Osteoarthritis is the most common form of arthritis and affects millions of people worldwide. The CDC says in the United States, 24% of all adults, or 58.5 million people have OA. Unfortunately, there are many myths surrounding this condition that can lead to misunderstanding and confusion. In this blog post, we will get explore what it is, how you know you have it, treatment options, and some of the myths surrounding this diagnosis. Osteoarthritis is not something to be feared or taken as a life sentence of pain. Rather, it is important to understand what it is, how common it is, why it’s not a big deal, and what you can do about it!
What is Osteoarthritis
Osteoarthritis, also known as “degenerative joint disease”, is a type of arthritis that affects the cartilage in our joints. Cartilage is the firm but flexible tissue that cushions our bones and allows for smooth joint movement. As we age, this cartilage naturally starts to break down. OA isn’t a disease any more than getting grey hairs or wrinkles! Recently medicine is considering it a normal part of the aging process. However, it can also develop from an injury or other medical conditions.
It’s important to note that there are other forms of arthritis, such as rheumatoid arthritis. RA is an autoimmune disease that is caused by inflammation in the joints and the body attacking itself. While RA may share some symptoms with osteoarthritis, they are very different conditions.
Despite being a normal part of aging, the internet and media often portray osteoarthritis as a death sentence for our joints and our quality of life. However, this is far from the truth! While osteoarthritis may cause pain and discomfort, it doesn’t have to. There are many research studies showing people without pain have OA! With proper management and treatment, people with osteoarthritis can still live active and fulfilling lives.
What Does OA Feel Like?
Symptoms of OA tend to build over time, rather than show up suddenly. They include pain or aching in a joint during activity, after long activity, or at the end of the day. Joint stiffness typically occurs first thing in the morning or after resting. People with OA may also experience a limited range of motion, which may improve with movement. (Motion is always lotion)
Osteoarthritis (OA) is associated with various types of pain. Some people with OA may experience aching, dull pain, which is similar to the type of pain experienced after a muscle strain. Others may feel shooting, electric, tingling, burning, or pins-and-needles pain, which is associated with nerve pain. It’s important to remember that neuroplastic pain can also be at play with chronic pain, even when arthritis is seen on imaging.
Tightness is another sensation that people with OA may feel. It’s often associated with muscle spasms. Additionally, many people report hearing the snap, crackle, and pop of joints, known as crepitus. Super common in knees! Mine have cracked and popped since I was a teen! Usually, this isn’t a cause for concern, as it’s considered a normal occurrence. If crepitus is regular and accompanied by pain, swelling, or other concerning symptoms, it may indicate arthritis or another medical condition. As always, if you are really concerned, see someone about it!
Remember to talk about how your pain affects your daily life and not just what it feels like. I have a whole blog post on communicating about pain with your medical team – check it out here.
What Causes Osteoarthritis? OR Maybe Better Put – What are Risk Factors?
Factors that may contribute to the development of OA include
- The risk of developing OA increases with age and symptoms generally, but not always, appear in people over 50. (There’s that aging thing again!)
- A bone fracture or cartilage or ligament tear can lead to OA, sometimes more quickly than in cases where there is not an obvious injury.
- Using the same joints over and over in a job or sport may result in OA.
- Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight adds stress to weight-bearing joints, such as your hips and knees. Also, fat tissue produces proteins that can cause harmful inflammation in and around your joints.
- Women are more likely to develop OA than men.
- Bone Density
- Certain metabolic diseases including diabetes, conditions like EDS with connective tissue laxity, and a condition in which your body has too much iron (hemochromatosis)
- It is possible low Vitamin D levels may contribute to OA.
Where Can I “Get” OA?
Although osteoarthritis can be in any joint, it most commonly affects joints in your hands, knees, hips, and spine.
I think it’s important to remember that OA is often blamed on pain because of imaging. (More on that here) We go along in life with no pain, and therefore no pictures of our innards. Then one day stuff starts hurting, and it keeps hurting until it gets to the point we need some help. We see the Doc and they order pictures of our insides. Once those images come back we go ” AH-HA” It must be that arthritis right there causing your pain! But that really is what we call post hoc reasoning.
For clarity, I am not saying to ignore an OA diagnosis. I am saying it doesn’t have to mean that you have pain for the rest of your life that just keeps getting worse and worse!
