Osteoarthritis has no cure, but symptoms can be managed

Osteoarthritis can't be ignored.

On a grand scale, it is the most common form of arthritis (which actually isn't a specific disease but rather a general term for inflammation in a joint), accounting for more cases than all the other forms combined. It affects an estimated 31 million Americans and is a leading cause of disability among adults.

On the individual level, it can produce pain and other symptoms in joints sufficient to limit and even prohibit the performance of everyday tasks. A chronic condition, it becomes more common with age, especially after 65, and once it starts it typically gets worse.

And there's no known cure.

But the picture isn't totally bleak: There are treatments that can relieve pain and maintain joint function.

Osteoarthritis is the thinning or wearing down of cartilage, which is the cushion between the separate bones in a joint. When your doctor says you have arthritis, most often they are referring to osteoarthritis."

Francis C. Luk, M.D., rheumatologist, Wake Forest Baptist Health

When cartilage wears down, the bones in the joint can rub against each other, causing pain during or after movement. Other symptoms include stiffness after periods of inactivity, tenderness, loss of flexibility, mild swelling and a clicking or cracking sound when the joint is bent. Osteoarthritis also can cause damage to the synovium (the membrane that lines joints) and the bones themselves.

The primary risk factors for osteoarthritis are aging, obesity, prior injury, repetitive stress on a joint and genetics. Osteoarthritis can occur in any joint, but the most common locations are the knees, hips and hands, especially in the joints of the fingers and at the base of the thumb.

"Of course symptoms vary from person to person but someone with osteoarthritis of the knee typically will have pain when they stand up from a seated position or when they're walking, especially when going up and down stairs," Luk said. "With osteoarthritis of the hands, people typically experience pain when they do things that involve gripping – washing dishes, holding a wrench, opening a jar, things like that."

Does the presence of symptoms like these mean it's time to see a doctor?

"In general, if you have pain that's not going away over time or is preventing you from doing daily activities – working, cooking, etc. – that would be a good time to ask your family doctor," Luk said. "In most cases, a primary care physician can figure out what's going on and prescribe treatments."

But no doctor, whether a primary care provider or specialist, will be able to do more than ease the symptoms of osteoarthritis. The reason for that is simple.

"Once cartilage is gone, it's gone for good and there's no replacement that we know of," Luk said. "All the medications that we have are only for temporary pain relief."

Fortunately, most of these medications are available over the counter, including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve).

"Acetaminophen has fewer side effects than the NSAIDs but may not be as effective for pain relief," Luk said. "Which one of these works best and which one is safest depends entirely on the individual."

Osteoarthritis pain also can be eased by non-prescription topical creams and gels, such as those containing trolamine salicylate (Aspercreme), and by the application of heat and cold with heating pads, ice packs and the like.

Assistive devices such as canes, shoe orthotics, jar openers and tools with thicker handles can help osteoarthritis patients with mobility and the ability to do routine tasks.

For those with more advanced cases, there are prescription pills and creams and steroid injections. As a last resort, there's joint-replacement surgery, especially of knees and hips.

"We always try to delay turning to surgery for as long as we can," Luk said. "However, if you get to a point where you can't walk from your living-room chair to the bedroom, it would be a good idea to see an orthopedic surgeon."

But the most effective ways to combat osteoarthritis don't involve pills or creams, injections or operations. They are weight control and physical activity.

"Excess weight puts a lot of pressure on your joints, especially the knees and hips," Luk said. "Losing weight if you're overweight and maintaining a healthy weight reduces that pressure, which can slow the progress of osteoarthritis and maybe even prevent it."

Physical activity, meanwhile, strengthens the muscles around joints and makes them more stable, which can reduce joint pain and stiffness, improve flexibility and delay cartilage loss. Regular exercise also can contribute to attaining and maintaining a healthy weight.

"I tell people to do as much as they can tolerate until they have some pain and then rest," Luk said. "I never recommend completely stopping activities, because the downside of inactivity is worse than osteoarthritis."

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