concerns about the potential for physicaland psychological dependence on these drugs, doctorsgenerally reserve them for short-term use.
Corticosteroids: Corticosteroids are powerful anti-inflammatory hormones made naturally in the body orman-made for use as medicine. They may be injectedinto the affected joints to temporarily relieve pain. Thisis a short-term measure, generally not recommendedfor more than two to four treatments per year. Oral cor-ticosteroids are not routinely used to treat osteoarthritis.They are occasionally used for inflammatory flares.
Hyaluronic acid substitutes: Sometimes called vis-cosupplements, these products are designed to replacea normal component of the joint involved in jointlubrication and nutrition. Depending on the particularproduct your doctor prescribes, it will be given in aseries of three to five injections. These products areapproved only for osteoarthritis of the knee.
21
Because most medicines used to treat osteoarthritishave side effects, it’s important to learn as much as pos-sible about the medications you take, even the onesavailable without a prescription. Certain health prob-lems and lifestyle habits can increase the risk of sideeffects from NSAIDs. These include a history of pepticulcers or digestive tract bleeding, use of oral corticos-teroids or anticoagulants (blood thinners), smoking, andalcohol use.
There are measures you can take to help reduce the riskof side effects associated with NSAIDs. These includetaking medications with food and avoiding stomachirritants such as alcohol, tobacco, and caffeine. In somecases, it may help to take another medication alongwith an NSAID to coat the stomach or block stomachacids. While these measures may help, they are notalways completely effective.
Questions To Ask Your Doctor orPharmacist About Medicines
n How often should I take this medicine?
n Should I take this medicine with food or betweenmeals?
n What side effects might occur?
n Should I take this medicine with the other pre-scription medicines I take?
n Is this medication safe considering other medicalconditions I have?
22
Surgery
For many people, surgery helps relieve the pain and dis-ability of osteoarthritis. Surgery may be performed toachieve one or more of the following:
n removal of loose pieces of bone and cartilagefrom the joint if they are causing symptoms ofbuckling or locking
n repositioning of bones
n resurfacing (smoothing out) of bones.
Surgeons may replace affected joints with artificial jointscalled prostheses. These joints can be made from metalalloys, high-density plastic, and ceramic material. Someprostheses are joined to bone surfaces with specialcements. Others have porous surfaces and rely on thegrowth of bone into that surface (a process called bio-logic fixation) to hold them in place. Artificial joints canlast 10 to 15 years or longer. Surgeons choose the designand components of prostheses according to theirpatient’s weight, sex, age, activity level, and other med-ical conditions.
The decision to use surgery depends on several factors,including the patient’s age, occupation, level of disabil-ity, pain intensity, and the degree to which arthritis inter-feres with his or her lifestyle. After surgery andrehabilitation, the patient usually feels less pain andswelling, and can move more easily.
23
Complementary and alternative therapies
When conventional medical treatment doesn’t providesufficient pain relief, people are more likely to try com-plementary and alternative therapies. The following aresome alternative therapies used to treat osteoarthritis.
Acupuncture: Some people have found pain relief usingacupuncture, a practice in which fine needles are insertedby a licensed acupuncture therapist at specific points onthe skin. Preliminary research shows that acupuncturemay be a useful component in an osteoarthritis treatmentplan for some patients. Scientists think the needles stimu-late the release of natural, pain-relieving chemicals pro-duced by the nervous system.
Folk remedies: These include wearing copper bracelets,drinking herbal teas, taking mud baths, and rubbing WD-40 on joints to “lubricate” them. While these practicesmay or may not be harmful, no scientific research to dateshows that they are helpful in treating osteoarthritis. Theycan also be expensive, and using them may cause peopleto delay or even abandon useful medical treatment.
Nutritional supplements: Nutrients such as glucosamineand chondroitin sulfate have been reported to improve thesymptoms of people with osteoarthritis, as have certainvitamins. Additional studies have been carried out to fur-ther evaluate these claims. (See Current Research)
24
Who Treats Osteoarthritis?
