One of the more common questions I am asked is if a patient’s arthritis will ever get better. When told that osteoarthritis is causing their pain, some patients get despondent and say something like, “Oh, I was afraid of that. I guess that’s just part of getting older. It can’t get better, right? I mean, even if we treat the symptoms, the arthritis won’t go away.”
This is one of the challenging aspects of treating patients with osteoarthritis. In addition to convincing them that the symptoms can be treated, I also want people to understand that it is not typically necessary to treat the bony anatomy in osteoarthritis. As long as the inflammation is treated, and as long as the muscles are stretched and strengthened appropriately around the joints, the symptoms need never recur even though it is true that the bony anatomy will likely remain unchanged.
One of the things we need to all understand is that seeing bony changes consistent with osteoarthritis is ubiquitous as people get older. If I took an x-ray of a 75-year-old patient and didn’t see at least some osteoarthritis, I’d be very surprised. However, that doesn’t mean I think a 75-year-old should have pain – I don’t. However, bony changes consistent with osteoarthritis do not equal pain and they do not equal immobility. Perhaps the most accurate thing to infer from osteoarthritis seen on x-ray is that it may represent that symptoms are more likely to develop.
There are times when bony changes need to be addressed. A bone spur, for example, that is compressing and causing symptoms in a nerve root may need to be surgically decompressed. More commonly, however, the bone spur is close to a nerve root and it is the inflammation caused by this proximity that needs to be addressed.
So we come back to the question: does arthritis every “go away?” The only way to truly address the bony changes in arthritis is through surgically changing them. Even when surgically addressing osteoarthritis, other changes in the joints develop and future osteoarthrtic changes may occur. However, it is not typically necessary to surgically address the bony changes in most patients. The symptoms of arthritis can certainly go away regardless of whether the bony changes are addressed.