Essentially, osteoarthritis is a condition in which one or more joints is damaged over time through inflammation, causing the joint spaces to shrink and the lining cartilage to be damaged, worn down, and torn. With the joint spaces shrunken and the lining cartilage damaged, the joint itself is limited in how far it can flex/extend both due to pain and due to the damage. This can be noted with pain, stiffness, and reduced function, especially with more activity. This usually either a small number of joints or may be more widespread, affecting many joints on both sides of the body.
Signs and Symptoms:
Signs of a disease are the physical signs it is present, such as swelling or redness, while symptoms of a disease are the internal feelings and sensations including pain, tingling, or numbness that are not physically or visually obvious.
Signs may include: redness, swelling, thickened joints, joint deformity (misshapen appearance at rest), reduced range of joint motion
Symptoms may include: pain especially with activity that improves with rest, stiffness especially in the morning, joint-line tenderness
For osteoarthritis, there may be affected joints that will classically demonstrate certain features.
For example, knee osteoarthritis tends to be associated with bilateral involvement (both knees affected); knee effusion (increased fluid inside the knee joint - typically mild-to-moderate); and typically does not involve posterior pain unless there is a Baker’s cyst present (no pain at the back of the knee usually unless there’s a pocket of fluid from the effusion there).
Diagnosis: Osteoarthritis may be diagnosed clinically in conjunction with certain features, or based on conventional radiography demonstrating classic characteristics of the disease.
If a patient has persistent, use-related joint pain in one or a few joints; is 45 years or older; and experiences associated morning stiffness for 30 minutes or less; these features alone are sufficient to diagnose osteoarthritis.
Essentially, diagnosis can be made if someone sees a doctor with certain complaints and certain exam findings, or just with x-ray imaging.
Other classic characteristics that may support the diagnosis further may include but are not limited to slow progressive onset of symptoms (as opposed to sudden onset); pain aggravated with activity and improved with rest; and stiffness aggravated with inactivity.
Imaging findings on x-ray may include joint space narrowing, osteophytes (bony spurs along the joint edges), loss of articular cartilage (“bone on bone” appearance), and ankylosis(stiffness of the joint, so it is not oriented as it should).
Related Diagnoses:
Other conditions that may feel or look similar include patellofemoral pain, patellar tendinopathy, quadriceps tendinopathy, iliotibial band syndrome (IT band / ITB syndrome), Baker’s cyst, degenerative meniscus tears, or biceps femoris tendinopathy may be considered by your doctor before a diagnosis of osteoarthritis is made. These conditions tend to cause knee pain with overuse or “wear-and-tear” in some way without a specific traumatic injury.
Management:
Treatment typically is offered in a stepwise fashion, starting with non-pharmacologic measures. These refer to the treatments that do not involve procedures or medication, and include exercise; physical therapy; if overweight/obese losing 10+% body weight; and use of a cane, walker, or braces for support while weight-bearing.
If still symptomatic, treatment options will advance to include pharmacologic measures that will start with topical agents, progress to oral, and then injectable into the knee joint itself. Often your doctor may start with a topical NSAID like diclofenac (Voltaren) to apply directly to the painful areas. Some people may find topical capsaicin soothing, especially if only a few joints are involved, as the medication creates a sensation of heat similar to chili peppers when applied. If that is insufficient, an oral NSAID such as over-the-counter ibuprofen or prescription strength celecoxib or meloxicam. These have potential side effects that may impact the gastrointestinal, renal, and/or cardiovascular systems and should be discussed with your doctor prior to using for regular treatment. You may be prescribed duloxetine, an SNRI, as well to take daily to address both musculoskeletal and neuropathic pain.
Some people offer intra-articular injections of glucocorticoids directly into the affected joint, but there may be limited utility with this type of treatment while possibly causing further damage to the cartilage; often if these are offered, it is a short term solution. Ultimately, the last treatment offered is surgical intervention with a partial or total joint replacement depending on extent of disease.
Essentially, treatment first recommended is being active and losing weight if you have been told you are overweight or obese. Some people may need a cane or walking stick or walker to hold and use for support while standing and walking, and may use braces to support and provide relief.
If increased activity, losing weight, and using braces/sleeves and/or canes/walkers is not enough to manage your pain, you may be recommended medicine to use. People like to start with a cream, gel, or ointment to rub into their skin where they feel pain. This may be purchased at a store without a prescription, or be prescribed by your doctor. Some of these creams are NSAIDs to lower swelling and pain, and some people use capsaicin which makes the skin feel warm like when eating hot peppers. If medicines you rub into your painful area don’t provide enough relief, you may be recommended buying ibuprofen at a drugstore or given a prescription for a stronger NSAID like celecoxib or meloxicam. These may have side effects on the stomach, heart, blood pressure, and kidneys, so you should talk to your doctor about these before using them regularly.
Some doctors may give you a steroid injection into the bad knee a few times, but some do not because there is only some benefit to this treatment and it can hurt the lining of your knee joint even more if used too much. Many people eventually require surgery in which your doctor will put you to sleep to give you a new joint, either part of one or a whole new joint.