T reating arthritis often requires a multidisciplinary orteam approach. Many types of health professionals
care for people with arthritis. You may choose a few ormore of the following professionals to be part of yourhealth care team:
Primary care physicians: doctors who treat patientsbefore they are referred to other specialists in the healthcare system.
Rheumatologists: doctors who specialize in treatingarthritis and related conditions that affect joints, muscles,and bones.
Orthopaedists: surgeons who specialize in the treatmentof, and surgery for, bone and joint diseases.
Physical therapists: health professionals who work withpatients to improve joint function.
Occupational therapists: health professionals who teachways to protect joints, minimize pain, perform activitiesof daily living, and conserve energy.
Dietitians: health professionals who teach ways to use agood diet to improve health and maintain a healthyweight.
Nurse educators: nurses who specialize in helpingpatients understand their overall condition and implementtheir treatment plans.
25
Physiatrists (rehabilitation specialists): medical doc-tors who help patients make the most of their physicalpotential.
Licensed acupuncture therapists: health professionalswho reduce pain and improve physical functioning byinserting fine needles into the skin at specific points onthe body.
Psychologists: health professionals who seek to helppatients cope with difficulties in the home and workplaceresulting from their medical conditions.
Social workers: professionals who assist patients withsocial challenges caused by disability, unemployment,financial hardships, home health care, and other needsresulting from their medical conditions.
What You Can Do: The Importance of Self-Care and a Good-Health Attitude
W hile health care professionals can prescribe or rec-ommend treatments to help you manage your arthri-
tis, the real key to living well with the disease is you.Research shows that people with osteoarthritis who takepart in their own care report less pain and make fewerdoctor visits. They also enjoy a better quality of life.
Living well and enjoying good health despite arthritisrequires an everyday lifelong commitment. Following aresix habits worth committing to:
26
1. Get educated: To live well with osteoarthritis, it pays tolearn as much as you can about the disease. Three kinds ofprograms 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.
These programs teach people about osteoarthritis, its treat-ments, exercise and relaxation, patient and health careprovider communication, and problem solving. Researchhas shown that people who participate in these programsare more likely to have positive outcomes.
Self-Management Programs Do Help
People with osteoarthritis find that self-manage-ment programs help them:
n understand the disease
n reduce pain while remaining active
n cope physically, emotionally, and mentally
n have greater control over the disease
n build confidence in their ability to live an active,independent life.
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2. Stay active: Regular physical activity plays a key role inself-care and wellness. Three types of exercise are impor-tant in osteoarthritis management. The first type, strength-ening exercises, help keep or increase muscle strength.Strong muscles help support and protect joints affected byarthritis. The second type, aerobic conditioning exercises,improve cardiovascular fitness, help control weight, andimprove overall function. The third type, range-of-motionexercises, help reduce stiffness and maintain or increaseproper joint movement and flexibility.
Most people with osteoarthritis exercise best when theirpain is least severe. Start with an adequate warm-up andbegin exercising slowly. Resting frequently ensures agood workout and reduces the risk of injury.
Before beginning any type of exercise program, consultyour doctor or physical therapist to learn which exercisesare appropriate for you and how to do them correctly,because doing the wrong exercise or exercising improp-erly can cause problems. A health care professional canalso advise you on how to warm up safely and when toavoid exercising a joint affected by arthritis.
3. Eat well: Though no specific diet will necessarilymake your arthritis better, eating right and controllingyour weight can help by minimizing stress on the weight-bearing joints such as the knees and the joints of the feet.It can also minimize your risk of developing other healthproblems.
Exercises for Osteoarthritis
Strengthening
Aerobic conditioning
Range of motion
People with osteoarthritis should do different kinds of exercise fordifferent benefits to the body. Consult your health professionalbefore starting.