I had imaging done of my hips and low back in 2013. Turns out you can see OA at my pubic symphysis and in both my hips. I have no pain there! ( I think it was also seen on cervical (neck) films in 2008. I’ve had it in my knees since I was a teen, and yeah sometimes it bugs me. Sometimes it doesn’t hurt at all, and sometimes it’s just plain crippling! The thing is… the crippling pain episodes, yeah those are pretty much always related to an increase in activity load AND emotional load.
When I apply the lessons of neuroplasticity and calming my nervous system. Pacing, grading my load, popping some Tylenol or Advil and you know, practicing what I preach… it’s manageable and then goes away until I decide I should really try running again for my mental and physical health.
The point of me sharing this isn’t to tell you to suck it up, it’s to show you just because it’s on a film doesn’t mean it will always cause you pain!
How do I get a diagnosis?
If you feel that an OA diagnosis is important to your healing process here is the medical process.
Your primary care physician should probably be the first medical professional you consult. They will evaluate your medical history, symptoms, how the pain affects your daily activities, as well as any other medical conditions and medication usage. Hopefully, they will examine and move your joints! Next, they may order blood tests or imaging studies such as an X-ray or MRI. Remember, an X-ray looks at bone. An MRI will look at soft tissues and are not necessary for an OA diagnosis.
It is also possible you may undergo a joint aspiration. After numbing the area, a needle is inserted into the joint to pull out the fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.
Tests are often run to rule things out depending on your history and physical. So don’t be alarmed if all of these things aren’t done.
Ok, I know I Have Osteoarthritis, What do I do Now to Make it go Away!
In no particular order, you have:
Medications
Analgesics. Acetaminophen (Tylenol, others) has been shown to help some people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dose of acetaminophen can cause liver damage. Acetaminophen is available over the counter (OTC).
Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, naproxen, and celecoxib, available either OTC or by prescription. Stronger NSAIDs are available by prescription.
Counterirritants. These OTC products contain ingredients like capsaicin, menthol, and lidocaine that irritate nerve endings, so the painful area feels cold, warm, or itchy to take focus away from the pain. (Think Icy Hot)
Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.
Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain. ( The mystery and miracle of calming a nervous system!)
Compounded Medication. MDs can write a script for a combination of medications that can be put into creams and applied topically, for fewer side effects.
Non-Drug Therapies
Physical therapy. A physical therapist can show you exercises to strengthen the muscles around your joints, ways to modify movement for a time, and help you make a plan to return to activity. Regular gentle exercise that you do on your own, such as swimming or walking, can be equally effective.
Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have osteoarthritis in your hands. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis. (OTs are really underutilized in the USA!)
T.E.N.S units can be very helpful. They use a low-voltage electrical current to relieve pain. As with anything pain-related some people love it ( like me) and others hate it. Try it before you invest in one.
Compression Garments/Braces/ Taping. All of these things can provide more input to the brain and create safety, which will less the pain and any feelings of instability.
Surgical and Other Procedures
Cortisone injections. Injections of a corticosteroid into your joint might relieve pain for a few weeks. Your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone injections you can receive each year is generally limited to three or four because the medication is known to worsen joint damage over time.
Lubrication injections. Injections of hyaluronic acid might relieve pain by providing some cushioning in your knee, though some research suggests that these injections offer no more relief than a placebo. Hyaluronic acid is similar to a component normally found in your joint fluid.
Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.
Joint replacement. In joint replacement surgery, your surgeon removes your damaged joint surfaces and replaces them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and might eventually need to be replaced.
What about this supplement my friend/neighbor/co-worker/ Dr. Oz suggested?
Let’s keep this brief – it’s time to save your hard-earned cash. Numerous studies demonstrate that those pills and dietary supplements are practically useless; they are placebos. Do yourself a favor and go for something that really works, and hang onto your money.
My Prefered Treatment Would Also Include…
All that good stuff I talk about. Things like movement you enjoy, pacing, breaking things down into smaller bites. Weight loss, in the case of knee pain – can actually help reduce pain. Managing inflammation through medication, movement, and healthy habits. Getting good sleep! Figure out what is in your cup and start emptying the cup.
As with all things pain, it is individual to you and your nervous system. Treating just one aspect of chronic pain is insufficient to provide a lasting solution. We gotta take care of the whole person, not just the tissue.
If you want some more guidance, book a consult with me and we can get you sorted.
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