H E A L T h

Osteoarthritis
O N
H A N D O U T

U.S. Department of Health and

Human Services
National Institutes of Health
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
For Your Information
This publication contains information about medications
used to treat the health condition discussed here. When
this booklet was printed, 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
the U.S. Food and Drug Administration at
1888INFOFDA (18884636332, a toll-free
call) or visit its Web site at www.fda.gov.

For updates and questions about statistics, please

contact the Centers for Disease Control and
Preventions National Center for Health Statistics
toll free at 18002324636 or visit its Web site
at www.cdc.gov/nchs.

This booklet is not copyrighted. Readers are

encouraged to duplicate and distribute as many
copies as needed.

Additional copies of this booklet are available from the

National Institute of Arthritis and Musculoskeletal and
Skin Diseases, NIAMS/National Institutes of Health,
1 AMS Circle, Bethesda, MD 208923675, and on the
NIAMS Web site at www.niams.nih.gov.
Table of Contents
What Is Osteoarthritis? . . . . . . . . . . . . . . . . . . . . . . . 1
Who Has Osteoarthritis? . . . . . . . . . . . . . . . . . . . . . . 2
How Does Osteoarthritis Affect People? . . . . . . . . . . 4
Osteoarthritis Basics: The Joint and Its Parts . . . . . . 5
How Do You Know if You Have Osteoarthritis? . . . 8
How Do Doctors Diagnose Osteoarthritis? . . . . . . . 10
How Is Osteoarthritis Treated? . . . . . . . . . . . . . . . . 13
Who Treats Osteoarthritis? . . . . . . . . . . . . . . . . . . . 24
What You Can Do: The Importance of
Self-Care and a Good Health Attitude . . . . . . . . . . 25
What Research Is Being Done on Osteoarthritis? . . 30
Hope for the Future . . . . . . . . . . . . . . . . . . . . . . . . . 40
Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . 40
Key Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Illustrations
What Areas Does Osteoarthritis Affect? . . . . . . . . . . 3
A Healthy Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A Joint With Severe Osteoarthritis . . . . . . . . . . . . . . 6
Exercises for Osteoarthritis . . . . . . . . . . . . . . . . . . . 28
Information Boxes
Cartilage: The Key to Healthy Joints . . . . . . . . . . . . 7
The Warning Signs of Osteoarthritis . . . . . . . . . . . . . 9
Four Goals of Osteoarthritis Treatment . . . . . . . . . 12
Treatment Approaches to Osteoarthritis . . . . . . . . . 12
On the Move: Fighting Osteoarthritis
with Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Questions to Ask Your Doctor or Pharmacist
About Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Self-Management Programs Do Help . . . . . . . . . . . 26
Enjoy a Good Health Attitude . . . . . . . . . . . . . . . . . 29
Osteoarthritis
This booklet is for people who have osteoarthritis, their
families, and others interested in learning more about
the disorder. It describes osteoarthritis and its symptoms
and contains information about diagnosis and treatment,
as well as current 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). The booklet also discusses
pain relief, exercise, and quality of life for people with
osteoarthritis. If you have further questions after reading
this booklet, you may wish to discuss them with your doctor.

What Is Osteoarthritis?

O steoarthritis (pronounced 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 or osteoarthrosis.

Osteoarthritis mostly affects cartilage (pronounced

KAR-til-ij), 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 down
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

1
 or cartilage can break off and float inside the joint
space. This causes more pain and damage.

People with osteoarthritis usually have joint pain and

some movement limitations. Unlike some other forms
of arthritis, such as rheumatoid arthritis, osteoarthritis
affects only joint function and does not affect skin
tissue, the lungs, the eyes, or the blood vessels.

In rheumatoid arthritis, the second most 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 uncommonly feverish.

Who Has Osteoarthritis?

O steoarthritis 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.

Although osteoarthritis is more common in older

people, 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.

As the population ages, the number of people with

osteoarthritis will only grow. By 2030, 20 percent of

2
What Areas Does Osteoarthritis Affect?

Osteoarthritis most often occurs in the hands (at the ends of the
fingers and thumbs), spine (neck and lower back), knees, and hips.

3
 Americans about 72 million people will have passed
their 65th birthday and will be at high risk for the disease.

How Does Osteoarthritis Affect People?

P eople 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 in different

ways. Although in some people it progresses quickly, in
most individuals 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.

Although osteoarthritis is a disease of the joints, its

effects are not just physical. In many people with
osteoarthritis, lifestyle and finances also decline.

Lifestyle effects include

n depression
n anxiety
n feelings of helplessness
n limitations on daily activities
n job limitations
n difficulty participating in everyday personal
and family joys and responsibilities.

Financial effects include

n the cost of treatment
n wages lost because of disability.

4
Fortunately, most people with osteoarthritis live
active, productive lives despite these limitations.
They do so by using treatment strategies such as rest
and exercise, pain relief medications, education and
support programs, learning self-care, and having a
good attitude.

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
Osteoarthritis
shock from movements like walking
or repetitive motions. These hurts people in
movable joints are made up of more than their
the following parts:
joints: their
Cartilage: a hard but slippery
finances and
coating on the end of each bone.
Cartilage, which breaks down and lifestyles also
wears away in osteoarthritis, is areaffected.
described in more detail on the
next two pages.