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4. Get plenty of sleep: Getting a good night’s sleep on aregular basis can minimize pain and help you cope betterwith the effects of your disease. If arthritis pain makes itdifficult to sleep at night, speak with your doctor and/orphysical therapist about the best mattress or comfortablesleeping positions or the possibility of timing medicationsto provide more pain relief at night. You may alsoimprove your sleep by getting enough exercise early inthe day; avoiding caffeine or alcoholic beverages at night;keeping your bedroom dark, quiet, and cool; and taking awarm bath to relax and soothe sore muscles at bedtime.
5. Have fun: While having osteoarthritis certainly isn’tfun, it doesn’t mean you have to stop having fun. If arthri-tis makes it difficult to participate in favorite activities,ask an occupational therapist about new ways to do them.Activities such as sports, hobbies, and volunteer work candistract your mind from your own pain and make you ahappier, more well-rounded person.
Enjoy a “Good-Health Attitude”
n Focus on your abilities instead of disabilities.
n Focus on your strengths instead of weaknesses.
n Break down activities into small tasks that youcan manage.
n Incorporate fitness and nutrition into daily routines.
n Develop methods to minimize and manage stress.
n Balance rest with activity.
n Develop a support system of family, friends, andhealth professionals.
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6. Keep a positive attitude: Perhaps the best thing you cando for your health is to keep a positive attitude. Peoplemust decide to make the most of things when faced withthe challenges of osteoarthritis. This attitude – a good-health mindset – doesn’t just happen. It takes work, everyday. And with the right attitude, you will achieve it.
What Research Is Being Done onOsteoarthritis?
The leading role in osteoarthritis research is played by theNational Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), a part of the Department ofHealth and Human Services’ National Institutes of Health(NIH). NIAMS funds many researchers across the UnitedStates to study osteoarthritis. Scientists at NIAMS Multi-disciplinary Clinical Research Centers conduct basic andclinical research aimed at understanding the causes, treat-ment options, and prevention of arthritis and musculoskele-tal diseases.
In 2004, NIAMS and other institutes and offices of the NIHbegan recruiting participants for the Osteoarthritis Initiative(OAI). The OAI is a collaboration that pools the funds andexpertise of the NIH and industry to hasten the discovery ofosteoarthritis biomarkers: physical signs or biological sub-stances that indicate changes in bone or cartilage. Researchersare collecting images and specimens from approximately5,000 people at high risk of having osteoarthritis as well asthose at high risk of progression to severe osteoarthritis dur-ing the course of the study. Scientists are following partici-pants for 5 years, collecting biological specimens (blood,urine, and DNA), images (x rays and magnetic resonanceimaging scans), and clinical data annually. For updates on thisinitiative, go to www.niams.nih.gov/ne/oi/.
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Other key areas of research supported by NIAMS andother institutes within NIH include the following:
Animal models of osteoarthritis
Animal models help researchers learn many things aboutosteoarthritis, such as what happens to cartilage, howtreatment strategies might work, and what might preventthe disease. Animal models also help scientists studyosteoarthritis in very early stages before it causesdetectable joint damage. In a study that concluded in2004, a group of researchers led by David Kingsley,Ph.D., of Stanford University, and supported by NIAMS,used mice to study the role of genes in the body’s produc-tion of cartilage.
Diagnostic tools
Scientists are searching for ways to detect osteoarthritis atearlier stages so they can treat it sooner. Abnormalities inthe blood, joint fluid, or urine of people with osteoarthritismay provide clues. Other scientists use new technologiesto analyze the differences between the cartilage from dif-ferent joints. For example, many people have osteoarthri-tis in the knees or hips, but few have it in the ankles. Canankle cartilage be different? Does it age differently?Answering these questions will help us understand thedisease better. Many studies now involve the developmentof a rapid magnetic resonance imaging (MRI) procedurethat doctors use to quickly and noninvasively evaluatejoint cartilage. The procedure could potentially be used todiagnose the disease. More importantly, it may be aneffective method to study disease progression.
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Genetics studies
Osteoarthritis in all its various forms appears to have astrong genetic connection. Gene mutations may be a fac-tor in predisposing individuals to develop osteoarthritis.
