Signs and Symptoms

The hallmark symptom of OA is pain. Typical OA pain is worse with movement and improves with rest. Pain at night is common, especially as the disease progresses, and is usually worse after a more active day. Osteoarthritis commonly affects the weight bearing joints, such as knees and hips, but other joints commonly affected include the fingers and neck. Stiffness after prolonged rest is common with this disease. For example, the individual with OA will experience stiffness after getting out of bed in the morning or getting up after watching a movie.

Examination by the doctor reveals certain characteristics that are typical with OA. Moving the joint results in a crackling noise, this sounds like crunching of the cereal Rice Krispies. Arthritic joints are not able to move through a full range of motion. For example, a person with OA may not be able to fully straighten the leg. Another common sign a doctor will notice is a swollen joint – which is often associated with fluid in the joint.

Diagnosis

A doctor can usually make the diagnosis of osteoarthritis with a history and physical exam. If in doubt an X-ray is ordered. Joint pain and x-ray changes consistent with OA and one of the following – age greater than 50, creaking in the bone on physical exam or stiffness greater than 30 minutes after getting up – are diagnostic of OA.

Laboratory tests do not diagnose OA but help rule out any other disease processes that may mimic OA. If there is fluid in the joint, the doctor may remove it with a needle. This procedure can help relieve some of the pressure associated with the extra fluid. The fluid is typically examined under a microscope to help rule out any other diseases that mimic arthritis.

Treatment of osteoarthritis focuses on pain control and maintaining function. In the near future there may be treatments available to reverse or even cure the disease process, but at present, symptom control is the only option. Treatments focus on medication and non-medication means to control the pain and minimize disability.

Non-drug treatment is first line management as it bypasses the negative effects drugs have on the body. Non-drug treatments include: exercise, nutrition, physical and occupational therapy, heat and cold treatments, ultrasound, weight loss, magnets and patient education.

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Exercise needs to be tailored for those suffering with OA. Exercise that does not overly tax the arthritic joints is recommended. Exercises that limits strain placed on the joints commonly affected by OA include: water exercise, such a water aerobics; bicycling, especially recumbent biking; and elliptical exercise equipment, which can be found at many gyms. Exercises that strain the joints such as running and high impact aerobics are not recommended as they can actually damage the joints and cause more pain.

Different types of exercise are important in the treatment of OA. Aerobic exercise – such as biking, swimming, walking and water aerobics – is important not only for the treatment of OA but also for general health. Flexibility training or stretching exercises reduces stiffness and helps improve function. Strength training keeps the muscles strong to support the joints.

Good nutrition is beneficial in OA. Foods high in a substance called boron may decrease inflammation of OA and is found in apples, peaches, peas, beans, peanuts, almonds and grapes. Antioxidants such as vitamin C and E help reduce the pain, inflammation and halt the progression of the disease. Vitamin C is found in such foods as mangoes, cantaloupe, papaya and citrus fruit. Vitamin E is found in green leafy vegetables, seeds and nuts. Omega-3 fatty acids, which are found in fish such as mackerel, herring, salmon and rainbow trout, may also help with OA.

Physical and occupational therapists can be extremely important in the treatment of OA. They can assist in strengthen the muscles, improving flexibility and providing non-drug means of pain control such as ultrasound or heat/cold treatments.

OA is a profound contributor to disability and improving the home environment promotes function and safety. Occupational therapists provide home assessments. Home assessments can help maximize the safety of the home while implemented interventions to make the home safer. Bars in the bathroom, next to the toilet and in the shower or bathtub are examples of home interventions carried out by occupational therapists.

As OA progresses, mobility becomes increasing impaired. Reliance on mobility aids – such as canes and walkers – becomes essential to ambulate. Physical therapists can help teach patients how to use canes, walkers and other mobility devises.

Heat and cold treatments are helpful for patients with OA. Cold treatment decreases inflammation and reduces pain. It is best to apply cold in a moldable form such as a bag of frozen peas for no more than twenty minutes at a time and watch for any complications associated with cold such as any red or white patches on the skin or if the area becomes completely numb.

Heat is another common modality in the treatment of OA. Heat will increase the blood flow to the area, aids in healing and relaxes muscles. It should be used no longer than 30 minutes per application and should not be applied directly to the skin. While neither heat nor cold will modify the course of the disease either is acceptable. Utilize the modality that provides the most comfort and pain relief. Many patients find heat more soothing for their aching joints than cold.

Magnets are a popular therapy for OA because they can decrease pain. Scientific data to prove their effectiveness is lacking but magnets do not have significant side effects and are considered safe for use. Magnets are sold in a variety of places including pharmacies, grocery stores, on-line and on TV. Talk to you health care provider about this type of therapy and its use in your situation

Weight loss can significant reduce the pain and disability from OA by reducing the load that excess weight puts on the joints. Weight loss is accomplished through a combination of diet and exercise. Physical therapists or exercise specialists teach how to exercise safely, while a dietitian aids with dietary interventions for weight loss.