Joint capsule: a tough membrane sac that encloses all

the bones and other joint parts.

Synovium (pronounced 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.

5
 A Healthy Joint
Medial collateral ligament
Joint capsule
Muscles Synovial membrane

Tendons

Posterior Anterior
cruciate cruciate
ligament ligament

Cartilage Bone

Lateral Synovial fluid

collateral
ligament
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

Medial collateral ligament
Bone spurs Synovial membrane
Muscles

Tendons

Posterior Anterior
cruciate cruciate
ligament ligament

Worn-away Bone
cartilage Cartilage Synovial fluid
Lateral
collateral fragments
ligament in fluid

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.

6
Ligaments, tendons, and muscles are tissues that
surround the bones and joints; they allow the joints
to bend and move. Ligaments are tough, cord-like
tissues that connect one bone to another. Tendons
are 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.

Cartilage: The Key to Healthy Joints

Cartilage is 65 to 80 percent water. The remaining
three components collagen, proteoglycans, and
chondrocytes are described below.
n collagen (pronounced KAHL-uh-jen): A
family of fibrous proteins, collagens are the
building blocks of skin, tendon, bone, and
other connective tissues.
n proteoglycans (pronounced PRO-tee-uh-GLY-
kanz): Made up of proteins and sugars, strands
of proteoglycans interweave with collagens and
form a mesh-like tissue. This allows cartilage to
flex and absorb physical shock.
n chondrocytes (pronounced KAHN-druh-sytz):
Found throughout the cartilage, chondrocytes
are cells that produce cartilage and help it stay
healthy as it grows. Sometimes, however, they
release substances called enzymes that destroy
collagen and other proteins. Researchers are
trying to learn more about chondrocytes.

7
 How Do You Know if You Have Osteoarthritis?

U sually, 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 general warning signs of osteoarthritis, see the
box on the next page. The joints most often affected
by osteoarthritis are described below.

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, youre at greater than average risk
of having it, too. Women are more likely than men
to have hand involvement and, for most, it develops
after menopause.

When osteoarthritis involves the hands, small,

bony knobs may appear on the end joints (those
closest to the nails) of the fingers. They are called
Heberdens (pronounced HEB-err-denz) nodes.
Similar knobs, called Bouchards (pronounced boo-
SHARDZ) nodes, can appear on the middle joints
of the fingers. Fingers can become enlarged and
gnarled, and they may ache or be stiff and numb.
The base of the thumb joint also is commonly
affected by osteoarthritis.

8
Knees: The knees are among the joints most
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.

The Warning Signs of Osteoarthritis

n stiffness in a joint after getting out of bed
or sitting for a long time
n swelling in one or more joints
n a crunching feeling or the sound of bone
rubbing on bone
About a third of people whose x rays show
evidence of osteoarthritis report pain or other
symptoms. For those who experience steady or
intermittent pain, it is typically aggravated by
activity and relieved by rest.
If you feel hot or your skin turns red, you
probably do not have osteoarthritis. Check
with your doctor about other causes, such as
rheumatoid arthritis.

9
 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 or numbness of the
arms and legs.

How Do Doctors Diagnose Osteoarthritis?

N o single test can diagnose osteoarthritis.

Most doctors use a combination of the
following methods to diagnose the disease
and rule out other conditions.

Clinical history
The doctor begins by asking the patient to describe
the symptoms, when and how the condition started,
and how the symptoms have changed over time. The
doctor will also ask about any other medical problems
the patient and close family members have and
about any medications the patient is taking. Accurate
answers to these questions can help the doctor make
a diagnosis and understand the impact the disease has
on the patients life.

Physical examination
The doctor will check the patients reflexes and general
health, including muscle strength. The doctor will also
examine bothersome joints and observe the patients
ability to walk, bend, and carry out activities of
daily living.

10
X rays
Doctors take x rays to see how much joint damage
has been done. X rays of the 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 It usually is not
by the x ray and the degree of pain difficult to tell
and disability felt by the patient.
Also, x rays may not show early if a patient has
osteoarthritis damage before much osteoarthritis. It
cartilage loss has taken place.
is more difficult
Magnetic resonance imaging to tell if the
Also known as an MRI, magnetic disease is causing
resonance imaging provides
the patients
high-resolution computerized
images of internal body tissues. This symptoms.
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 to 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.

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 It usually is not difficult to tell if a patient has
osteoarthritis. It is more difficult to tell if the disease is
causing the patients symptoms. Osteoarthritis is so
common especially in older people that symptoms
seemingly caused by the disease actually may be due
to 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. The severity of symptoms in
osteoarthritis can be influenced greatly by the patients
attitude, anxiety, depression, and daily activity level.

Four Goals of Osteoarthritis Treatment

n to control pain
n to improve joint function
n to maintain normal body weight
n to achieve a healthy lifestyle

Treatment Approaches to Osteoarthritis

n exercise
n weight control
n rest and relief from stress on joints
n nondrug pain relief techniques
n medications to control pain
n surgery
n complementary and alternative therapies

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How Is Osteoarthritis Treated?