For example, scientists have identified amutation (a gene defect) affecting colla-gen, an important part of cartilage, inpatients with an inherited kind ofosteoarthritis that starts at an early age.The mutation weakens collagen protein,which may break or tear more easilyunder stress. Scientists are looking forother gene mutations in osteoarthritis.Researchers have also found that thedaughters of women who have kneeosteoarthritis have a significant increasein cartilage breakdown, thus makingthem more susceptible to disease. In the
future, a test to determine who carries the genetic defect(or defects) could help people reduce their risk forosteoarthritis by making lifestyle adjustments.
Tissue engineering
This technology involves removing cells from a healthypart of the body and placing them in an area of diseasedor damaged tissue to improve certain body functions.Currently, it is used to treat small traumatic injuries ordefects in cartilage, and, if successful, could eventuallyhelp treat osteoarthritis. Researchers at NIAMS areexploring three types of tissue engineering. The two most
Osteoarthritis in
all its various
forms appears to
have a strong
genetic
connection.
common methods being studied today include cartilagecell replacement and stem cell transplantation. The thirdmethod is gene therapy.
Cartilage cell replacement: In this procedure, research-ers remove cartilage cells from the patient’s own jointand then clone or grow new cellsusing tissue culture and other labora-tory techniques. They then inject thenewly grown cells into the patient’sjoint. Patients with cartilage cellreplacement have fewer symptoms ofosteoarthritis. Actual cartilage repairis limited, however.
In one area of research, scientists aretesting fibroblastic cells (precursors tocells that make up components ofconnective tissue) for their ability todifferentiate into cartilage cells in alab dish. The researchers will then see if the resultingcartilage cells can form functional joint cartilage.
Stem cell transplantation: Stem cells are primitive cellsthat can transform into other kinds of cells, such as mus-cle or bone cells. They usually are taken from bone mar-row. In the future, researchers hope to insert stem cellsinto cartilage, where the cells will make new cartilage. Ifsuccessful, this process could be used to repair early car-tilage damage and avoid the need for surgical jointreplacements later in life.
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Tissue
engineering,
if successful,
could eventually
help treat
osteoarthritis.
Gene therapy: Scientists are working to genetically engi-neer cells that would inhibit certain enzymes that mayhelp break down cartilage and cause joint damage. Ingene therapy, cells are removed from the body, geneti-cally changed, and then injected back into the affectedjoint. They reside in the joint and secrete substances thatinhibit the damaging enzymes.
Patient education
Effective treatment for osteoarthritis takes more thanmedicine or surgery. Getting help from a variety of healthcare professionals often can improve patient treatmentand self-care. (See “Who Treats Osteoarthritis?”)Research shows that adding patient education and socialsupport is a low-cost, effective way to decrease pain andreduce the amount of medicine used. One NIAMS-fundedproject involves developing and testing an interactiveWeb site by which health professionals and patients couldcommunicate concerning appointments and treatmentinstructions, thus giving patients a greater role in and con-trol of their care.
Exercise and weight reduction
Exercise plays a key part in a comprehensive treatmentplan. Researchers are studying exercise in greater detailand finding out just how to use it in treating or preventingosteoarthritis. For example, several scientists have studiedknee osteoarthritis and exercise. Their results included thefollowing:
n Walking can result in better functioning, and themore you walk, the farther you will be able towalk.
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n People with knee osteoarthritis who are active inan exercise program feel less pain. They also func-tion better.
Research has shown that losing extra weight can help peo-ple who already have osteoarthritis. Moreover, overweightor obese people who do not have osteoarthritis may reducetheir risk of developing the disease by losing weight. ANIAMS-funded study is investigating the use of regular aer-obic exercise in people with osteoarthritis of the knee todetermine if standard guidelines for cardiovascular fitnessmay be useful for the treatment of early osteoarthritis aswell.
Treatment
Researchers are studying the effectiveness of a variety ofdifferent types of treatment. These include:
Drugs to prevent joint damage: No treatment actuallyprevents osteoarthritis or reverses or blocks the diseaseprocess once it begins. Present treatments just relieve thesymptoms.
