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May 2016

Handout on Health:

Osteoarthritis

This publication is for people who have

osteoarthritis, their families, and others

interested in learning more about the

disorder. The publication describes

osteoarthritis and its symptoms and contains

information about diagnosis and treatment,

as well as research efforts supported by the

National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS)

and other components of the U.S.

Department of Health and Human Services’

National Institutes of Health (NIH). It also

discusses pain relief, exercise, and quality of

life for people with osteoarthritis. At the end is

a list of key words to help you understand the

terms used in this publication. If you have

further questions after reading this, you may

wish to discuss them with your doctor.

What Is Osteoarthritis?

Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is

the most common type of arthritis and is seen

especially among older people. Sometimes it

is called degenerative joint disease.

Osteoarthritis mostly affects cartilage

(KAR-til-uj), the hard but slippery tissue that

covers the ends of bones where they meet to

form a joint. Healthy cartilage allows bones to

glide over one another. It also absorbs

energy from the shock of physical movement.

In osteoarthritis, the surface layer of cartilage

breaks and wears away. This allows bones

under the cartilage to rub together, causing

pain, swelling, and loss of motion of the joint.

Over time, the joint may lose its normal

shape. Also, small deposits of bone—called

osteophytes or bone spurs—may grow on the

edges of the joint. Bits of bone or cartilage

can break off and float inside the joint space.

This causes more pain and damage.

Who Has Osteoarthritis?

We want to hear from you

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How Does Osteoarthritis Affect

People?

Osteoarthritis Basics: The Joint and

Its Parts

How Do You Know if You Have

Osteoarthritis?

How Do Doctors Diagnose

Osteoarthritis?

How Is Osteoarthritis Treated?

Who Provides Care for People With

Osteoarthritis?

Research Highlights

Hope for the Future

For More Information

Key Words

Illustrations

What Areas Does Osteoarthritis

Affect?

A Healthy Joint

A Joint With Severe Osteoarthritis

Information Boxes

Four Goals of Osteoarthritis

Treatment

Treatment Approaches to

Osteoarthritis

On the Move: Fighting Osteoarthritis

with Exercise

People with osteoarthritis usually have joint

pain and stiffness. Unlike some other forms

of arthritis, such as rheumatoid arthritis,

osteoarthritis affects only joint function. It

does not affect skin tissue, the lungs, the

eyes, or the blood vessels.

In rheumatoid arthritis, another common form

of arthritis, the immune system attacks the

tissues of the joints, leading to pain,

inflammation, and eventually joint damage

and malformation. It typically begins at a

younger age than osteoarthritis, causes

swelling and redness in joints, and may make

people feel sick, tired, and feverish. Also, the

joint involvement of rheumatoid arthritis is

symmetrical; that is, if one joint is affected,

the same joint on the opposite side of the

body is usually similarly affected.

Osteoarthritis, on the other hand, can occur

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in a single joint or can affect a joint on one

side of the body much more severely.

Who Has Osteoarthritis?

Osteoarthritis is by far the most common type

of arthritis, and the percentage of people who

have it grows higher with age. An estimated

27 million Americans age 25 and older have

osteoarthritis.1

1Lawrence RC, Felson DT, Helmick CG,

Arnold LM, Choi H, Deyo RA, Gabriel S,

Hirsch R, Hochberg MC, Hunder GG, Jordan

JM, Katz JN, Kremers HM, Wolfe F.

Estimates of the prevalence of arthritis and

other rheumatic conditions in the United

States: Part II. Arthritis Rheum. 2008

Jan;58(1):26-35.

Although osteoarthritis becomes more

common with age, younger people can

develop it, usually as the result of a joint

injury, a joint malformation, or a genetic

defect in joint cartilage. Both men and

women have the disease. Before age 45,

more men than women have osteoarthritis;

after age 45, it is more common in women. It

is also more likely to occur in people who are

overweight and in those with jobs that stress

particular joints.

How Does Osteoarthritis Affect

People?

People with osteoarthritis usually experience

joint pain and stiffness. The most commonly

affected joints are those at the ends of the

fingers (closest to the nail), thumbs, neck,

lower back, knees, and hips.