M ost successful treatment programs involve

a combination of treatments tailored to the
patients needs, lifestyle, and health. Most programs
include ways to manage pain
and improve function. These
can involve exercise, weight
control, rest and relief from Patients must
stress on joints, pain relief
learn to recognize
techniques, medications,
surgery, and complementary the bodys
and alternative therapies. s ignals, and know
These approaches are
described below. when to stop or
slow down.
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 or physical therapist can recommend specific
types of exercise depending on the patients particular
situation. (See What You Can Do: The Importance of
Self-Care and a Good Health Attitude on page 25.)

13
 On the Move: Fighting Osteoarthritis
withExercise
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 treatment plan for arthritis.
n Strengthening exercises strengthen muscles
that support joints affected by arthritis. They
can be performed with weights or with exercise
bands, inexpensive devices that add resistance.
n Aerobic activities such as walking or low-impact
aerobics, get your heart pumping and can keep
your lungs and circulatory system in shape.
n Range-of-motion activities keep your
joints limber.
n Agility exercises can help you maintain
daily living skills.
Ask your doctor or physical therapist what
exercises are best for you. Ask for guidelines
on exercising when a joint is sore or if swelling
is present. Also, check if you should (1) use
pain-relieving drugs, such as analgesics
or nonsteroidal anti-inflammatory drugs
(NSAIDs) to make exercising easier, or (2) use
ice afterward.

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Weight control
Osteoarthritis patients who are overweight or obese
should try to lose weight. Weight loss can reduce
stress on weight-bearing joints, limit further injury,
and increase mobility. A dietitian can help you
develop healthy eating habits. A healthy diet and
regular exercise help reduce weight.

Rest and relief from stress on joints

Treatment plans include regularly scheduled rest.
Patients must learn to recognize the bodys signals
and know when to stop or slow down. This will
prevent the pain caused by overexertion. Although
pain can make it difficult to sleep, getting proper
sleep is important for managing arthritis pain. If you
have trouble sleeping, you may find that relaxation
techniques, stress reduction, and biofeedback can
help, as can timing medications to provide maximum
pain relief through the night.

Some people use canes to take pressure off painful

joints. They may use splints or braces to provide
extra support for joints or to keep them in proper
position during sleep or activity. Splints should be
used only for limited periods of time because joints
and muscles need to be exercised to prevent stiffness
and weakness. If you need a splint, an occupational
therapist or a doctor can help you get a properly
fitted one.

If joint pain interferes with your ability to sleep or

rest, consult your doctor.

15
 Nondrug pain relief
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, 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 approach to pain relief, a massage

therapist will lightly stroke 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.

16
Medications to control pain
Doctors prescribe medicines to eliminate or reduce
pain and to improve functioning. They consider a
number of factors when choosing
medicines for their patients with
osteoarthritis. These factors include
the intensity of pain, potential Most medicines
side effects of the medication, used to treat
your medical history (other health
osteoarthritis
problems you have or are at risk
for), and other medications you have side effects,
are taking. so it is important
Because some medications can for people to
interact with one another and learn about
certain health conditions put you
at increased risk of drug side the medicines
effects, its important to discuss they take.
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.

17
 The following types of medicines are commonly used
in treating osteoarthritis:

Acetaminophen: A medication commonly used to

relieve pain, acetaminophen (for example, Tylenol)1
is available without a prescription. It
is often the first medication doctors
Check with recommend for osteoarthritis patients
because of its safety relative to some
your health other drugs and its effectiveness
care provider against pain.
or p harmacist NSAIDs (nonsteroidal
before you take anti-inflammatory drugs): A large
class of medications useful against
NSAIDs in addition both pain and inflammation,
to another NSAIDs2 are staples in arthritis
treatment. Aspirin, ibuprofen,
m edication. naproxen, and naproxen sodium are
examples of NSAIDs. They are often
the first type of medication used. All
NSAIDs work similarly by blocking substances
1
Brand names included in this booklet are provided as examples only,
and their inclusion does not mean that these products are endorsed
by the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned, this
does not mean or imply that the product is unsatisfactory.
2
Warning: NSAIDs can cause stomach irritation or, less often, they
can affect kidney function. 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 they alter the way the body uses or
eliminates these other drugs. Check with your health care provider
or pharmacist before you take NSAIDs. Also, NSAIDs sometimes
are associated with serious gastrointestinal problems, including
ulcers, bleeding, and perforation of the stomach or intestine. People
over age 65 and those with any history of ulcers or gastrointestinal
bleeding should use NSAIDs with caution.

18
called prostaglandins that contribute to inflammation
and pain. However, each NSAID is a different
chemical, and each has a slightly different effect on
the body.

Some NSAIDs are available over the counter; more

than a dozen others, including a subclass called
COX-2 inhibitors, are available only with
a prescription.

All NSAIDs can have significant side effects, and

for unknown reasons, some people seem to respond
better to one than another. Any person taking
NSAIDs regularly should be monitored
by a doctor.