Researchers are looking for drugs that would prevent,slow down, or reverse joint damage. Drugs under studyinclude:
n doxycycline, an antibiotic drug that may stop cer-tain enzymes known to damage cartilage. A recentclinical trial found that doxycycline had a modesteffect on slowing the rate at which the joint spacenarrows in the knee. The trial also found that peo-ple who were taking doxycycline experienced jointpain less often than those who were not.
35
n the bisphosphonate drug risedronate: In a recentBritish study of several hundred people with mild-to-moderate osteoarthritis of the knee, thosetreated with risedronate showed a clear trendtoward reduced symptoms and improved jointstructure.
More studies are needed for both drugs.
Estrogen: In studies of older women, scientists found alower risk of osteoarthritis in those who had used oralestrogens for hormone replacement therapy. Theresearchers suspect that having low levels of estrogencould increase the risk of developing osteoarthritis.
However, the 15-year, NIH-funded Women’s Health Ini-tiative found that taking estrogen plus progestin increasedthe risk of heart attack, stroke, blood clots, and breast can-cer, while taking estrogen alone increased the risk ofstroke and blood clots. The Food and Drug Administrationrecommends that hormone therapy be used at the lowestdoses for the shortest duration needed to achieve treatmentgoals. Hormone therapy should always be used under adoctor’s care.
Several other research projects are underway. The goal ofone is to determine if estrogen protects cartilage. Other pro-jects are examining the effects on joint cartilage of a selec-tive estrogen receptor molecule (SERM) called raloxifene,which is often used in place of estrogen to treat and preventosteoporosis.
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Complementary and alternative therapies:
n acupuncture: One of the most popular alternativepain-relief methods is acupuncture, an ancientChinese practice in which fine needles areinserted at specific points in the body. Accordingto research funded by the National Center forComplementary and Alternative Medicine,acupuncture may help reduce pain and improvefunction for individuals with knee osteoarthritiswhen used as an adjunct to medication.
One study underway compares the benefits ofacupuncture with physical therapy to the benefits ofphysical therapy alone. The hope is that acupunc-ture will help relieve pain that makes exercise diffi-cult and, therefore, will improve the effectivenessof traditional exercise physical therapy.
n glucosamine and chondroitin sulfate: In recentyears, the nutritional supplement pair glucosamineand chondroitin has shown some potential forreducing the pain of osteoarthritis, though no con-clusive proof has emerged to date. Both of thesenutrients are found in small quantities in food andare components of normal cartilage.
The recently concluded Glucosamine/ChondroitinArthritis Intervention Trial (GAIT), which was co-sponsored by the National Center for Comple-mentary and Alternative Medicine and theNational Institute of Arthritis and Musculoskeletaland Skin Diseases, assessed the effectiveness andsafety of these supplements, when taken togetheror separately.
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The trial found that the combinationof glucosamine and chondroitin sul-fate did not provide significant relieffrom osteoarthritis pain among allparticipants. However, a smallersubgroup of study participants withmoderate-to-severe pain showed sig-nificant relief with the combinedsupplements.
The 4-year trial was conducted at 16sites across the United States. Theresults were published in the Feb.23, 2006 edition of the New EnglandJournal of Medicine.
n other complementary and alternative therapies:Other research suggests that certain hyaluronicacid preparations; substances calledanthraquinones; gelatin-related substances; andelectrical stimulation may have a beneficialeffect on cartilage growth and repair. Althoughthese agents have shown varying degrees ofpromise in basic and clinical studies, additionaltrials are needed.
n vitamins D, C, E, and beta carotene: The pro-gression of osteoarthritis may be slower in peoplewho take higher levels of vitamin D, C, E, or betacarotene. NIAMS is sponsoring a clinical trial onuse of Vitamin D to treat osteoarthritis. Morestudies are needed to confirm these reports.