When non-drug methods do not provide adequate relief, medications are used to treat OA. Acetaminophen (Tylenol), primarily due to its lack of negative affects on the stomach, is recommended as fist line treatment for OA. Two extra strength acetaminophen tablets every six hours is the maximum dose. It can be taken on a routine basis or on an as needed basis.

Prolonged use of acetaminophen in higher than recommended doses or when combined with alcohol or certain medicines such as some cholesterol lowering drugs can damage the liver. Caution should be used in patients who take acetaminophen when they are on warfarin. The combination of acetaminophen and warfarin can increase the levels of warfarin in the blood.

Non-steroidal anti-inflammatory drugs (NSAID), such as Ibuprofen (Motrin, Advil), Celecoxib (Celebrex), are used when patients with OA do not respond to non-drug treatments or acetaminophen. These drugs have more side effects than acetaminophen. Side effects common to NSAIDs include high blood pressure, swelling, gastrointestinal bleeding and kidney failure.

Celecoxib is a special type of NSAID that is less likely to cause gastrointestinal bleeding. This is a prescription drug and is dosed once or twice a day. A special concern with the use of Celecoxib is the risk for cardiovascular complications.

Tramadol (Ultram), which is used in dosages of 100-300 mg a day, is indicated for moderate to severe pain. The side effects include nausea, constipation and dizziness. This is an effective pain medicine when it is combined with acetaminophen, which is sold in a combination pill called Ultracet. Caution must be used when this drug is combined with certain antidepressant medications as this increases the risk for seizures.

Topical agents can provide significant relief for patients with OA. Capsaicin decreases the neurotransmitter called substance P, which is involved in the transmission of pain. Capsaicin is applied three to four times a day. It takes Capsaicin a few weeks before it provides significant pain relief. Hands should be washed after contact with the substance.

Another topical agent sometimes used for treatment of localized pain is the lidoderm patch. This is not approved by the food and drug administration for use in OA, but is often used. It is a small patch applied to the skin around the painful joint and it numbs the joint, consequently reducing the pain.

Narcotic medicines are used when pain cannot be controlled with other means. Narcotics are more powerful pain medications but have side effects. While these drugs do have side effects, they are arguably safer than the use on NSAIDs as they lack the risk of gastrointestinal bleeding, kidney failure and heart disease. Narcotics are potentially addicting medications and have the potential side effects of sedation, respiratory failure, dizziness, falls, constipation and addiction. Narcotics include; Darvon (Propoxyphene), oxycodone (Oxycontin), Hydromorphone (Dilaudid), Fentanyl (Duragesic), and morphine, to name a few.

Intra-articular steroid injections can be used for painful joints. This involves placing a needle directly into the arthritic joint and injecting a steroid and numbing agent. These are very effective treatments but their length of effect is variable.

Hyaluronic acid derivatives (Synvisc & Hyalgan) are substances that mimic the joint lubricant – which is typically reduced in those with advanced OA – that naturally occurs in the knee. These products provide relief that may last a few months. Side effects include discomfort, infection, swelling and pain at the injections site.

Alternative treatments have shown some benefits. Glucosamine and chondroitin have been shown to slow the progression of OA, decrease cartilage loss, decrease pain and inflammation as well as improve joint function.

Side effects associated with glucosamine include abdominal discomfort and increased blood sugar levels. It should not be used in patients who are allergic to shellfish. Due to the issues with blood sugar caution should be used in those with diabetes. It is dosed 500 mg three times a day.

Chondroitin, in doses 500-1200 mg in divided doses, is also used to treat arthritis. Neither glucosamine nor chondroitin should be used in patients sensitive to sulfites. Treatment may not result in any noticeable benefit until the patient has been on the treatment for up to three weeks.

SAMe is another supplement that is used to treat OA. Side effects of SAMe include nausea, vomiting, diarrhea, and headache and should be used with extreme caution in patients with Parkinson’s disease and bipolar disease. The dose is 400 mg three times a day for 3 weeks than 200 mg two times a day.

Surgery

When medical treatment fails surgery is the next option. Joint replacement and joint repair – called arthroscopy – are the two most common procedures for severe OA. Arthroscopy cleans out the damaged cartilage. Joint replacement surgery replaces the damaged joint. Even under the best of circumstances, surgery cannot return the joint to its normal state (artificial joints do not have all of the motion of a normal joint). However, an artificial joint will very likely diminish pain. The two joints most commonly replaced are the hip joint and the knee joint

Health Care Responsibility

Taking responsibility for your disease can significantly aid in managing OA. The treatment of this disease is based on control of symptoms. The better you understand your disease and able to report this to your doctor, the better a treatment plan can be devised to help manage OA.