Osteoarthritis affects different people

differently. It may progress quickly, but for

most people, joint damage develops

gradually over years. In some people,

osteoarthritis is relatively mild and interferes

little with day-to-day life; in others, it causes

significant pain and disability.

What Areas Does

Osteoarthritis Affect?

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Osteoarthritis most often occurs

in the hands (at the ends of the

fingers and thumbs), spine (neck

and lower back), knees, and hips

Osteoarthritis Basics: The Joint

and Its Parts

A joint is the point where two or more bones

are connected. With a few exceptions (in the

skull and pelvis, for example), joints are

designed to allow movement between the

bones and to absorb shock from movements

like walking or repetitive motions. These

movable joints are made up of the following

parts:

Cartilage: A hard but slippery coating on the

end of each bone. Cartilage breaks down and

wears away in osteoarthritis.

Joint capsule: A tough membrane sac that

encloses all the bones and other joint parts.

Synovium (sin-O-vee-um): A thin

membrane inside the joint capsule that

secretes synovial fluid.

Synovial fluid: A fluid that lubricates the joint

and keeps the cartilage smooth and healthy.

Ligaments, tendons, and muscles: Tissues

that surround the bones and joints, and allow

the joints to bend and move. Ligaments are

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tough, cord-like tissues that connect one

bone to another.

Tendons: Tough, fibrous cords that connect

muscles to bones. Muscles are bundles of

specialized cells that, when stimulated by

nerves, either relax or contract to produce

movement.

A Healthy Joint

(Representation)

In a healthy joint, the ends of

bones are encased in smooth

cartilage. Together, they are

protected by a joint capsule lined

with a synovial membrane that

produces synovial fluid. The

capsule and fluid protect the

cartilage, muscles, and

connective tissues.

A Joint With Severe

Osteoarthritis

(Representation)

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With osteoarthritis, the cartilage

becomes worn away. Spurs grow

out from the edge of the bone,

and synovial fluid increases.

Altogether, the joint feels stiff and

sore.

How Do You Know if You Have

Osteoarthritis?

Usually, osteoarthritis comes on slowly. Early

in the disease, your joints may ache after

physical work or exercise. Later on, joint pain

may become more persistent. You may also

experience joint stiffness, particularly when

you first wake up in the morning or have

been in one position for a long time.

Although osteoarthritis can occur in any joint,

most often it affects the hands, knees, hips,

and spine (either at the neck or lower back).

Different characteristics of the disease can

depend on the specific joint(s) affected. For

information on the joints most often affected

by osteoarthritis, see the following

descriptions:

Hands: Osteoarthritis of the hands seems to

have some hereditary characteristics; that is,

it runs in families. If your mother or

grandmother has or had osteoarthritis in their

hands, you’re at greater-than-average risk of

having it too. Women are more likely than

men to have osteoarthritis in the hands. For

most women, it develops after menopause.

Knees: The knees are among the joints most

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commonly affected by osteoarthritis.

Symptoms of knee osteoarthritis include

stiffness, swelling, and pain, which make it

hard to walk, climb, and get in and out of

chairs and bathtubs. Osteoarthritis in the

knees can lead to disability.

Hips: The hips are also common sites of

osteoarthritis. As with knee osteoarthritis,

symptoms of hip osteoarthritis include pain

and stiffness of the joint itself. But sometimes

pain is felt in the groin, inner thigh, buttocks,

or even the knees. Osteoarthritis of the hip

may limit moving and bending, making daily

activities such as dressing and putting on

shoes a challenge.

Spine: Osteoarthritis of the spine may show

up as stiffness and pain in the neck or lower

back. In some cases, arthritis-related

changes in the spine can cause pressure on

the nerves where they exit the spinal column,

resulting in weakness, tingling, or numbness

of the arms and legs. In severe cases, this

can even affect bladder and bowel function.

How Do Doctors Diagnose

Osteoarthritis?

No single test can diagnose osteoarthritis;

however, sometimes doctors use tests to

help confirm a diagnosis or rule out other

conditions that could be causing your

symptoms. Most doctors use a combination

of the following methods:

Clinical History

The doctor begins by asking you to describe

the symptoms, when and how the condition

started, as well as how the symptoms have

changed over time. The doctor will also ask

about any other medical problems you and

close family members have and about any

medications you are taking.

