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Osteoarthritis

Osteoarthritis is a condition that affects your joints, and makes them stiff and painful. It's sometimes called 'wear and tear’ arthritis. Osteoarthritis most often affects the joints in your body that carry weight, for example, your knees, hips, feet and spine. However, it can also affect your fingers, the base of your thumbs, elbows and shoulders, or potentially any other joint in your body.

Osteoarthritis is sometimes confused with osteoporosis (thinning of the bones) because the names are similar. However, they are different conditions.

Osteoarthritis causes the cartilage on the end of your bones to get rougher and thinner. The bone underneath thickens and grows outwards, creating growths called osteophytes that can make your joint look knobbly. The capsule around the joint also thickens and tightens. Sometimes fluid builds up and your joint can look and feel swollen.

These changes to your joints can cause pain and stiffness and make it more difficult for you to get around, or do everyday tasks. Osteoarthritis can affect people in different ways. It may get worse over a short period of time and cause a lot of damage to your joints. This can have a significant impact on your day-to-day life. Or, you may find that your condition develops slowly over many years, causing small changes to your joints that don’t get any worse. They may even ease over time.

There are many treatments and self-help measures that can ease your symptoms even though there isn't a cure for osteoarthritis.

Osteoarthritis is the most common type of arthritis in the UK; it causes joint pain in around eight and a half million people. It’s more common over the age of 50, although it can develop in younger people too.

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An image showing how the knee is affected by osteoarthritis

Details

  • Symptoms Symptoms of osteoarthritis

    When osteoarthritis first develops, you may have some stiffness and pain in your joint. This might get worse when you move or put weight on it.

    As your condition develops you may notice other symptoms. The main ones are listed below.

    • A deep, aching joint pain. Depending on which of your joints is affected, you may find this pain spreads. For example, if you have osteoarthritis in your hip, you may have pain down the side or front of your thigh and into your buttock. This is called radiated pain.
    • A reduction in your range of movement in the joint. This means you won’t be able to move your joint into the positions you did before, or move them as far.
    • A crunching and grinding sensation and noise in your joints when you move them. This is called crepitus.
    • A change in the shape of your joint, with hard bony growths and soft swelling caused by extra fluid.
    • Your joint may give way when you put weight on it. This can happen because your muscles have weakened or because your joint is less stable.

    There may be times when your symptoms get worse. For example, when the weather is damp or when you have been more active than usual.

    If you have any of these symptoms, see your GP.

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  • Diagnosis Diagnosis of osteoarthritis

    Your GP will ask about your symptoms and will ask to examine you. He or she may also ask you about your medical history.

    There is no single test for osteoarthritis and an examination is often all that is needed to diagnose the condition. Your GP may look to see if you have any bony growths and swelling and any creaking in your joint. He or she might also check how well your joint moves and how stable it is.

    Your GP may suggest you have an X-ray of your affected joint. An X-ray can help to show if the normal space in your joint is reduced because you have lost protective cartilage. It can also show if you have any extra bone growth around your joint or any roughening or thickening of the surface of your joint. Sometimes calcification of the cartilage can be seen on X-ray images. This is when calcium builds up in a joint, usually your knee. It’s more likely in older people who have osteoarthritis.

  • Treatment Treatment options for osteoarthritis

    There are a number of treatments that can help you to manage osteoarthritis and control your symptoms. However, there is no cure for the condition.

    Which treatments you’re offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    Self-help

    There are many things you can do to reduce the pain and stiffness in your joints, and to make day-to-day life easier. Self-help measures can help to reduce the stress on your joints and reduce the severity of your condition. Some of the main ones are listed below.

    • Try to maintain a healthy weight for your height. This may mean losing excess weight because this can put more stress on your joints and make osteoarthritis worse.
    • Exercise regularly and keep moving. Exercise can help to keep your joints working well.
    • Pace yourself. For example, spread out any chores that need doing, rather than trying to do them all at once.
    • Use a walking stick to ease any stress on your knee or hip joint.
    • Wear shoes with a soft, thick, cushioned sole or use an insole. This will help to reduce any jarring.
    • Massage the muscles around your joint to help ease pain.
    • Use a heat pad or an ice pack to help relieve pain. Don’t put either of these directly onto your skin as they may damage it or even give you a burn. Wrap them in a towel or dishcloth first.
    • Think about making changes to your car, home or workplace to ease any stress on your joints. You may be able to get help from an occupational therapist. This is a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.
    • Use braces or supports to keep your joint stable and provide support. Ask your GP about these.