Other medications: Doctors may prescribe several

other medicines for osteoarthritis. They include
the following:

Topical pain-relieving creams, rubs, and sprays:

These products, which are applied directly to the
skin over painful joints, contain ingredients that
work in one of three different ways: by stimulating
the nerve endings to distract the brains attention
from the joint pain; by depleting the amount
of a neurotransmitter called substance P that
sends pain messages to the brain; or by blocking
chemicals called prostaglandins that cause
pain and inflammation. Examples of topical
medications are Zostrix, Icy Hot, Therapeutic
Mineral Ice, Aspercreme, and BenGay.

19
 Tramadol (Ultram): A prescription pain reliever
that is sometimes prescribed when over-the-counter
medications dont provide sufficient relief. It
carries risks that dont exist with acetaminophen
and NSAIDs, including the potential for addiction.

Mild narcotic painkillers: Medications containing

narcotic analgesics such as codeine or hydrocodone
are often effective against osteoarthritis pain. But
because of concerns about the potential for physical
and psychological dependence on these drugs,
doctors generally reserve them for short-term use.

Corticosteroids: Corticosteroids are powerful

anti-inflammatory hormones made naturally in
the body or synthetically for use as medicine.
They may be injected into the affected joints to
relieve pain temporarily. 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, these products 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.

20
Because most medicines used to treat osteoarthritis
have side effects, its important to learn as much as
possible about the medications you take, even the
ones available without a prescription. Certain health
problems and lifestyle habits can increase the risk of
side effects from NSAIDs. These include a history of
peptic ulcers or digestive tract bleeding, use of oral
corticosteroids or anticoagulants (blood thinners),
smoking, and alcohol use.

There are measures you can take to help reduce

the risk of side effects associated with NSAIDs.
These include taking medications with food and
avoiding stomach irritants such as alcohol, tobacco,
and caffeine. In some cases, it may help to take
another medication along with an NSAID to
coat the stomach or block stomach acids. Although
these measures may help, they are not always
completely effective.

Questions to Ask Your Doctor or

PharmacistAbout Medicines
n How often should I take this medicine?
n Should I take this medicine with food or
between meals?
n What side effects might occur?
n Should I take this medicine with the other
prescription medicines I take?
n Is this medication safe considering other
medical conditions I have?

21
 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:
n removal of loose pieces of bone and cartilage
from the joint if they are causing symptoms
of buckling or locking
n repositioning of bones
n resurfacing (smoothing out) of bones.

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 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 patients weight, sex,
age, activity level, and other medical conditions.

The decision to use surgery depends on several

factors, including the patients 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.

22
Complementary and alternative therapies
When conventional medical treatment doesnt
provide sufficient pain relief, people are more
likely to try complementary and alternative
therapies. The following are some alternative
therapies used to treat osteoarthritis.

Acupuncture: 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. Preliminary research
shows that acupuncture may be a useful component
in an osteoarthritis treatment plan for some patients.
Scientists think the needles stimulate the release of
natural, pain-relieving chemicals produced by the
nervous system.

Folk remedies: These include wearing copper bracelets,

drinking herbal teas, taking mud baths, and rubbing
WD-40 on joints to lubricate them. While these
practices may or may not be harmful, no scientific
research to date shows that they are helpful in treating
osteoarthritis. They can also be expensive, and using
them may cause people to delay or even abandon
useful medical treatment.

Nutritional supplements: Nutrients such as

glucosamine and chondroitin sulfate have been
reported to improve the symptoms of people with
osteoarthritis, as have certain vitamins. Additional
studies have been carried out to further evaluate
these claims. (See What Research Is Being Done on
Osteoarthritis? on page 30.)

23
 Who Treats Osteoarthritis?

T reating 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.

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 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.

24
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.

What You Can Do: The Importance of

Self-Care and a Good Health Attitude

A lthough health care professionals can prescribe or

recommend treatments to help you manage your
arthritis, the real key to living well with the disease is
you. Research shows that people with osteoarthritis
who take part in their own care report less pain and
make fewer doctor visits. They also enjoy a better
quality of life.

Living well and enjoying good health despite arthritis

requires an everyday lifelong commitment. The
following six habits are worth committing to:

25
 1. Get educated: To live well with osteoarthritis, it
pays to learn as much as you can about the disease.
Three kinds of programs help people understand
osteoarthritis, learn self-care, and improve their
good health attitude. They are:
n patient education programs
n arthritis self-management programs
n arthritis support groups.

These programs teach people about osteoarthritis,

its treatments, exercise and relaxation, patient and
health care provider communication, and problem
solving. Research has shown that people who
participate in these programs are more likely to
have positive outcomes.

Self-Management Programs Do Help

People with osteoarthritis find that
self-management programs help them:
n understand the disease
n reduce pain while remaining active
n cope physically, emotionally, and mentally
n have greater control over the disease
n build confidence in their ability to live an
active, independent life.

26
2. Stay active: Regular physical activity plays a key
role in self-care and wellness. Three types of exercise
are important in osteoarthritis management.
Strengthening exercises help keep or increase muscle
strength. Strong muscles help support and protect
joints affected by arthritis. Aerobic conditioning exercises
improve cardiovascular fitness, help control weight,
and improve overall function. Range-of-motion
exercises help reduce stiffness and maintain or
increase proper joint movement and flexibility.