Physical Examination

The doctor will check your reflexes and

general health, including muscle strength.

The doctor will also examine bothersome

joints and observe your ability to walk, bend,

and carry out activities of daily living.

X Rays

X rays can help doctors determine the form

of arthritis a person has and how much joint

damage has been done. X rays of the

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affected joint can show such things as

cartilage loss, bone damage, and bone

spurs. But there often is a big difference

between the severity of osteoarthritis as

shown by the x ray and the degree of pain

and disability you feel. Also, x rays may not

show early osteoarthritis damage until much

cartilage loss has taken place.

Magnetic Resonance Imaging

Also known as MRI, magnetic resonance

imaging provides high-resolution

computerized images of internal body

tissues. This procedure uses a strong

magnet that passes a force through the body

to create these images. Doctors often use

MRI tests if there is pain, if x-ray findings are

minimal, and if the findings suggest damage

to other joint tissues such as a ligament or

the pad of connective tissue in the knee

known as the meniscus.

Other Tests

The doctor may order blood tests to rule out

other causes of symptoms. He or she may

also order a joint aspiration, which involves

drawing fluid from the joint through a needle

and examining the fluid under a microscope.

Joint fluid samples could reveal bacteria,

indicating joint pain is caused by an infection

or uric acid crystals, indicating gout.

Osteoarthritis is so common, especially in

older people, that symptoms seemingly

caused by the disease actually may be

caused by other medical conditions. The

doctor will try to find out what is causing the

symptoms by ruling out other disorders and

identifying conditions that may make the

symptoms worse.

How Is Osteoarthritis Treated?

Most successful treatment programs involve

a combination of approaches tailored to the

patient’s needs, lifestyle, and health. Most

programs include ways to manage pain and

improve function. These approaches are

described below.

Four Goals of

Osteoarthritis Treatment

to control pain

to improve joint function

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to maintain normal body

weight

to achieve a healthy

lifestyle.

Treatment Approaches to

Osteoarthritis

exercise

weight control

nondrug pain relief

techniques and alternative

therapies

medications to control

pain

surgery.

Exercise

Research shows that exercise is one of the

best treatments for osteoarthritis. Exercise

can improve mood and outlook, decrease

pain, increase flexibility, strengthen the heart

and improve blood flow, maintain weight, and

promote general physical fitness. Exercise is

also inexpensive and, if done correctly, has

few negative side effects. The amount and

form of exercise prescribed will depend on

which joints are involved, how stable the

joints are, and whether a joint replacement

has already been done. Walking, swimming,

and water aerobics are a few popular types

of exercise for people with osteoarthritis.

Your doctor and/or physical therapist can

recommend specific types of exercise

depending on your particular situation.

Attention to rest and periods of relief from

stress on the joints is also important.

On the Move: Fighting

Osteoarthritis With

Exercise

You can use exercises to keep

strong and limber, improve

cardiovascular fitness, extend

your joints’ range of motion, and

reduce your weight. The following

types of exercise are part of a

well-rounded arthritis treatment

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plan.

Strengthening

exercises: These

exercises strengthen

muscles that support

joints affected by arthritis.

They can be performed

with weights or with

exercise bands,

inexpensive devices that

add resistance.

Aerobic activities: These

are exercises, such as

brisk walking or

low-impact aerobics, that

get your heart pumping

and can keep your lungs

and circulatory system in

shape.

Range-of-motion

activities: These keep

your joints limber.

Balance and agility

exercises: These help

you maintain daily living

skills.

Ask your doctor or physical

therapist what exercises are best

for you. Ask for guidelines on

exercising.

Weight Control

If you are overweight or obese, you should

try to lose weight. Weight loss can reduce

stress on weight-bearing joints, limit further

injury, increase mobility, and reduce the risk

of associated health problems. A dietitian can

help you develop healthy eating habits. A

healthy diet and regular exercise help reduce

weight.