    Exercise

    Researchers have been looking into whether exercise classes supervised by a physiotherapist and information sessions have benefits for people with osteoarthritis in their hip. They compared this with people who just went to the information sessions. Their results showed that people who did the exercise sessions had less pain from their osteoarthritis than those who only received information. The people who did exercise were also able to move around more easily, and their condition progressed more slowly. This meant that they were less likely to need a hip replacement operation.

    Ask your GP if there are exercise programmes in your area. They may be able to refer you or give you information about physiotherapists who are running them.

    Medicines

    Painkillers may help to ease your pain and stiffness, but they can’t make your condition better. Paracetamol may help for mild pain. You can also try non-steroidal anti-inflammatory (NSAID) creams and gels, such as ibuprofen and diclofenac. You can rub these directly onto your joint. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    If these medicines don’t work, your GP may suggest you take NSAIDs as tablets rather than as a cream or gel. He or she may also suggest a stronger type of painkiller called an opioid. If you’re taking NSAID tablets regularly, your GP may offer you a medicine called a proton pump inhibitor as well. This will protect your stomach and reduce the risk of side-effects from NSAIDs. Using NSAIDs for long periods is usually safe but it has been linked with heart, kidney and stomach problems.

    Your GP may offer you a medicine called capsaicin cream to help ease your pain. Capsaicin cream is made from pepper plants and is an effective painkiller, particularly if you have hand or knee osteoarthritis. Side-effects are uncommon but can include a slight burning or itching sensation where you apply the cream.

    If you have a particularly painful, swollen joint, your GP may suggest you have a steroid injection directly into your joint. This can only be done a few times each year, but can help to reduce inflammation and ease pain. The injection usually works within a few days, and can last for weeks or months. Although side-effects are unlikely, steroid injections may cause a temporary ‘flare up’ of your symptoms.

    Non-surgical treatments

    You may decide to try a type of pain relief called transcutaneous electrical nerve stimulation (TENS). This is an electronic device that sends pulses through your skin to your nerve endings. It interferes with the messages being sent to your brain and may help to relieve your pain. Some people with osteoarthritis find it useful, although it doesn’t work for everyone.

    You can buy a TENS machine from your pharmacy. You could ask your physiotherapist if you can borrow one to trial before you decide to buy one.

    Surgery

    If you have severe pain from osteoarthritis or it has a significant impact on your life, your doctor may suggest you have surgery. Which type of surgery you’re offered will depend on your personal circumstances. This could be keyhole surgery or an operation to replace part, or the whole, of your affected joint with an artificial one. Your doctor will discuss these options with you to help you make a decision that’s right for you.

    Surgery may help to ease your pain if other treatments haven’t been effective for you. As with every procedure, there are some risks associated with having surgery for osteoarthritis. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Complementary therapies

    Many people with osteoarthritis take supplements or use complementary medicines to ease their symptoms.

    You might find that fish oils, such as cod liver oil, help to ease pain and stiffness. However, there is no strong evidence that they work for osteoarthritis.

    Glucosamine and chondroitin are two of the most commonly used supplements for osteoarthritis. Current research suggests that they don’t work to reduce joint pain and they aren’t recommended as treatments for osteoarthritis. However, some people with osteoarthritis do see a benefit from taking them. If you decide to take glucosamine or chondroitin, it may take up to two months before you will know if they work for you.

    There is little evidence that other therapies, such as acupuncture, are effective at treating osteoarthritis. However, acupuncture may help if you have osteoarthritis in your knee. Speak to your GP before you try a complementary therapy or herbal remedy.

  • Causes Causes of osteoarthritis

    The exact reasons why you may develop osteoarthritis aren’t fully understood at present. However, certain factors may increase your risk of developing the condition. You’re more likely to develop osteoarthritis if:

    • one of your parents has the condition
    • you’re over 50
    • you’re overweight or obese
    • you have previously injured or had an infection in your joint
    • you have another arthritic condition, such as rheumatoid arthritis or gout
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  • Living with osteoarthritis Living with osteoarthritis

    Living with osteoarthritis can be difficult and the more severe your condition is, the bigger the impact it’s likely to have on your life.

    As with many long-term conditions that cause pain and discomfort, having osteoarthritis can affect your emotions and your relationships with those around you. It can also have an impact on your sleep, which may affect other areas of your life, or lead to depression. Talk to your GP about the impact the condition has on your day-to-day life and what can be done to help you. You may also find it helpful to contact support groups and talk to other people living with osteoarthritis.