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The GAIT trial
assessed the
effectiveness and
safety of the
supplements
glucosamine and
chondroitin
sulfate.
n green tea: Many studies have shown that green teapossesses anti-inflammatory properties. Onerecent study showed that mice predisposed to acondition similar to human osteoarthritis had mildarthritis and little evidence of cartilage damageand bone erosion when green tea polyphenolswere added to their drinking water. Another studyshowed that when added to human cartilage cellcultures, the active ingredients in green tea inhib-ited chemicals and enzymes that lead to cartilagedamage and breakdown. Further studies are look-ing at the effects of green tea compounds onhuman cartilage.
n prolotherapy: This is a popular, growing, andunregulated therapy for chronic musculoskeletalpain in which an irritant solution is injected intopainful ligaments and adjacent joint spaces. How-ever, no rigorous, scientifically valid clinical trialshave proven the therapy’s action or usefulness. Aclinical trial sponsored by the National Center forComplementary and Alternative Medicine isstudying prolotherapy’s effectiveness for the painof knee osteoarthritis. It is also using animals toassess the healing response after prolotherapy.
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Hope for the Future
R esearch is opening up new avenues of treatment forpeople with osteoarthritis. A balanced, comprehensive
approach is still the key to staying active and healthywith the disease. People with osteoarthritis should com-bine exercise, relaxation, education, social support, andmedications in their treatment strategies. Meanwhile, asscientists unravel the complexities of the disease, newtreatments and prevention methods should become appar-ent. Such developments are expected to improve the qual-ity of life for people with osteoarthritis and their families.
Additional ResourcesNational Institute of Arthritis and Musculoskeletaland Skin Diseases (NIAMS)National Institutes of Health1 AMS CircleBethesda, MD 20892–3675Phone: 301–495–4484 or877–22–NIAMS (226–4267) (free of charge)TTY: 301–565–2966Fax: 301–718–6366E-mail: [email protected]
NIAMS provides information about various forms ofarthritis and other rheumatic diseases, and other bone,muscle, joint, and skin diseases. It distributes patient andprofessional education materials and refers people toother sources of information. Additional information andupdates can also be found on the NIAMS Web site.
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NIH Osteoporosis and Related BoneDiseases~National Resource Center2 AMS CircleBethesda, MD 20892-3676Phone: 202–223–0344 or 800–624–BONE TTY: 202–466–4315 Fax: 202–293–2356www.niams.nih.gov/bone
The NIH Osteoporosis and Related BoneDiseases~National Resource Center provides patients,health professionals, and the public with an importantlink to resources and information on metabolic bone dis-eases. The mission of NIH ORBD~NRC is to expandawareness and enhance knowledge and understanding ofthe prevention, early detection, and treatment of these dis-eases as well as strategies for coping with them. The cen-ter provides information on osteoporosis, Paget’s diseaseof bone, osteogenesis imperfecta, primary hyperparathy-roidism, and other metabolic bone diseases and disorders.
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American Academy of Orthopaedic SurgeonsP.O. Box 1998Des Plaines, IL 60017847–823–7186 or800–824–BONE (2663) (free of charge)Fax: 847–823–8125www.aaos.org
The academy provides education and practice manage-ment services for orthopaedic surgeons and allied healthprofessionals. It also serves as an advocate for improvedpatient care and informs the public about the science oforthopaedics. The orthopaedist’s scope of practiceincludes disorders of the body’s bones, joints, ligaments,muscles, and tendons. For a single copy of an AAOSbrochure, send a self-addressed stamped envelope to theaddress above or visit the AAOS Web site.
American College of Rheumatology1800 Century Place, Suite 250Atlanta, GA 30345Phone: 404–633–3777Fax: 404–633–1870www.rheumatology.org
This association provides referrals to doctors and healthprofessionals who work on arthritis, rheumatic diseases,and related conditions. It also provides educational mate-rials and guidelines for the treatment of osteoarthritis.
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American Physical Therapy Association 1111 North Fairfax StreetAlexandria, VA 22314–1488Phone: 703–684–2782 or 800–999–APTA (2782) (free of charge)Fax: 703–684–7343 www.apta.org
This association is a national professional organizationrepresenting physical therapists, allied personnel, and stu-dents. Its objectives are to improve research, publicunderstanding, and education in the physical therapies.