Most people with osteoarthritis exercise best when their

pain is least severe. Start with an adequate warmup,
and begin exercising slowly. Resting frequently
ensures a good workout and reduces the risk of injury.

Before beginning any type of exercise program,

consult your doctor or physical therapist to learn
which exercises are appropriate for you and how to
do them correctly because doing the wrong exercise or
exercising improperly can cause problems. A health
care professional can also advise you on how to warm
up safely and when to avoid exercising a joint affected
by arthritis.

3. Eat well: Although no specific diet will necessarily

make your arthritis better, eating right and controlling
your weight can help by minimizing stress on the
weight-bearing joints such as the knees and the
joints of the feet. It can also minimize your risk of
developing other health problems.

27
 Exercises for Osteoarthritis

Strengthening

Aerobic conditioning

Range of motion
People with osteoarthritis should do different kinds of exercise
for different benefits to the body. Consult your health
professional before starting.

28
4. Get plenty of sleep: Getting a good nights sleep on a
regular basis can minimize pain and help you cope better
with the effects of your disease. If arthritis pain makes
it difficult to sleep at night, speak with your doctor or
physical therapist about the best mattress, the most
comfortable sleeping positions, or the possibility of
timing medications to provide more pain relief at night.
You may also improve your sleep by getting enough
exercise early in the day; avoiding caffeine or alcoholic
beverages at night; keeping your bedroom dark, quiet,
and cool; and taking a warm bath to relax and soothe
sore muscles at bedtime.

5. Have fun: Although having osteoarthritis certainly

isnt fun, it doesnt mean you have to stop having fun.
If arthritis makes it difficult to participate in favorite
activities, ask an occupational therapist about new
ways to do them. Activities such as sports, hobbies, and
volunteer work can distract your mind from your own
pain and make you a happier, more well-rounded person.

Enjoy a Good Health Attitude

n Focus on your abilities instead of disabilities.
n Focus on your strengths instead of weaknesses.
n Break down activities into small tasks that you
can manage.
n Incorporate fitness and nutrition into
daily routines.
n Develop methods to minimize and manage stress.
n Balance rest with activity.
n Develop a support system of family, friends,
and health professionals.
29
 6. Keep a positive attitude: Perhaps the best thing you
can do for your health is to keep a positive attitude.
People must decide to make the most of things when faced
with the challenges of osteoarthritis. This attitude a
good health mindset doesnt just happen. It takes work,
every day. And with the right attitude, you will achieve it.

What Research Is Being Done on Osteoarthritis?

T he leading role in osteoarthritis research is played

by 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). NIAMS funds
many researchers across the United States to study
osteoarthritis. Scientists at NIAMS Multidisciplinary
Clinical Research Centers conduct basic and
clinical research aimed at understanding the causes,
treatment options, and prevention of arthritis and
musculoskeletal diseases.

In 2004, NIAMS and other NIH institutes and offices

began recruiting participants for the Osteoarthritis
Initiative (OAI). The OAI is a collaboration that pools
the funds and expertise of NIH and industry to hasten
the discovery of osteoarthritis biomarkers physical
signs or biological substances that indicate changes in
bone or cartilage. Researchers are collecting images
and specimens from approximately 5,000 people
at high risk of having osteoarthritis as well as those
at high risk of progression to severe osteoarthritis
during the course of the study. Scientists are following
participants for 5 years, collecting biological specimens
(blood, urine, and DNA), images (x rays and MRI
scans), and clinical data annually. For updates on this
initiative, go to www.niams.nih.gov/ne/oi/.
30
Other key areas of research supported by NIAMS and
other NIH institutes include the following:

Animal models of osteoarthritis

Animal models help researchers learn many things
about osteoarthritis, such as what happens to
cartilage, how treatment strategies might work, and
what might prevent the disease. Animal models also
help scientists study osteoarthritis in very early stages
before it causes detectable joint damage. In a study
that concluded in 2004, a group of researchers led by
David Kingsley, Ph.D., of Stanford University, and
supported by NIAMS, used mice to study the role
of genes in the bodys production of cartilage.

Diagnostic tools
Scientists are searching for ways to detect
osteoarthritis at earlier stages so they can treat it
sooner. Abnormalities in the blood, joint fluid, or
urine of people with osteoarthritis may provide clues.
Other scientists use new technologies to analyze the
differences between the cartilage from different joints.
For example, many people have osteoarthritis in
the knees or hips, but few have it in the ankles. Can
ankle cartilage be different? Does it age differently?
Answering these questions will help us understand
the disease better. Many studies now involve
the development of a rapid MRI procedure that
doctors use to evaluate joint cartilage quickly and
noninvasively. The procedure could potentially be
used to diagnose the disease. More important, it may
be an effective method to study disease progression.

31
 Genetics studies
Osteoarthritis in all its various forms appears to
have a strong 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
Osteoarthritis important part of cartilage, in patients
with an inherited kind of osteoarthritis
in all its various
that starts at an early age. The
forms appears mutation weakens collagen protein,
to have a which may break or tear more easily
under stress. Scientists are looking for
strong genetic other gene mutations in osteoarthritis.
connection. Researchers have also found that
the daughters of women who have
knee osteoarthritis have a significant
increase in cartilage breakdown, thus
making them more susceptible to disease. In the future,
a test to determine who carries the genetic defect(s)
could help people reduce their risk for osteoarthritis
by making lifestyle adjustments.

