About osteoarthritis
What is osteoarthritis?
Osteoarthritis (OA) is a progressive joint disease that is caused by a breakdown of cartilage in a joint. Cartilage is a protein substance that acts as a cushion between bones, allowing joints to glide smoothly. Without it, movements can become stiff, unpleasant, and even painful1.
Unlike other forms of arthritis, OA is non-inflammatory to begin; although it can become inflammatory at later stages. This means that it is not an autoimmune or systemic condition. However, symptoms may worsen if the underlying cause is not addressed. Osteoarthritis severity can be classified based on X-rays to determine joint damage or the impact of the disease on a person’s life14:
The most common symptoms are joint pain and stiffness. OA can affect any joint, but hands and weight-bearing joints—including the spine, hips, and knees—are most often affected. Other joints, like shoulders, elbows, and ankles, are less likely to be affected unless the joint has been previously damaged by injury.
The main issue is that the joint pain and stiffness caused by OA can make it harder to be physically active and participate in life events. For example, OA is a leading cause of mobility limitations which indirectly contributes to life expectancy2. Further, people with OA may attend fewer social events that could benefit mental health and wellbeing3.
Who can develop osteoarthritis?
Osteoarthritis is by far the most common type of arthritis. As of 2017, it was estimated to affect more than 4 million Canadians adults, or 1 in 74. Risk factors for OA include age, a family history of OA, excess body weight, as well as joint injury and repeated overuse of the joint1. For example, data shows that youth who sustain joint injuries are at an elevated risk of developing knee OA in the following decade5. Osteoarthritis strikes most commonly after the age of 45, but people of all ages—from children to older adults – are at risk6. Unlike some other forms of arthritis, women and men are equally likely to be affected by OA.
Getting a diagnosis of osteoarthritis
There are several warning signs for OA. These include1:
As is the case with most forms of arthritis, early diagnosis of OA is a key factor in maintaining joint health and preventing disability and deformity. There are things you can do to slow the progression of joint damage.
Treatment for osteoarthritis
Depending on the severity of the case, there are both non-medication and medication treatment options. For mild knee OA, focusing on education, lifestyle and exercise, are first-line therapies. For moderate to severe OA, a doctor may also recommend medications or joint surgery depending on symptoms.
Lifestyle
A first line of treatment is lifestyle changes. For example, maintaining a healthy weight reduces the load placed on joints, and in many cases, minimizes pain. Well-balanced eating may support metabolism and energy levels. People with OA, like everyone, should aim to achieve 150 minutes of physical activity each week. Best thing of all, these modalities are proven to be effective if adopted as habits and have a variety of benefits.
Exercise7,8
Exercise is another important component of any treatment plan as movement signals joints to produce more cartilage. The key is to participate in the right kinds of exercise. Generally, exercises that put less stress on joints, like swimming and other water-based types of exercise, are the ideal starting point. Once joints are strengthened, slowly transition to an elliptical or a stationary cycle for greater cardiovascular challenge and begin to incorporate mobility exercises. There is good evidence to suggest that strength training can build muscle, which may help to relieve the impact on the joints.
Medication9-13
In mild cases of OA, joint pain may be sufficiently managed with an over-the-counter pain reliever, like acetaminophen (Tylenol®). Acetaminophen can be effective in reducing pain, but is not an anti-inflammatory medication and cannot stop joint damage. Speak to your doctor before starting any medication.
If a pain reliever like acetaminophen is not enough, doctors may prescribe a non-steroidal anti-inflammatory drug (NSAID). Examples of NSAIDs available without a prescription include ibuprofen (Motrin® or Advil®) and acetylsalicylic acid (Aspirin®). Some more powerful NSAIDs require a prescription such as naproxen (Naprosyn®). These are potent medications which can reduce joint inflammation and pain, but do not work to reduce joint damage. In rare cases, NSAIDs have been linked to cardiovascular, kidney or gastro-intestinal side effects, like stomach ulcers. Speak with your doctor before adding an NSAID to any treatment plan for OA.
COX-2 inhibitors are a class of NSAID which work to reduce inflammation but do not carry the same risk of gastrointestinal side effects as non-COX-2 inhibitors. Celecoxib (Celebrex) is an example of a COX-2 inhibitor. It is important to know that while COX-2 inhibitors cause fewer gastrointestinal side effects, research has shown that they may have the same or higher risk of cardiovascular (heart) side effects compared to traditional NSAIDs.
Sometimes, an injection of corticosteroid (sometimes called 'cortisone') into the affected joint may help to reduce the inflammation of moderate to advanced OA in the hip and knee where mobility is impacted or pain is severe. It is important to note that these injections should only be done intermittently (less than three per year) into each affected joint, as multiple corticosteroid injections may weaken the cartilage, causing further joint damage. Corticosteroid injections are not a long-term treatment, but rather a temporary solution, to be used very occasionally due to the risk of side effects.