Nondrug Pain Relief and

Alternative Therapies

People with osteoarthritis may find many

nondrug ways to relieve pain. Below are

some examples:

Heat and cold: Heat or cold (or a

combination of the two) can be useful for joint

pain. Heat can be applied in a number of

different ways—with warm towels, hot packs,

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or a warm bath or shower—to increase blood

flow and ease pain and stiffness. In some

cases, cold packs (bags of ice or frozen

vegetables wrapped in a towel), which

reduce inflammation, can relieve pain or

numb the sore area. (Check with a doctor or

physical therapist to find out if heat or cold is

the best treatment.)

Transcutaneous electrical nerve

stimulation (TENS): TENS is a technique

that uses a small electronic device to direct

mild electric pulses to nerve endings that lie

beneath the skin in the painful area. TENS

may relieve some arthritis pain. It seems to

work by blocking pain messages to the brain

and by modifying pain perception.

Massage: In this pain-relief approach, a

massage therapist will lightly stroke and/or

knead the painful muscles. This may

increase blood flow and bring warmth to a

stressed area. However, arthritis-stressed

joints are sensitive, so the therapist must be

familiar with the problems of the disease.

Acupuncture: When conventional medical

treatment doesn't provide sufficient pain

relief, people are more likely to try

complementary and alternative therapies to

treat osteoarthritis. Some people have found

pain relief using acupuncture, a practice in

which fine needles are inserted by a licensed

acupuncture therapist at specific points on

the skin. Scientists think the needles

stimulate the release of natural, pain-relieving

chemicals produced by the nervous system.

Nutritional supplements: Nutritional

supplements such as glucosamine and

chondroitin sulfate have been reported to

improve symptoms in some people with

osteoarthritis, as have certain vitamins.

Additional studies have been carried out to

further evaluate these claims (see “Research

Highlights”). It is unknown whether they might

change the course of disease.

Medications to Control Pain

Doctors prescribe medicines to eliminate or

reduce pain and to improve functioning.

Doctors consider a number of factors when

choosing medicines for their patients with

osteoarthritis. These include the intensity of

pain, potential side effects of the medication,

your medical history (other health problems

you have or are at risk for), and other

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medications you are taking.

Because some medications can interact with

one another and certain health conditions put

you at increased risk of drug side effects, it's

important to discuss your medication and

health history with your doctor before you

start taking any new medication, and to see

your doctor regularly while you are taking

medication. By working together, you and

your doctor can find the medication that best

relieves your pain with the least risk of side

effects.

The following types of medicines are

commonly used in treating osteoarthritis: 2

2All medicines can have side effects. Some

side effects may be more severe than others.

You should review the package insert that

comes with your medicine and ask your

health care provider or pharmacist if you

have any questions about the possible side

effects.

Over-the-counter pain relievers: Oral pain

medications, such as acetaminophen, are

often a first-line approach to relieve pain in

people with osteoarthritis.

NSAIDs (nonsteroidal anti-inflammatory

drugs): A large class of medications useful

against both pain and inflammation,

(NSAIDs)3 are a common arthritis treatment.

Aspirin and ibuprofen are examples of

NSAIDs.

3 Warning: Side effects of NSAIDs include

stomach problems; skin rashes; high blood

pressure; fluid retention; and liver, kidney,

and heart problems. The longer a person

uses NSAIDs, the more likely he or she is to

have side effects, ranging from mild to

serious. Many other drugs cannot be taken

when a patient is being treated with NSAIDs,

because NSAIDs alter the way the body uses

or eliminates these other drugs. Check with

your health care provider or pharmacist

before you take NSAIDs. NSAIDs should only

be used at the lowest dose possible for the

shortest time needed.

Some NSAIDs are available over the counter,

while more than a dozen others, including a

subclass called COX-2 inhibitors, are

available only with a prescription.

Narcotic or central acting agents:

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Prescription pain relievers are sometimes

prescribed when over-the-counter

medications don't provide sufficient relief or

when people have certain medical problems

that would make traditional NSAIDs or other

first-line therapies unsafe. These medications

can carry risks, including the potential for

addiction.

Corticosteroids: Corticosteroids are

powerful anti-inflammatory hormones made

naturally in the body or man-made for use as

medicine. They may be injected into the

affected joints to temporarily relieve pain.