Tissue engineering
This technology involves removing cells from a
healthy part of the body and placing them in an
area of diseased or damaged tissue to improve
certain body functions. Currently, it is used to treat
small traumatic injuries or defects in cartilage and,
if successful, could eventually help treat osteoarthritis.
Researchers at NIAMS are exploring three types of
tissue engineering. The two most common methods

32
being studied today include cartilage cell replacement
and stem cell transplantation. The third method is
gene therapy.

Cartilage cell replacement: In this procedure, researchers

remove cartilage cells from the patients own joint and
then clone or grow new cells using
tissue culture and other laboratory
techniques. They then inject the
newly grown cells into the patients Tissue
joint. Patients with cartilage cell engineering,
replacement have fewer symptoms
of osteoarthritis. Actual cartilage if successful,
repair is limited, however. could eventually

In one area of research, scientists are help treat

testing fibroblastic cells (precursors osteoarthritis.
to cells that make up components of
connective tissue) for their ability to
differentiate into cartilage cells in a
lab dish. The researchers will then see if the resulting
cartilage cells can form functional joint cartilage.

Stem cell transplantation: Stem cells are primitive cells

that can transform into other kinds of cells, such as
muscle or bone cells. They usually are taken from
bone marrow. In the future, researchers hope to insert
stem cells into cartilage, where the cells will make new
cartilage. If successful, this process could be used to
repair early cartilage damage and avoid the need for
surgical joint replacements later in life.

33
 Gene therapy: Scientists are working to genetically
engineer cells that would inhibit certain enzymes
that may help break down cartilage and cause joint
damage. In gene therapy, cells are removed from the
body, genetically changed, and then injected back into
the affected joint. They reside in the joint and secrete
substances that inhibit the damaging enzymes.

Patient education
Effective treatment for osteoarthritis takes more
than medicine or surgery. Getting help from a variety
of health care professionals often can improve
patient treatment and self-care. (See Who Treats
Osteoarthritis?on page 24.) Research shows that
adding patient education and social support is a
low-cost, effective way to decrease pain and reduce
the amount of medicine used. One NIAMS-funded
project involves developing and testing an interactive
Web site by which health professionals and patients
could communicate concerning appointments and
treatment instructions, thus giving patients a greater
role in, and control of, their care.

Exercise and weight reduction

Exercise plays 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. For example, several
scientists have studied knee osteoarthritis and exercise.
Their results included the following:
n Walking can result in better functioning,
and the more you walk, the farther you will
be able to walk.

34
 n People with knee osteoarthritis who are active
in an exercise program feel less pain. They also
function better.

Research has 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. A NIAMS-funded study is
investigating the use of regular aerobic exercise in people
with osteoarthritis of the knee to determine if standard
guidelines for cardiovascular fitness may be useful for
the treatment of early osteoarthritis as well.

Treatment
Researchers are studying the effectiveness of a variety
of different types of treatment. These include:

Drugs to prevent joint damage: No treatment actually

prevents osteoarthritis or reverses or blocks the disease
process once it begins. Present treatments relieve the
symptoms only.

Researchers are looking for drugs that would prevent,

slow down, or reverse joint damage. Drugs under
study include:

n doxycycline, an antibiotic drug that may stop

certain enzymes known to damage cartilage. A
recent clinical trial found that doxycycline had
a modest effect on slowing the rate at which the
joint space narrows in the knee. The trial also
found that people who were taking doxycycline
experienced joint pain less often than those who
were not.

35
 n risedronate, a bisphosphonate drug. In a recent
British study of several hundred people with
mild to moderate osteoarthritis of the knee,
those treated with risedronate showed a clear
trend toward reduced symptoms and improved
joint structure.

More studies are needed for both drugs.

Estrogen: In studies of older women, scientists found

a lower risk of osteoarthritis in those who had used
oral estrogens for hormone replacement therapy. The
researchers suspect that having low levels of estrogen
could increase the risk of developing osteoarthritis.

However, the 15-year, NIH-funded Womens Health

Initiative found that taking estrogen plus progestin
increased the risk of heart attack, stroke, blood clots,
and breast cancer, and taking estrogen alone increased
the risk of stroke and blood clots. The Food and Drug
Administration recommends that hormone therapy
be used at the lowest doses for the shortest duration
needed to achieve treatment goals. Hormone therapy
should always be used under a doctors care.

Several other research projects are under way. The goal

of one is to determine if estrogen protects cartilage.
Other projects are examining the effects on joint
cartilage of a selective estrogen receptor molecule
(SERM) called raloxifene, which is often used in place
of estrogen to treat and prevent osteoporosis.

