11 Facts About Osteoarthritis Everyone Should Knowby Amy Marturana Winderl Health Writer
Some things get better with age—wine, wisdom, and a worn-in pair of jeans, for example. Unfortunately, your joints are not one of them. In fact, more than 32.5 million American adults are living with osteoarthritis (OA), a.k.a. “wear-and-tear” arthritis. OA happens when cartilage—the elastic tissue that connects and protects the ends of bones in a joint—thins over time, says Kirk A. Campbell, M.D., orthopedic surgeon at NYU Langone Health in New York City. Cartilage can’t repair itself, and the damage can trigger inflammation, pain, and stiffness in the joint, he says. Here’s why it happens, who’s at risk, and more facts about OA everyone should know.
Age Isn't the Only Reason Cartilage Wears Down
Imagine picking up two rocks and rubbing them together. Now imagine there’s a sponge between them. The second scenario represents how cartilage functions at a joint—it’s like a cushion that prevents bones from rubbing against each other, says Julius Kunle Oni, M.D., medical director of orthopedics at Johns Hopkins Bayview in MD. But over time, cartilage can wear away and become thin enough to cause OA. Beyond the normal aging process, an injury to a specific joint or overuse (think knees after decades as a marathon runner) can also chip away at precious cartilage.
OA Is Not the Same as Rheumatoid Arthritis
OA and rheumatoid arthritis (RA) both involve joint pain and damage, but they’re very different diseases. OA is the breakdown of a joint, while RA is an autoimmune disease in which the immune system misfires and attacks the membrane surrounding joints as if fighting an infection. Both lead to inflammation, but the chronic inflammation that occurs with RA is much worse, says Dee Dee Wu, M.D., assistant attending physician at Hospital for Special Surgery in Paramus, NJ. Treatment is different and having one type of arthritis doesn’t preclude you from having another. One more difference: RA typically feels better when you move, whereas OA typically feels worse, Dr. Wu says.
Weight-Bearing Joints Are More Prone to OA
OA can pop up anywhere if there’s enough damage, but it typically occurs in the weight-bearing joints of the knees, hips, and spine, as well as the hands, Dr. Oni says. Any joint that’s been previously injured is also at higher risk for developing OA, even if it happened many years ago (high school sports injury, anyone?). Depending on where your OA is, you’ll likely work with a specialist, in addition to an orthopedist, to figure out the best way to manage your symptoms.
OA Can Create Bony Growths
If you look at an X-ray of a joint with OA, the space between bones looks thinner than it would in a healthy joint. Eventually, the space gets so small that the bones touch each other, Dr. Campbell says. When this happens, osteophytes, also known as bone spurs, may form. Unlike cartilage, bones can regrow when damaged, Dr. Oni explains. So bony growths often form in response to the loss of cartilage in an arthritic joint. Most bone spurs are small and don’t cause pain, but they can exacerbate OA symptoms, Dr. Campbell says.
OA Risk Increases With Age
No big surprise here: The older you get, the more likely you are to develop OA. But that doesn’t mean it never happens in young people. “Typically, we see arthritis in people over age 50,” Dr. Campbell says. “While it’s not common for people to develop OA in their twenties or thirties, it certainly can and does happen.” Joint overuse, injury, gender (women are more likely to get it than men), genetics, and obesity are all factors that can impact if and when you get OA.
Weight Loss Is a Common OA Treatment
Weight-bearing joints like the knees and hips are under a lot of pressure during everyday activities like walking, climbing stairs, or simply standing up. Add excess weight to the mix, and that pressure intensifies and can speed up joint damage. The risk of knee OA, in particular, is strongly correlated with weight, Dr. Wu says. “People who are obese are 6.8 times more likely than people at a healthy weight to develop knee OA.” If you are overweight, losing weight can help slow down OA progression, reduce pain, and improve joint function.
Exercise Is Essential
It may seem counterintuitive, but the right form of exercise can help improve joint function and reduce OA symptoms, Dr. Wu says. “Exercise helps build muscle mass to support the joints and also contributes to a healthy weight,” she says. The key is keeping exercise low-impact so that you don’t contribute to wear and tear on weight-bearing joints. Biking, swimming, and bodyweight strength exercises in the water are all great options for improving cardiovascular fitness and strength.
X-rays Don't Tell the Whole Story
X-rays are important for diagnosing OA and seeing the severity of cartilage and joint damage, but they don’t reveal much about your symptoms. “There’s not a real direct correlation between how lousy X-rays look and how bad you feel,” Dr. Wu says. “Some people have bone-on-bone and minimal pain, while others have minor X-ray changes and a lot of pain.” Because OA treatment is all about managing symptoms, the way you feel is sometimes more important than what a scan can show, Dr. Wu says.
OA Can Impact More Than Just Physical Health
Living with any form of arthritis, including OA, can take a real toll on your mental health. Dealing with chronic pain is stressful, and for some people, it may contribute to mood disorders like depression and anxiety. Plus, if OA symptoms prevent you from doing activities you enjoy and spending time with loved ones, you may feel isolated or alone. On the flipside, depression may make it harder to cope with OA pain. This is all normal. Talk openly with your doctor to find the help you need.
Managing Symptoms Takes Some Trial and Error
There’s no one miracle treatment for OA. Anti-inflammatory medications (NSAIDs), icing, strength training, and physical therapy can all help keep symptoms in check, but they may not work for everyone. Injections are another option: Corticosteroid injections reduce inflammation, typically work within a few days, and last a few months, Dr. Campbell explains, while viscosupplementation injects a gel-like substance to lubricate the joint and reduce inflammation. “It takes a few weeks to start working, but lasts longer than corticosteroids,” he says. Your doctor can help you decide if you’re a good candidate for either.
Surgery Is the Only "Fix" for OA
Joint replacement surgery is the only way to truly treat and “cure” OA, Dr. Campbell says. Full or partial joint replacement surgery is typically very successful and can restore normal joint function, but it’s not a decision people should take lightly, he says. “When pain and dysfunction are negatively impacting quality of life and you’ve tried nonsurgical options but still can’t do the things you enjoy, that’s when you’d consider it.” Talk with your doctor about the pros and cons to figure out if surgery is the right option for you.