  • FAQs FAQs

    Does diet have any effect on osteoarthritis?

    Answer

    If you have osteoarthritis, it's important to eat a healthy diet and to lose any excess weight. Although there are various claims about specific foods affecting osteoarthritis there is little scientific evidence to support these.

    Explanation

    Certain foods (such as cider vinegar and honey) and supplements (such as glucosamine and chondroitin) have been claimed to help treat osteoarthritis. However, there is very little evidence to demonstrate this. It's also been suggested that various vitamins and minerals can affect osteoarthritis. For example, a lack of vitamin D in your diet may speed the progression of osteoarthritis but again, the research is conflicting.

    The most important point is to ensure your diet enables you to maintain an appropriate weight for your height. If you have excess weight, it will put a strain on your joints, particularly your knees, hips and lower back. This will affect how mobile you are. If you lose excess weight and exercise, the scientific evidence suggests this will reduce pain and stiffness in your joints. See our factsheet on exercise and weight control for more information.

    Some treatments for osteoarthritis might have an effect on certain vitamins and minerals you need. For example, if you have regular steroid injections, it’s a good idea to make sure you get enough calcium in your diet. This is because taking steroids can increase your risk of getting osteoporosis. Getting enough calcium in your diet can help to maintain healthy bones and prevent this condition. It's important to eat a healthy, balanced diet as this will supply all the vitamins you need. Eat at least five portions of fruit and vegetables a day. Only take supplements if your GP recommends you do so.

    What can I do at home to make life easier?

    Answer

    Making changes to your home and car can help to protect your joints and reduce pain and stiffness. These include finding new ways to move or lift things and pacing yourself to reduce the stress on your joints.

    Explanation

    There are many things you can do at home to make day-to-day tasks easier for you and reduce the stress on your joints. If you make a few small changes, it may help to protect your joints and ease aches and pains. Some helpful tips are listed below.

    • Use labour-saving gadgets and aids specially designed for people with arthritis. These include devices for turning on taps, kitchen utensils with padded handles and automatic can openers.
    • Rearrange your kitchen and other rooms to make sure the things you use most are easy to reach.
    • When you’re lifting things, try to reduce the weight of the item and spread the load across more than one joint. For example, lift with two hands instead of one. If you can’t reduce the weight of an item, slide it rather than picking it up, for example, slide heavy pans across the worktop.
    • Plan ahead and pace your day. Don’t do large jobs all at once. Instead split them up and do a little at a time. You may find it easier to leave larger tasks for the afternoons when you’re less stiff and sore.
    • Adapt your car to make driving easier. A padded steering wheel, extra side mirrors or a steering wheel knob may all help. If your osteoarthritis is more severe, you may wish to consider driving an automatic rather than a manual car.

    An occupational therapist can assess you in your home to see whether you may be eligible for financial help to make changes to your home. Your local social services department may also be able to help with equipment or adaptations to your home. Some equipment may be available through the NHS but you may have to pay some costs yourself.

    What type of exercise is best for osteoarthritis?

    Answer

    It's important to exercise regularly if you have osteoarthritis. Exercise can help to ease pain and stiffness and will keep your joints and muscles strong and flexible. Follow a programme that includes exercises to strengthen your muscles and improve your range of movement, as well as aerobic exercise to improve your fitness.

    Explanation

    If you have osteoarthritis, exercise is very important. It helps to keep your muscles strong and your joints flexible and can help to ease pain and stiffness. Regular exercise won’t make your arthritis worse or damage your joints any further. Without regular exercise your muscles lose their strength and your joints will become stiffer, less flexible and more painful.

    You can exercise at different intensities. Moderate intensity means your breathing is faster, your heart rate is increased and you feel warmer. At this level of activity, your heart and lungs are being stimulated and this goes towards making you fitter. Vigorous intensity activity means that your breathing will be much stronger and your heart rate will increase rapidly. You will find it difficult to hold a conversation while doing vigorous exercise.

    Aim to do some physical activity every day. The recommended healthy level is 150 minutes (two and a half hours) of moderate exercise over a week. You can do this by carrying out 30 minutes on at least five days each week. Alternatively, you can do 75 minutes of vigorous intensity activity once a week.

    It’s important that you include activities to build up muscle strength. Try to spend as little time as possible being inactive.

    Swimming can be particularly good for osteoarthritis. It can soothe your joints and ease stiffness. The water also supports your joints and muscles while you exercise.

