7 Warning Signs of Osteoarthritisby Jerilyn Covert Health Writer
Did you know there are more than 100 types of arthritis? Many look and feel similar, making them hard to tell apart. The most common by far is osteoarthritis (OA). Unlike rheumatoid arthritis (RA), which happens when the immune system misfires and attacks the joints as it would a virus or other foreign invader; or lupus arthritis, which is caused by underlying disease, OA is the outcome of a process that happens to everyone, to some extent, with age: the wearing of joint cartilage. Read on to learn more about the specific symptoms of OA.
Joint Pain That Gets Worse Over Time
The first symptom you’ll likely notice is joint pain, says Karmela Kim Chan, M.D., a rheumatologist at the Hospital for Special Surgery in New York City. It’s a dull, achy, or sharp pain that comes and goes at first and gets more constant over time, she says. As OA progresses—and cartilage wears completely away—bones rub against each other, causing pain to become sharper and more difficult to deal with. Joint pain is a classic symptom of all types of arthritis, but there are specific clues that point to OA.
Joint Pain During or After Activity or at the End of the Day
OA pain acts up when you move the affected joint, and it may be triggered by a specific activity—like knee pain when you climb stairs or pain in the base of your thumb when you twist open a jar or turn a doorknob, Dr. Chan says. Extended activity, like long walks or prolonged standing, can also lead to pain. And it may get worse as you use the joint throughout the day. Conversely, pain from inflammatory arthritis (like rheumatoid) tends to feel better with movement, not worse, Dr. Chan says.
It Affects Your Hand, Knee, Hip, or Spine (or a Previously Injured Joint)
OA can happen in any joint, but it’s most common in joints that experience the most stress and repetitive movement—such as the hand (especially the joint near your fingertip, the middle finger joint, and the base of the thumb) as well as weight-bearing joints of the knees, hips, and spine. Joints that have been previously injured—such as a tear, sprain, or strain—also have increased risk of developing OA. Pain from hip OA can be tricky, because it can show up in the groin, front of the thigh, or buttocks.
Stiffness for a Few Minutes in the Morning or After Rest
OA patients often report feeling stiff and creaky for five or 10 minutes after they’ve been inactive for a while—like when you wake up in the morning or get up after eating dinner or watching a movie, Dr. Chan says. When that happens, your joints may feel a bit restricted—meaning you can’t bend or straighten them all the way, explains Rachel Frank, M.D., an orthopedic surgeon at UCHealth in Denver. For example, you may find it harder to stand up and walk. RA patients have this stiffness too, but for them it tends to last much longer—at least 30 minutes.
Swelling That Comes and Goes
While OA is a “non-inflammatory” form of arthritis, swelling is still a common symptom, says Spencer Stein, M.D., assistant professor in the department of orthopedic surgery at NYU Langone Health. As cartilage wears away, the bone suffers more stress—and the joint reacts by producing extra fluid, causing swelling. Swelling can range from “barely noticeable” to “big and obvious” and may come and go day-to-day (unlike the persistent swelling you’ll get with uncontrolled RA), Dr. Stein says. Try ice: Fill a zip-top bag with ice and place it on your joint, with a paper towel in between (to prevent ice burn), he says. Alternate 20 minutes on, 20 minutes off, as needed.
When cartilage wears away, bone cells are activated to create new bits of bone around the affected joint—called osteophytes, or “bone spurs.” “The body wants to regrow cartilage,” explains Dr. Frank, “but it doesn’t know how to regrow cartilage. And so bone spurs begin to form.” Bone spurs can happen in any joint but are most noticeable in the hand. They may affect the finger knuckle closest to the fingertip, causing it to appear bigger than usual—almost like it’s swollen but the “swelling” is hard, not squishy. Bone spurs in other joints may not be visible to you but can be spotted on an X-ray, Dr. Stein says.
Grind, Crackle, Pop!
That’s not Rice Krispies’ new tagline. It’s the sensation many OA patients feel when they bend or straighten their affected joint. “The doctor word for that is ‘crepitus,’” Dr. Frank says. But patients describe it as “crackling,” “crunching,” “grinding,” or “popping.” Why does it happen? With OA, once-smooth cartilage becomes rough, causing friction when you move the joint. Plus, as bone spurs grow, they may rub against muscles or tendons. And as more bone is exposed, bones may start rubbing together too. Between the rough cartilage, the bone spurs, and the exposed bone, “everything is just rubbing,” Dr. Frank says.
When to See a Doctor
No need to rush to the doctor for mild or infrequent joint pain, but you should mention it to your primary care physician at your next checkup. However, if you have mystery joint pain that lasts longer than three days or several episodes within one month, you should book a visit with your doctor. Another good reason to call your doc: Joint pain is interfering with an activity you would otherwise enjoy (often a telltale sign of OA), Dr. Chan says. Your doctor may refer you to a specialist, like an orthopedist or a rheumatologist, who can help make a diagnosis.
How a Diagnosis Is Made
After taking your medical history, your doc will look at your joints and check for signs of inflammation (warmth and swelling), which could suggest a more inflammatory arthritis like rheumatoid, Dr. Chan says. They may also feel for bone spurs if the joint is accessible, like in your hand or knee. And they’ll check your range of motion—by moving your joint while you keep your muscles relaxed (to rule out muscle pain as a cause). X-rays can help confirm diagnosis by revealing if the space between the bones is narrowing, a sign of cartilage loss. If your symptoms and X-ray results line up with OA, a diagnosis is usually made.