Surgery
Joint surgery is an option if joint damage progresses to the point where overall function and mobility are reduced or pain is severe for an extended period. The most common type of joint surgery for OA is joint replacement; knees and hips are the most common joints to be treated with joint replacement surgery.
Key take-aways
The Osteoarthritis (OA) Tool has been developed for primary care providers who are managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand. This tool will help clinicians identify symptoms and provide evidence-based and goal-oriented non-pharmacological and pharmacological treatments while identifying triggers for investigations or referrals.
Osteoarthritis tool for patients
Good communication between patients and their health care providers is very important in reaching an accurate diagnosis and building effective treatment plans. Based on that evidence, Arthritis Consumer Experts, other patient organizations, as well as scientific and clinical experts in OA, have developed the Talk to Your Doctor About Joint Pain Handout designed to improve the quality of life for individuals with arthritis, including their physical activity, sleep, mental health (like mood or depression), relationships and work life, specifically by:
Références
| ACE is committed to using inclusive language that is free from words, phrases and tone that reflect discriminatory or stereotyped views of underrepresented people or groups. In our attempt to avoid bias or using language that appropriates other cultures as it relates to Indigenous Peoples health and wellness, ACE consults with Indigenous advisors to ensure its website and other written materials use terms and expressions that align with Indigenous identities and are culturally appropriate. |
Osteoarthritis (OA) is a progressive joint disease that is caused by a breakdown of cartilage in a joint. Cartilage is a protein substance that acts as a cushion between bones, allowing joints to glide smoothly. Without it, movements can become stiff, unpleasant, and even painful1.
Unlike other forms of arthritis, OA is non-inflammatory to begin; although it can become inflammatory at later stages. This means that it is not an autoimmune or systemic condition. However, symptoms may worsen if the underlying cause is not addressed. Osteoarthritis severity can be classified based on X-rays to determine joint damage or the impact of the disease on a person’s life14:
- Mild knee osteoarthritis – Low levels of or short bouts of knee pain with well-preserved joint function and quality of life.
- Moderate to severe knee osteoarthritis – Persistent pain which significantly reduces joint function, and quality of life.
The most common symptoms are joint pain and stiffness. OA can affect any joint, but hands and weight-bearing joints—including the spine, hips, and knees—are most often affected. Other joints, like shoulders, elbows, and ankles, are less likely to be affected unless the joint has been previously damaged by injury.
The main issue is that the joint pain and stiffness caused by OA can make it harder to be physically active and participate in life events. For example, OA is a leading cause of mobility limitations which indirectly contributes to life expectancy2. Further, people with OA may attend fewer social events that could benefit mental health and wellbeing3.
Who can develop osteoarthritis?
Osteoarthritis is by far the most common type of arthritis. As of 2017, it was estimated to affect more than 4 million Canadians adults, or 1 in 74. Risk factors for OA include age, a family history of OA, excess body weight, as well as joint injury and repeated overuse of the joint1. For example, data shows that youth who sustain joint injuries are at an elevated risk of developing knee OA in the following decade5. Osteoarthritis strikes most commonly after the age of 45, but people of all ages—from children to older adults – are at risk6. Unlike some other forms of arthritis, women and men are equally likely to be affected by OA.
Getting a diagnosis of osteoarthritis
There are several warning signs for OA. These include1:
- Joint pain and/or stiffness lasting for more than two weeks
- Swelling in joints of the hands and feet
- Reduced muscle strength and joint mobility
As is the case with most forms of arthritis, early diagnosis of OA is a key factor in maintaining joint health and preventing disability and deformity. There are things you can do to slow the progression of joint damage.
Treatment for osteoarthritis
Depending on the severity of the case, there are both non-medication and medication treatment options. For mild knee OA, focusing on education, lifestyle and exercise, are first-line therapies. For moderate to severe OA, a doctor may also recommend medications or joint surgery depending on symptoms.
Lifestyle
A first line of treatment is lifestyle changes. For example, maintaining a healthy weight reduces the load placed on joints, and in many cases, minimizes pain. Well-balanced eating may support metabolism and energy levels. People with OA, like everyone, should aim to achieve 150 minutes of physical activity each week. Best thing of all, these modalities are proven to be effective if adopted as habits and have a variety of benefits.
Exercise7,8
Exercise is another important component of any treatment plan as movement signals joints to produce more cartilage. The key is to participate in the right kinds of exercise. Generally, exercises that put less stress on joints, like swimming and other water-based types of exercise, are the ideal starting point. Once joints are strengthened, slowly transition to an elliptical or a stationary cycle for greater cardiovascular challenge and begin to incorporate mobility exercises. There is good evidence to suggest that strength training can build muscle, which may help to relieve the impact on the joints.