Arthritis FoundationP.O. Box 7669 Atlanta, GA 30357-0669Phone: 404–872–7100 or 800–568–4045 (free of charge) or your local chapter(listed in the telephone directory)www.arthritis.org
This is the major voluntary organization devoted to arthri-tis. The foundation publishes free informationalbrochures on various types of arthritis, includingosteoarthritis, as well as a monthly magazine for mem-bers that provides up-to-date information on all forms ofarthritis. The foundation also can provide addresses andphone numbers for local chapters and physician andclinic referrals.
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Key WordsAcupuncture – the use of fine needles inserted at specificpoints on the skin. Primarily used for pain relief,acupuncture may be a helpful component of anosteoarthritis treatment plan for some people.
Analgesics – medications designed to relieve pain. Pureanalgesics do not have an effect on inflammation.
Biomarkers – physical signs or biological substancesthat indicate changes in bone or cartilage. Doctors believethey may one day be able to use biomarkers for diagnos-ing osteoarthritis before it causes noticeable joint damageand for monitoring the progression of the disease and itsresponsiveness to treatment.
Bone spurs – small growths of bone that can occur on theedges of a joint affected by osteoarthritis. These growthsare also known as osteophytes.
Bouchard’s nodes – small, bony knobs associated withosteoarthritis of the hand that can occur on the middlejoints of the fingers.
Cartilage – a hard but slippery coating on the end of eachbone. The breakdown of joint cartilage is the primary fea-ture of osteoarthritis.
Chondrocytes – components of cartilage. Chondrocytesare cells that produce cartilage, are found throughout car-tilage, and help it stay healthy as it grows. Sometimes,however, they release certain enzymes that destroy colla-gen and other proteins.
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Chondroitin sulfate – a naturally existing substance injoint cartilage that is believed to draw fluid into thecartilage. Chondroitin is often taken in supplement formalong with glucosamine as a treatment for osteoarthritis.See the “glucosamine and chondroitin sulfate” sectionunder Complementary and Alternative Therapies for moreinformation.
Collagen – a family of fibrous proteins that are compo-nents of cartilage. Collagens are the building blocks ofskin, tendon, bone, and other connective tissues.
Corticosteroids – powerful anti-inflammatory hormonesmade naturally in the body or man made for use as medi-cine. Corticosteroids may be injected into the affectedjoints to temporarily reduce inflammation and relieve pain.
COX-2 inhibitors – a relatively new class of nonsteroidalanti-inflammatory drugs (NSAIDs) that are formulated torelieve pain and inflammation. For information about therisk posed by NSAIDs, see “NSAIDs” in the “How IsOsteoarthritis Treated?” section.
Estrogen – the major sex hormone in women. Estrogen isknown to play a role in regulation of bone growth.Research suggests that estrogen may also have a protectiveeffect on cartilage.
Glucosamine – a substance that occurs naturally in thebody, providing the building blocks to make and repaircartilage. See the “glucosamine and chondroitin sulfate”section under Complementary and Alternative Therapiesfor more information.
45
Heberden’s nodes – small, bony knobs associated withosteoarthritis of the hand that can occur on the joints ofthe fingers closest to the nail.
Hyaluronic acid – a substance that gives healthy jointfluid its viscous (slippery) property and that may bereduced in people with osteoarthritis. For some peoplewith osteoarthritis of the knee, replacing hyaluronic acidwith injections of agents referred to as viscosupplementsis useful for increasing lubrication, reducing pain, andimproving function.
Joint capsule – a tough membrane sac that holds thebones and other joint parts together.
Ligaments – tough bands of connective tissue that attachbones to each other, providing stability.
Magnetic resonance imaging (MRI) – provides high-resolution computerized images of internal body tissues.This procedure uses a strong magnet that passes a forcethrough the body to create these images.