This is a short-term measure, generally not

recommended for more than two to four

treatments per year. Oral corticosteroids are

not routinely used to treat osteoarthritis. They

are occasionally used for inflammatory flares.

Hyaluronic acid substitutes: Sometimes

called viscosupplements, hyaluronic acid

substitutes are designed to replace a normal

component of the joint involved in joint

lubrication and nutrition. Depending on the

particular product your doctor prescribes, it

will be given in a series of three to five

injections. These products are approved only

for osteoarthritis of the knee.

Other medications: Doctors may prescribe

several other medicines for osteoarthritis.

They include topical pain-relieving creams,

rubs, and sprays, which are applied directly

to the skin over painful joints.

Surgery

For many people, surgery helps relieve the

pain and disability of osteoarthritis. Surgery

may be performed to achieve one or more of

the following:

Removal of loose pieces of bone and

cartilage from the joint if they are

causing symptoms of buckling or

locking (arthroscopic debridement).

Repositioning of bones (osteotomy).

Resurfacing (smoothing out) bones

(joint resurfacing).

Surgeons may replace affected joints with

artificial joints called prostheses. These joints

can be made from metal alloys, high-density

plastic, and ceramic material. Some

prostheses are joined to bone surfaces with

special cements. Others have porous

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surfaces and rely on the growth of bone into

that surface (a process called biologic

fixation) to hold them in place. Artificial joints

can last 10 to 15 years or longer. Surgeons

choose the design and components of

prostheses according to their patient’s

weight, sex, age, activity level, and other

medical conditions.

Joint replacement advances have included

the ability, in some cases, to replace only the

damaged part of the knee joint, leaving

undamaged parts of the joint intact, and the

ability to perform hip replacement through

much smaller incisions than previously

possible.

The decision to use surgery depends on

several factors, including the patient’s age,

occupation, level of disability, pain intensity,

and the degree to which arthritis interferes

with his or her lifestyle. After surgery and

rehabilitation, the patient usually feels less

pain and swelling and can move more easily.

Who Provides Care for People

With Osteoarthritis?

Treating arthritis often requires a

multidisciplinary or team approach. Many

types of health professionals care for people

with arthritis. You may choose a few or more

of the following professionals to be part of

your health care team:

Primary care physicians: Doctors who treat

patients before they are referred to other

specialists in the health care system. Often a

primary care physician will be the main

doctor to treat your arthritis. Primary care

physicians also handle other medical

problems and coordinate the care you

receive from other physicians and health care

providers.

Rheumatologists: Doctors who specialize in

treating arthritis and related conditions that

affect joints, muscles, and bones.

Orthopaedists: Surgeons who specialize in

the treatment of, and surgery for, bone and

joint diseases.

Physical therapists: Health professionals

who work with patients to improve joint

function.

Occupational therapists: Health

professionals who teach ways to protect

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joints, minimize pain, perform activities of

daily living, and conserve energy.

Dietitians: Health professionals who teach

ways to use a good diet to improve health

and maintain a healthy weight.

Nurse educators: Nurses who specialize in

helping patients understand their overall

condition and implement their treatment

plans.

Physiatrists (rehabilitation specialists):

Medical doctors who help patients make the

most of their physical potential.

Licensed acupuncture therapists: Health

professionals who reduce pain and improve

physical functioning by inserting fine needles

into the skin at specific points on the body.

Psychologists: Health professionals who

seek to help patients cope with difficulties in

the home and workplace resulting from their

medical conditions.

Social workers: Professionals who assist

patients with social challenges caused by

disability, unemployment, financial hardships,

home health care, and other needs resulting

from their medical conditions.

Chiropractors: Health professionals who

focus treatment on the relationship between

the body's structure—mainly the spine—and

its functioning.

Massage therapists: Health professionals

who press, rub, and otherwise manipulate the

muscles and other soft tissues of the body.

They most often use their hands and fingers,

but may use their forearms, elbows, or feet.

Research Highlights

The leading role in osteoarthritis research is

played by the National Institute of Arthritis

and Musculoskeletal and Skin Diseases

(NIAMS), part of the National Institutes of

Health (NIH). The NIAMS funds many

researchers across the United States to

study osteoarthritis.