The better you understand what triggers OA and how specific treatments help your disease, the better you will feel. The better you can make yourself feel the better you will be able to function. Improved function will result in a longer life expectancy and more importantly a better quality of life.

Steps

1. Fill out your arthritis worksheet.  Discuss each one of the questions with your health care provider. This will assure that you understand how arthritis affects you personally.

2. Complete your arthritic pain tracking form to track symptoms. The worksheet does not need to be filled out each day, but should be filled out when you are having a change in your arthritic symptoms or when seeing the doctor about your arthritis. This will help assure that your doctor has a good history of your present symptoms and will significantly aid him or her in treating the disease most effectively. The worksheet is broken up into four columns. In the first column, for the corresponding time, report the location and the severity of the pain on a 0-10 scale. The next column report how severely function is affected due to the disease. Column three is a place to report the activity you are doing at the present time. Column four is a place to record the time you take your medication. This will help you understand how the disease affects you throughout the day during the activities that you perform and how medicines and treatments affect your disease. Study the worksheet and look for patterns. Bring this worksheet to any doctor appointment. Your health care provider will be able to look at this worksheet and offer suggestions to improve pain and function.

3. When presenting with a new pain – complete the new pain worksheet.  Not every pain is related to arthritis – some conditions can potentially be much more serious. New pains need to be evaluated completely and the use of the pain worksheet will help your doctor completely evaluate the pain. This worksheet will help rate the severity of your pain to help the health care provider understand where the pain is and how severe it is.

   For access to these forms including 9 ebooks:

    CLICK HERE TO IMPROVE YOUR HEALTH Questions to ask your health care provider

   1. What type of arthritis do I have? There are multiple kinds or arthritis. The most common type of arthritis is osteoarthritis but it is important to confirm with your doctor what type of arthritis you have because treatments are different based on the type.

      How was it diagnosed? Some health care providers feel comfortable to diagnosis the disease based on history and physical exam but other health care providers may do lab tests to rule out other conditions or X-rays to confirm the diagnosis.

      What type of exercise should I do? Like most health conditions, exercise can significantly improve OA. Special precautions need to be taken in patients with arthritis. While general exercise principles are the same, certain exercises are more appropriate for arthritics. Water exercise, biking, and walking are more appropriate exercises than jogging or high impact aerobics but talk to you health care provider or your physical therapist about which exercises are most appropriate for you.

      Could I benefit from physical therapy? Therapy can provide many benefits to the arthritic patient. They provide exercise training, pain control through heat and cold applications and ultrasound, patient education and assistance with mobility aides such as walkers or canes.

      Could I benefit from weight loss and how should I accomplish weight loss? Overweight individuals who are afflicted with OA can benefit from weight loss. Less body weight translates to less stress on the joints commonly affected by OA. Weight loss is accomplished by creating a calorie deficit by a combination of exercise and food restriction. Talk to your doctor about which diet is most beneficial for you. A registered dietitian can aid you in your weight loss efforts.

      If pain is not controlled, ask your provider what else can be done? As the disease progresses, pain will usually worsen and require increasing doses of pain medication or alteration in the pain management plan. Some over the counter medications may be beneficial in the management of disease. There are multiple medications or non-drug means of controlling the pain of arthritis. Your health care provider needs your input on the severity of your pain in order to manage your symptoms.

      What non-drug means can be used to treat my arthritis? Cold packs or heat can be applied directly to joints to manage the pain or stiffness. Talk to you health care provider or your physical therapist about which modality is most appropriate for you. Magnets may be beneficial for treatment of arthritis.

      Are there any supplements that may help control my disease? Will these supplements interact with any of my other medicines or have any side effects that would be risky for me? Glucosamine, chondroitin and SAMe are common supplements that can are used to treat osteoarthritis.

      What medicines are best to control my arthritis? There are a variety of medicines that can be used to treat arthritis; understanding the different medicines can help you partner with your doctor about picking the best medicine. Talk to your doctor about what medicines you can use for pain in addition to the medicines that your doctor prescribed. Specifically ask what you should take in times of increased pain. Having a medicine to take on an as need basis is important because the nature of the disease is fluctuating and pain will be worse on some days.

      Could I benefit from a steroid shot or artificial joint fluid injection? This is typically a second or third line of defense, after non-drug and oral drug treatments have failed.

      Do I need to see an orthopedic surgeon? Could I benefit from surgery? When pain is not controlled with other methods or one is unable to move due to the arthritis, surgery is considered.

      Reverences

      1. Lawrence RC, Felson DT, Helmeck CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States, Part II. Arthritis Rheumatology 2008; 58(1): 26-58