36
Complementary and alternative therapies:
n acupuncture: One of the most popular alternative
pain-relief methods is acupuncture, an ancient
Chinese practice in which fine needles are
inserted at specific points in the body. According
to research funded by the National Center for
Complementary and Alternative Medicine,
acupuncture may help reduce pain and improve
function for individuals with knee osteoarthritis
when used as an adjunct to medication.
One study under way compares the benefits
of acupuncture with physical therapy to the
benefits of physical therapy alone. The hope
is that acupuncture will help relieve pain that
makes exercise difficult and, therefore, will
improve the effectiveness of traditional exercise
and physical therapy.
n glucosamine and chondroitin sulfate: In
recent years, the nutritional supplement pair
glucosamine and chondroitin has shown some
potential for reducing the pain of osteoarthritis,
although no conclusive proof has emerged to
date. Both of these nutrients are found in
small quantities in food and are components
of normal cartilage.
The recently concluded Glucosamine/Chondroitin
Arthritis Intervention Trial (GAIT), which
was cosponsored by the National Center for
Complementary and Alternative Medicine
and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, assessed the
effectiveness and safety of these supplements,
when taken together or separately.

37
 The trial found that the
combination of glucosamine
The GAIT trial and chondroitin sulfate did not
assessed the provide significant relief from
osteoarthritis pain among all
effectiveness
participants. However, a smaller
and safety of subgroup of study participants
the supplements with moderate to severe pain
showed significant relief with
glucosamine the combined supplements.
and chondroitin The 4-year trial was conducted at
sulfate. 16 sites across the United States.
The results were published in the
February 23, 2006, edition of the
New England Journal of Medicine.

n other complementary and alternative

therapies: Other research suggests that certain
hyaluronic acid preparations, substances
called anthraquinones, gelatin-related
substances, and electrical stimulation may
have a beneficial effect on cartilage growth
and repair. Although these agents have shown
varying degrees of promise in basic and
clinical studies, additional trials are needed.

n vitamins D, C, E, and beta carotene: The

progression of osteoarthritis may be slower
in people who take higher levels of vitamins D,
C, E, or beta carotene. NIAMS is sponsoring
a clinical trial on the use of vitamin D to
treat osteoarthritis. More studies are needed
to confirm these reports.

38
n green tea: Many studies have shown that green
tea has anti-inflammatory properties. One
recent study showed that mice predisposed to a
condition similar to human osteoarthritis had
mild arthritis and little evidence of cartilage
damage and bone erosion when green tea
polyphenols were added to their drinking
water. Another study showed that when added
to human cartilage cell cultures, the active
ingredients in green tea inhibited chemicals
and enzymes that lead to cartilage damage
and breakdown. Further studies are looking
at the effects of green tea compounds on
human cartilage.

n prolotherapy: This is a popular, growing, and

unregulated therapy for chronic musculoskeletal
pain in which an irritant solution is injected
into painful ligaments and adjacent joint
spaces. However, no rigorous, scientifically
valid clinical trials have proven the therapys
action or usefulness. A clinical trial sponsored
by the National Center for Complementary and
Alternative Medicine is studying prolotherapys
effectiveness for the pain of knee osteoarthritis.
It is also using animals to assess the healing
response after prolotherapy.

39
 Hope for the Future

R esearch 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.

Additional Resources
National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 3014954484 or
87722NIAMS (2264267) (free of charge)
TTY: 3015652966
Fax: 3017186366
E-mail: [email protected]
www.niams.nih.gov

NIAMS provides information about various forms of

arthritis and other rheumatic diseases, as well as other
bone, muscle, joint, and skin diseases. It distributes
patient and professional education materials and
refers people to other sources of information.
Additional information and updates can also be
found on the NIAMS Web site.

40
NIH Osteoporosis and Related Bone Diseases ~
National Resource Center (NIH ORBD~NRC)
2 AMS Circle
Bethesda, MD 20892-3676
Phone: 2022230344 or
800624BONE (2663) (free of charge)
TTY: 2024664315
Fax: 2022932356
www.niams.nih.gov/bone

The NIH Osteoporosis and Related Bone Diseases ~

National Resource Center provides patients, health
professionals, and the public with an important
link to resources and information on metabolic
bone diseases. The mission of NIH ORBD~NRC is
to expand awareness and enhance knowledge and
understanding of the prevention, early detection, and
treatment of these diseases as well as strategies for
coping with them. The center provides information
on osteoporosis, Pagets disease of bone, osteogenesis
imperfecta, primary hyperparathyroidism, and other
metabolic bone diseases and disorders.

41
 American Academy of Orthopaedic Surgeons (AAOS)
P.O. Box 1998
Des Plaines, IL 60017
Phone: 8478237186 or
800824BONE (2663) (free of charge)
Fax: 8478238125
www.aaos.org

The academy provides education and practice

management services for orthopaedic surgeons and
allied health professionals. It also serves as an advocate
for improved patient care and informs the public about
the science of orthopaedics. The orthopaedists scope of
practice includes disorders of the bodys bones, joints,
ligaments, muscles, and tendons. For a single copy of an
AAOS brochure, send a self-addressed stamped envelope
to the address above or visit the AAOS Web site.