One area of focus of osteoarthritis research

in recent years has been the potential role of

inflammation in the disease. One NIAMSsupported study found that a pathway called

the complement system, which is a major

component of the innate immune system, is

critical to the development of osteoarthritis.

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Researchers found that expression and

activation of complement is abnormally high

in people with osteoarthritis. The researchers

confirmed the role of the pathway in mice,

which are an animal model for osteoarthritis.

If these findings about the complement’s role

hold true in people, blocking a part of the

complement system may be an effective

treatment for early osteoarthritis. Other key

areas of research supported by the NIAMS

and other institutes within NIH include the

following:

Biomarkers

The Osteoarthritis Initiative (OAI) is a

multicenter, longitudinal, prospective,

observational study of knee osteoarthritis that

was launched by NIH in 2002. The overall

aim of the OAI is to develop a public-domain

research resource to facilitate the scientific

evaluation of biomarkers for osteoarthritis as

potential surrogate endpoints for disease

onset and progression. The goals of the OAI

were to enroll approximately 5,000 volunteers

with risk factors for early knee osteoarthritis,

and to collect clinical and imaging data and

biological specimens from these participants

for originally 4, and now a total of 8 years of

follow up.

This study is expected to advance our

understanding of how modifiable and

nonmodifiable risk factors are linked to

development and worsening of knee

osteoarthritis. Such findings may, in turn, lead

to improved strategies for prevention of

disease and identification of novel treatment

targets, which could result in prevention of

later-life disability in individuals with knee

osteoarthritis.

Diagnostic Tools

Scientists are exploring various methods to

detect and monitor cartilage changes that

could eventually enable doctors to diagnose

osteoarthritis long before traditional x rays

would show damage. It could also allow

clinicians the opportunity to monitor the

impact of therapeutic interventions very early

in the disease process.

Pharmacologic Treatments

Researchers are looking for drugs that would

prevent, slow down, or reverse joint damage.

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For example, researchers supported by the

NIAMS have shown that teriparatide, a form

of human parathyroid hormone that triggers

new bone formation and is approved to treat

osteoporosis, can restore cartilage in a

mouse model of injury-induced osteoarthritis

of the knee. More studies are needed.

Complementary and Alternative

Therapies

The Glucosamine/Chondroitin Arthritis

Intervention Trial (GAIT), which was

cosponsored by the National Center for

Complementary and Alternative Medicine

(NCCAM) and the NIAMS, assessed the

effectiveness and safety of these nutritional

supplements when taken together or

separately. The trial found that the

combination of glucosamine and chondroitin

sulfate did not provide significant relief from

osteoarthritis pain among all participants.

However, a subgroup of study participants

with moderate-to-severe pain showed

significant relief with the combined

supplements. The 4-year trial was conducted

at 16 sites across the United States.

Healing Joint Injuries and Cartilage

Damage

When the anterior cruciate ligament

(ACL)—one of the main ligaments of the

knee, which connects the shin bone to the

thigh—is torn, it doesn’t heal the way other

tissues do. Unless the tear is repaired, the

knee can become unstable, resulting in

damage to the joint surfaces and the

eventual development of knee osteoarthritis.

Traditionally, repair has involved replacing

the ligament with ligament or tendon graft,

but NIAMS-funded research shows that filling

the tear with a collagen- and platelet-rich gel

material may enable it to heal, making a graft

unnecessary. Physicians believe that

preserving the patient’s own ACL (if it

becomes possible) would likely better protect

the mechanics of the knee.

Other NIAMS-supported scientists are

researching a way to patch damaged

cartilage that will allow new cartilage to grow

in and repair the damage. Using a unique

weaving machine of their own design, the

researchers have created a threedimensional fabric scaffold patch. In

laboratory tests, the scaffold had the same

mechanical properties as native cartilage.

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Genetic Studies

Osteoarthritis in all its various forms appears

to have a strong but complex genetic

connection. Gene mutations may be a factor

in predisposing individuals to develop

osteoarthritis. For example, scientists have

identified a mutation (a gene defect) affecting

collagen, an important part of cartilage, in

patients with an inherited kind of

osteoarthritis that starts at an early age. The

mutation weakens collagen protein, which

may break or tear more easily under stress.

