The Lowdown on Osteoarthritis (and How to Treat It)

By Eva Briggs, M.D.

‘I’m hoping that someday there will be a therapy discovered that will stimulate my knees to regrow new cartilage before they need replacement.’

Osteoarthritis (OA) is the most common type of arthritis. It develops over time, as the cartilage that cushions the ends of bones wears down. But it’s not just wear and tear of the cartilage. Inflammation of the joint lining, as well as changes in the adjacent bone and connective tissues that hold the joint together all contribute.

Who gets osteoarthritis? Age is one risk factor.

Gender is another.

OA is more common in women. Some people inherit a genetic susceptibility to OA. Other risk factors are injury, obesity, repetitive stress, bone deformities and some inherited metabolic diseases. The most commonly affected joints are knees, hips, hands and spine.

Symptoms of OA worsen over time, usually gradually, sometimes with flare-ups.

Pain is typically worse during or after movement. Joints can become stiff, especially first thing in the morning or following inactivity such as prolonged sitting. Affected areas may be tender to touch. Joints lose flexibility and range of motion, unable to bend as far as they once did. Soft tissue inflammation around the joint and fluid in the joint produce swelling. Bone spurs can form, further contributing to joint deformities and decreased movement. There may be a grating sensation in the joint.

Treatment starts with exercise to strengthen supporting muscles and weight loss to decrease the stress on weight-bearing joints. Exercise should include strengthening as well as aerobic activities such as walking, swimming, biking, yoga and tai chi.

Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, often effectively relieve pain. But they should be used with caution due to potential side effects. Some NSAIDs increase blood pressure and stroke risk. They can cause ulcers, intestinal bleeding and kidney damage. For this reason, don’t exceed the recommended dosage. Different people respond differently to various medicines, so it may be necessary to try experiment with different NSAIDs to find the most helpful one.

Acetaminophen (Tylenol) is not very effective but may ease mild pain.

Topical medicines — creams or gels applied to the skin — are another option. Some NSAIDs come in a topical form. They work best for knee or hand pain, but can be expensive. They cause fewer gastrointestinal side effects than NSAIDs taken by mouth. One of these medicines, Voltaren gel, is available over the counter. Capsaicin is an over-the-counter topical medicine that may help although it can cause stinging and burning. It is usually less effective than topical NSAIDs. There is no evidence that cannabidiol, lidocaine, or methyl salicylate are effective, but some people find relief from them.

Another option is duloxetine (Cymbalta). This antidepressant is also effective for chronic pain. It may take two to four weeks to work. Side effects include nausea, dry mouth and dizziness.

Tramadol, an opiate, is a last resort for severe pain. Its use may avoid the use of stronger opioids or surgery.

Steroid joint injections provide short-term relief of pain to a single joint. Hyaluronic acid injections have limited effectiveness and high cost. And stem cell injections come with safety risks and have no proof of efficacy.

There is limited evidence that supplements such as glucosamine sulfate or SAMe help. But they are unlikely to harm. They may require a few months to work.

If you have OA, you are not alone. Over 32.5 million US adults are in the same boat.

Personally, I’m hoping that someday there will be a therapy discovered that will stimulate my knees to regrow new cartilage before they need replacement.