Muscles – bundles of specialized cells that contract andrelax to produce movement when stimulated by nerves.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – aclass of medications available over the counter or with aprescription that ease pain and inflammation. Commonlyused NSAIDs include ibuprofen (Advil, Motrin),naproxen sodium (Aleve), and ketoprofen (Orudis, Oru-vail). For information about the risk posed by NSAIDs,see “NSAIDs” in the “How Is Osteoarthritis Treated?”section.
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Osteoarthritis – the most common form of arthritis. It ischaracterized by the breakdown of joint cartilage, leadingto pain, stiffness, and disability.
Osteophytes – small growths of bone that can appear onthe edges of a joint affected by osteoarthritis. Thesegrowths are also known as bone spurs.
Prolotherapy – an unregulated, unproven therapy forchronic musculoskeletal pain. Prolotherapy uses an irri-tant solution, which is injected into painful ligaments andadjacent joint spaces to promote inflammation and subse-quent healing.
Proteoglycans – components of cartilage. Made up ofproteins and sugars, strands of proteoglycans interweavewith collagens and form a mesh-like tissue. This allowscartilage to flex and absorb physical shock.
Rheumatoid arthritis – a form of arthritis in which theimmune system attacks the tissues of the joints, leading topain, inflammation, and eventually joint damage and mal-formation. It typically begins at a younger age thanosteoarthritis does, causes swelling and redness in joints,and may make people feel sick, tired, and uncommonlyfeverish. Rheumatoid arthritis may also affect skin tissue,the lungs, the eyes, or the blood vessels.
Stem cells – primitive cells, usually taken from the bonemarrow, that can transform into other kinds of cells, suchas muscle or bone cells. In the future, researchers hope tobe able to insert stem cells into cartilage and stimulatethem to replace cartilage damaged by arthritis or injury.
Synovium – a thin membrane inside the joint capsule thatsecretes synovial fluid.
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Synovial fluid – a fluid secreted by the synovium thatlubricates the joint and keeps the cartilage smooth andhealthy.
Tendons – tough, fibrous cords that connect muscles tobones.
Transcutaneous electrical nerve stimulation (TENS) –a technique that uses a small electronic device to directmild electric pulses to nerve endings that lie beneath theskin in a painful area. TENS may relieve some arthritispain. It seems to work by blocking pain messages to thebrain and by modifying pain perception.
X ray – a procedure in which low-level radiation ispassed through the body to produce a picture called aradiograph. X rays of joints affected by osteoarthritis canshow such things as cartilage loss, bone damage, andbone spurs.
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AcknowledgmentsThe NIAMS gratefully acknowledges the assistance ofGayle Lester, Ph.D., Joan McGowan, Ph.D., JamesPanagis, M.D., Susana Serrate-Sztein, M.D., andBernadette Tyree, Ph.D., NIAMS, NIH; Kenneth D.Brandt, M.D., Indiana University School of Medicine,Indianapolis; Victor M. Goldberg, M.D., University Hos-pitals of Cleveland, OH; Marc C. Hochberg, M.D.,M.P.H., University of Maryland, Baltimore; John Klippel,M.D., Arthritis Foundation, Atlanta; and RolandMoskowitz, M.D., Case Western Reserve University,Cleveland, OH in the preparation and review of this pub-lication. Special thanks also go to the patients whoreviewed this publication and provided valuable input.
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The mission of the National Institute of Arthritis andMusculoskeletal and Skin Diseases (NIAMS), a part ofthe Department of Health and Human Services’ NationalInstitutes of Health (NIH), is to support research intothe causes, treatment, and prevention of arthritis andmusculoskeletal and skin diseases; the training of basicand clinical scientists to carry out this research; and thedissemination of information on research progress inthese diseases. The National Institute of Arthritis andMusculoskeletal and Skin Diseases Information Clearing-house is a public service sponsored by the NIAMS thatprovides health information and information sources.Additional information can be found on the NIAMSWeb site at www.niams.nih.gov.
U.S. Department of Health andHuman ServicesPublic Health Service
National Institutes of Health
National Institute of Arthritis and Musculoskeletal and Skin Diseases
NIH Publication No. 06–4617July 2002Revised May 2006
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