The Johnston County Osteoarthritis Project,

a NIAMS-supported University of North

Carolina study focusing on a group of 5,000

adults, age 45 or older, identified six genes—

ABCG2, GDF5, IL1RN, IL6, and VDR—that

appear to increase susceptibility to knee

osteoarthritis.

Patient Education and

Self-Management

When patients understand and feel that they

have some control over their chronic disease,

the course of their disease is often improved.

Researchers are investigating a variety of

self-management approaches in people with

osteoarthritis, including coping skills training,

exercise training, patient education, and

social support. These strategies have shown

some success in managing pain and

improving function.

Exercise and Weight Reduction

Exercise and weight reduction/management

play a key part in a comprehensive treatment

plan. Researchers are studying exercise in

greater detail and finding out just how to use

it in treating or preventing osteoarthritis.

Studies have shown that losing extra weight

can help people who already have

osteoarthritis. Moreover, overweight or obese

people who do not have osteoarthritis may

reduce their risk of developing the disease by

losing weight.

More information on research is available

from the following websites:

NIH Clinical Research Trials and

You was designed to help people

learn more about clinical trials, why

they matter, and how to participate.

Visitors to the website will find

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information about the basics of

participating in a clinical trial,

first-hand stories from clinical trial

volunteers, explanations from

researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

Hope for the Future

Research is opening up new avenues of

treatment for people with osteoarthritis. A

balanced, comprehensive approach is still

the key to staying active and healthy with the

disease. People with osteoarthritis should

combine exercise, relaxation, education,

social support, and medications in their

treatment strategies. Meanwhile, as scientists

unravel the complexities of the disease, new

treatments and prevention methods should

become apparent. Such developments are

expected to improve the quality of life for

people with osteoarthritis and their families.

For More Information

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

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Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

NIH Osteoporosis and Related Bone

Diseases ~ National Resource Center

2 AMS Circle

Bethesda, MD 20892-3676

Phone: 202-223-0344

Toll free: 800-624-BONE (2663)

TTY: 202-466-4315

Fax: 202-293-2356

Email: NIHBoneInfo@mail.nih.gov

Website: http://www.bones.nih.gov

National Institute on Aging

Website: http://www.nia.nih.gov/

American Academy of Orthopaedic

Surgeons

Website: http://www.aaos.org (con

información en español)

American College of Rheumatology

Website: http://www.rheumatology.org

American Physical Therapy Association

Website: http://www.apta.org (con

información en español)

Arthritis Foundation

Website: http://www.arthritis.org

Key Words

Biomarkers. Physical signs or biological

substances that indicate changes in bone or

cartilage. Doctors believe they may one day

be able to use biomarkers for diagnosing

osteoarthritis before it causes noticeable joint

damage and for monitoring the progression

of the disease and its responsiveness to

treatment.

Bone spurs. Small growths of bone that can

occur on the edges of a joint affected by

osteoarthritis. These growths are also known

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as osteophytes.

Cartilage. A hard but slippery coating on the

end of each bone. The breakdown of joint

cartilage is the primary feature of

osteoarthritis.

Chondroitin sulfate. A naturally existing

substance in joint cartilage that is believed to

draw fluid into the cartilage. Chondroitin is

often taken in supplement form along with

glucosamine as a treatment for osteoarthritis.

See the "nutritional supplements" section

under “Complementary and Alternative

Therapies” for more information.

Collagen. A family of fibrous proteins that

are components of cartilage. Collagens are

the building blocks of skin, tendon, bone, and

other connective tissues.

Corticosteroids. Powerful anti-inflammatory

hormones made naturally in the body or

man-made for use as medicine.

Corticosteroids may be injected into the

affected joints to temporarily reduce

inflammation and relieve pain.

COX-2 inhibitors. A relatively new class of

nonsteroidal anti-inflammatory drugs

(NSAIDs) that are formulated to relieve pain

and inflammation. For information about the

risk posed by NSAIDs, see “NSAIDs” in the

“How Is Osteoarthritis Treated?” section.

Glucosamine. A substance that occurs

naturally in the body, providing the building

blocks to make and repair cartilage. See the

“nutritional supplements” section under

“Complementary and Alternative Therapies”

for more information.