Medication9-13
In mild cases of OA, joint pain may be sufficiently managed with an over-the-counter pain reliever, like acetaminophen (Tylenol®). Acetaminophen can be effective in reducing pain, but is not an anti-inflammatory medication and cannot stop joint damage. Speak to your doctor before starting any medication.
If a pain reliever like acetaminophen is not enough, doctors may prescribe a non-steroidal anti-inflammatory drug (NSAID). Examples of NSAIDs available without a prescription include ibuprofen (Motrin® or Advil®) and acetylsalicylic acid (Aspirin®). Some more powerful NSAIDs require a prescription such as naproxen (Naprosyn®). These are potent medications which can reduce joint inflammation and pain, but do not work to reduce joint damage. In rare cases, NSAIDs have been linked to cardiovascular, kidney or gastro-intestinal side effects, like stomach ulcers. Speak with your doctor before adding an NSAID to any treatment plan for OA.
COX-2 inhibitors are a class of NSAID which work to reduce inflammation but do not carry the same risk of gastrointestinal side effects as non-COX-2 inhibitors. Celecoxib (Celebrex) is an example of a COX-2 inhibitor. It is important to know that while COX-2 inhibitors cause fewer gastrointestinal side effects, research has shown that they may have the same or higher risk of cardiovascular (heart) side effects compared to traditional NSAIDs.
Sometimes, an injection of corticosteroid (sometimes called 'cortisone') into the affected joint may help to reduce the inflammation of moderate to advanced OA in the hip and knee where mobility is impacted or pain is severe. It is important to note that these injections should only be done intermittently (less than three per year) into each affected joint, as multiple corticosteroid injections may weaken the cartilage, causing further joint damage. Corticosteroid injections are not a long-term treatment, but rather a temporary solution, to be used very occasionally due to the risk of side effects.
Surgery
Joint surgery is an option if joint damage progresses to the point where overall function and mobility are reduced or pain is severe for an extended period. The most common type of joint surgery for OA is joint replacement; knees and hips are the most common joints to be treated with joint replacement surgery.
Key take-aways
- Osteoarthritis is so much more than a “wear and tear” condition. A combination of factors play a role in the development of OA.
- There are many ways to halt the progression of OA that are non-pharmacologic and include lifestyle changes including nutrition and exercise.
- Joint surgery include pre-habilitation and re-habilitation. To learn more, read this JointHealth™ insight on The Road to Joint Replacement Surgery.
The Osteoarthritis (OA) Tool has been developed for primary care providers who are managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand. This tool will help clinicians identify symptoms and provide evidence-based and goal-oriented non-pharmacological and pharmacological treatments while identifying triggers for investigations or referrals.
Osteoarthritis tool for patients
Good communication between patients and their health care providers is very important in reaching an accurate diagnosis and building effective treatment plans. Based on that evidence, Arthritis Consumer Experts, other patient organizations, as well as scientific and clinical experts in OA, have developed the Talk to Your Doctor About Joint Pain Handout designed to improve the quality of life for individuals with arthritis, including their physical activity, sleep, mental health (like mood or depression), relationships and work life, specifically by:
- Assisting those with or at risk of OA, in having better conversations with their doctors or other health care professionals, by informing them about the care they can expect to receive.
- Helping patients identify the causes of their joint pain and loss of mobility.
- Informing them of the basics of primary prevention strategies and self-care methods.
Références
| 1 | ACR Website |
| 2 | Siviero & EPOSA Research Group. (2020). Association between osteoarthritis and social isolation: data from the EPOSA study. https://doi.org/10.1111/jgs.16159 |
| 3 | Jagger & Robine (2011). Healthy life expectancy. (pp. 551-568). |
| 4 | Arthritis Society website |
| 5 | Thomas et al. (2017). Epidemiology of Posttraumatic Osteoarthritis. https://doi.org/10.4085/1062-6050-51.5.08 |
| 6 | Zhang & Jordan (2010). Epidemiology of osteoarthritis. https://doi.org/10.1016/j.cger.2010.03.001 |
| 7 | Exercise is Medicine website |
| 8 | Nguyen et al. (2016). Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review. |
| 9 | Arthritis Society website - NSAIDs |
| 10 | Pelletier et al. (2016). Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. https://doi.org/10.1016/j.semarthrit.2015.11.009 |
| 11 | Choueiri, M., Chevalier, X., & Eymard, F. (2021). Intraarticular Corticosteroids for Hip Osteoarthritis: A Review. https://doi.org/10.1177/1947603520951634 |
| 12 | Huang et al. (2019). Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis. https://doi.org/10.1007/s00132-018-03659-5 |
| 13 | Zeng et al. (2019). Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative. https://doi.org/10.1016/j.joca.2019.01.007 |
| 14 | Deveza & Bennell (2022). Management of moderate to severe knee osteoarthritis. |
Arthritis Consumer Experts
ACE thanks Arthritis Research Canada (ARC) for its scientific review of ACE and JointHealth™ information and education programs.