    Speak to your physiotherapist if you would like more information about exercising. He or she can help you to create an individual exercise programme that works for you.

    I have osteoarthritis in my hands. Will wearing splints help?

    Answer

    Wearing a splint on your hand, thumb or wrist may help to ease pain and stiffness and provide support for your joint. Resting splints may be helpful at night and working splints are worn when you’re using your hands.

    Explanation

    If you wear a hand or wrist splint, it may help to reduce your pain and ease the strain on your joints. There are two main types of splint.

    You may find it helpful to wear a resting splint overnight. They support your hand, wrist and forearm. Resting splints are usually custom made to fit you. Your physiotherapist or occupational therapist can give you advice on how to get a splint made.

    Working splints may help you when you’re using your hands, for example when you’re driving or gardening. They are made of an elastic material, which provides you with more flexible support. Working splints come in a number of different types, for example those that specifically support your thumb or wrist.

    Compression gloves, sometimes called isotoner gloves, may also be helpful in reducing pain and swelling. You may find these easier to wear than splints.

    It’s important that you don’t wear your splint all the time; don't wear it overnight unless your therapist specifically advises you to do this.

  • Resources Resources

    Further information

    Sources

    • Osteoarthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
    • Osteoarthritis. Medscape. www.emedicine.medscape.com, published 12 July 2013
    • Osteoarthritis. Arthritis Research UK. www.arthritisresearchuk.org, published November 2012
    • Osteoarthritis. National Institute for Health and Care Excellence (NICE), February 2008. www.nice.org.uk
    • Singh JA, Sperling J, Buchbinder R, et al. Surgery for shoulder osteoarthritis. Cochrane Database of Systematic Reviews 2010, Issue 10. doi: 10.1002/14651858.CD008089.pub2
    • Osteoarthritis – suspected. Map of Medicine. www.mapofmedicine.com, published 5 July 2013
    • Svege I, Nordsletten L, Fernandes L, et al. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis 2013. doi:10.1136/annrheumdis-2013-203628
    • Fransen M, McConnell S, Hernandez-Molina G, et al. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews 2014, Issue 4. doi: 10.1002/14651858.CD007912.pub2
    • Derry S, Moore RA, Rabbie R. Topical NSAIDS for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 9. doi: 10.1002/14651858.CD007400.pub2
    • Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012; 64(4):465–74. doi: 10.1002/acr.21596
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 8 October 2013
    • Rutjes AWS, Nüesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2009, Issue 4. doi: 10.1002/14651858.CD002823.pub2
    • Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Research UK. www.arthritisresearchuk.org, published October 2012
    • Diet and osteoarthritis. British Dietetic Association. www.bda.uk.com, published January 2012
    • Diet and arthritis. Arthritis Research UK. www.arthritisresearchuk.org, published April 2011
    • De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology 2011; 50(5):911–20. doi: 10.1093/rheumatology/keq379
    • Looking after your joints when you have arthritis. Arthritis Research UK. www.arthritisresearchuk.org, published April 2011
    • Everyday living and arthritis. Arthritis Research UK. www.arthritisresearchuk.org, published April 2013
    • Start active, stay active: a report on physical activity for health from the four home countries’ chief medical officers Department of Health. www.dh.gov.uk, published 2011
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    • Splints for arthritis of the wrist and hand. Arthritis Research UK. www.arthritisresearchuk.org, published April 2011
    • Lopez Hl. Nutritional interventions to prevent and treat osteoarthritis part II: focus on micronutrients and supportive nutraceuticals. PM R 2012; 4(5):S155–S68. doi: 10.1016/j.pmrj.2012.02.023
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    • Physical therapy interventions for knee pain secondary to osteoarthritis. Agency for Healthcare Research and Quality (AHRQ). www.effectivehealthcare.ahrq.gov, published 6 November 2012
    • Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2008, Issue 4. doi: 10.1002/14651858.CD004376.pub2
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    • Obesity. National Institute for Health and Care Excellence (NICE), December 2006. www.nice.org.uk
    • What are the possible side-effects? Arthritis Research UK. www.arthritisresearchuk.org, accessed January 16 2014
    • Surgery for osteoarthritis. Arthritis Research UK. www.arthritisresearchuk.org, accessed January 20 2014
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    • C-Gloves: the effectiveness of compression gloves in arthritis. UK Clinical Research Network. www.public.ukcrn.org.uk, accessed 21 January 2014
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