Hyaluronic acid. A substance that gives

healthy joint fluid its viscous (slippery)

property and that may be reduced in people

with osteoarthritis. For some people with

osteoarthritis of the knee, replacing

hyaluronic acid with injections of agents

referred to as viscosupplements is useful for

increasing lubrication, reducing pain, and

improving function.

Joint capsule. A tough membrane sac that

holds the bones and other joint parts

together.

Joint resurfacing. A procedure in which the

damaged cartilage surfaces are replaced

while the rest of the joint is left intact.

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Ligaments. Tough bands of connective

tissue that attach bones to each other,

providing stability.

Magnetic resonance imaging (MRI).

Provides high-resolution computerized

images of internal body tissues. This

procedure uses a strong magnet that passes

a force through the body to create these

images.

Muscles. Bundles of specialized cells that

contract and relax to produce movement

when stimulated by nerves.

Nonsteroidal anti-inflammatory drugs

(NSAIDs). A class of medications available

over the counter or with a prescription that

ease pain and inflammation. Commonly used

NSAIDs include ibuprofen, naproxen sodium,

and ketoprofen. For information about the

risks posed by NSAIDs, see “NSAIDs” in the

“How Is Osteoarthritis Treated?” section.

Osteoarthritis. The most common form of

arthritis. It is characterized by the breakdown

of joint cartilage, leading to pain, stiffness,

and disability.

Osteophytes. Small growths of bone that

can appear on the edges of a joint affected

by osteoarthritis. These growths are also

known as bone spurs.

Osteotomy. A procedure that involves

cutting and realigning bone, to shift the

weight from a damaged and painful bone

surface to a healthier one.

Rheumatoid arthritis. A form of arthritis in

which the immune system attacks the tissues

of the joints, leading to pain, inflammation,

and eventually joint damage and

malformation. It typically begins at a younger

age than osteoarthritis does, causes swelling

and redness in joints, and may make people

feel sick, tired, and feverish. Rheumatoid

arthritis may also affect skin tissue, the lungs,

the eyes, or the blood vessels.

Synovium. A thin membrane inside the joint

capsule that secretes synovial fluid.

Synovial fluid. A fluid secreted by the

synovium that lubricates the joint and keeps

the cartilage smooth and healthy.

Tendons. Tough, fibrous cords that connect

muscles to bones.

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Transcutaneous electrical nerve

stimulation (TENS). A technique that uses a

small electronic device to direct mild electric

pulses to nerve endings that lie beneath the

skin in a painful area. TENS may relieve

some arthritis pain. It seems to work by

blocking pain messages to the brain and by

modifying pain perception.

X ray. A procedure in which low-level

radiation is passed through the body to

produce a picture called a radiograph. X rays

of joints affected by osteoarthritis can show

such things as cartilage loss, bone damage,

and bone spurs.

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of previous versions

of this publication: Gayle Lester, Ph.D., Joan

McGowan, Ph.D., James Panagis, M.D.,

Susana Serrate-Sztein, M.D., and Bernadette

Tyree, Ph.D., NIAMS/NIH; Kenneth D.

Brandt, M.D., Indiana University School of

Medicine, Indianapolis, IN; Victor M.

Goldberg, M.D., University Hospitals of

Cleveland, OH; Marc C. Hochberg, M.D.,

M.P.H., University of Maryland, Baltimore,

MD; John Klippel, M.D., Arthritis Foundation,

Atlanta, GA; and Roland Moskowitz, M.D.,

Case Western Reserve University,

Cleveland, OH. Special thanks also go to the

patients who reviewed this publication and

provided valuable input.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services’

National Institutes of Health (NIH), is to

support research into the causes, treatment,

and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

by the NIAMS that provides health

information and information sources.

Additional information can be found on the

NIAMS website at www.niams.nih.gov.

For Your Information

This publication contains information about

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medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available.

Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

www.accessdata.fda.gov/scripts

/cder/drugsatfda. Drugs@FDA is a

searchable catalog of FDA-approved drug

products.

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

NIH Publication No. 16-4617

Many of our publications are

available in print. Would you like

to order publications on arthritis to

be mailed to you? Visit our online

order form.

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