American College of Rheumatology (ACR)/

Association of Rheumatology Health Professionals
1800 Century Place, Suite 250
Atlanta, GA 30345-4300
Phone: 4046333777
Fax: 4046331870
www.rheumatology.org

ACR is an organization of doctors and associated

health professionals who specialize in arthritis and
related diseases of the bones, joints, and muscles. The
Association of Rheumatology Health Professionals,
a division of ACR, aims to enhance the knowledge
and skills of rheumatology health professionals
and to promote their involvement in rheumatology
research, education, and quality patient care. The
association also works to advance and promote
basic and continuing education in rheumatology for
42
health professionals who provide care to people with
rheumatic diseases.

American Physical Therapy Association

1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 7036842782 or
800999APTA (2782) (free of charge)
Fax: 7036847343
www.apta.org

This national professional association represents physical

therapists, allied personnel, and students. Its objectives
are to improve research, public understanding, and
education regarding the physical therapies.

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357-0669
Phone: 4048727100 or
8002837800 (free of charge)
Fax: 7036847343
www.arthritis.org

The Arthritis Foundation is devoted to supporting

arthritis research and providing educational and other
services to individuals with arthritis. The foundation
publishes a free pamphlet on rheumatoid arthritis and
a magazine for members on all types of arthritis. It
also provides up-to-date information on research,
treatment, nutrition, alternative therapies, and
self-management strategies. Chapters nationwide offer
exercise programs, classes, support groups, doctor
referral services, and free literature. The foundation
also has free information about lupus, scleroderma,
and other autoimmune and rheumatic conditions on
its Web site.
43
 Key Words
Acupuncture the use of fine needles inserted at
specific points on the skin. Primarily used for pain
relief, acupuncture may be a helpful component of
an osteoarthritis treatment plan for some people.

Analgesics medications designed to relieve pain. Pure

analgesics do not have an effect on inflammation.

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 as osteophytes.

Bouchards nodes small, bony knobs associated with

osteoarthritis of the hand that can occur on the middle
joints of the fingers.

Cartilage a hard but slippery coating on the end

of each bone. The breakdown of joint cartilage is
the primary feature of osteoarthritis.

Chondrocytes components of cartilage. Chondrocytes

are cells that produce cartilage, are found throughout
cartilage, and help it stay healthy as it grows.
Sometimes, however, they release certain enzymes
that destroy collagen and other proteins.

44
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.
(For more information, see the glucosamine and
chondroitin sulfate section under Complementary
and alternative therapies on page 37.)

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 synthetically
for use as medicine. Corticosteroids may be injected
into the affected joints to reduce inflammation and
relieve pain temporarily.

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 pages 18-19 in
the How Is Osteoarthritis Treated? section.)

Estrogen the major sex hormone in women. Estrogen

is known to play a role in regulation of bone growth.
Research suggests that estrogen may also have a
protective effect on cartilage.

Glucosamine a substance that occurs naturally in the

body, providing the building blocks to make and repair
cartilage (For more information, see glucosamine
and chondroitin sulfate in the Complementary and
alternative therapies section on page 37.)

45
 Heberdens nodes small, bony knobs associated with
osteoarthritis of the hand that can occur on the joints
of the fingers closest to the nail.

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.

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 (Advil,
Motrin), naproxen sodium (Aleve), and ketoprofen
(Orudis, Oruvail). (For information about the risk
posed by NSAIDs, see pages 18-19 in the How Is
Osteoarthritis Treated? section.)

46
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.

Prolotherapy an unregulated, unproven therapy

for chronic musculoskeletal pain. Prolotherapy uses
an irritant solution, which is injected into painful
ligaments and adjacent joint spaces to promote
inflammation and subsequent healing.

Proteoglycans components of cartilage. Made up

of proteins and sugars, strands of proteoglycans
interweave with collagens and form a mesh-like
tissue. This allows cartilage to flex and absorb
physical shock.

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 uncommonly feverish. Rheumatoid arthritis
may also affect skin tissue, the lungs, the eyes, or the
blood vessels.

Stem cells primitive cells, usually taken from the

bone marrow, that can transform into other kinds
of cells, such as muscle or bone cells. In the future,
researchers hope to be able to insert stem cells into
cartilage and stimulate them to replace cartilage
damaged by arthritis or injury.

47
 Synovial fluid a fluid secreted by the synovium that
lubricates the joint and keeps the cartilage smooth
and healthy.

Synovium a thin membrane inside the joint capsule

that secretes synovial fluid.

Tendons tough, fibrous cords that connect muscles

to bones.

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.

48
Acknowledgments
NIAMS gratefully acknowledges the assistance of
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; Victor M. Goldberg, M.D., University
Hospitals of Cleveland; Marc C. Hochberg, M.D.,
M.P.H., University of Maryland, Baltimore; John
Klippel, M.D., Arthritis Foundation, Atlanta; and
Roland Moskowitz, M.D., Case Western Reserve
University, Cleveland, in the preparation and review
of this publication. Special thanks also go to the
patients who reviewed this publication and provided
valuable input.

49
The mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of
theU.S. Department of Health and Human Services
National Institutes of Health (NIH), is to support
research into thecauses, treatment, and prevention
of arthritis and musculoskeletal and skin diseases;
training of basic and clinical scientists to carry out this
research; and dissemination of information on research
progress in thesediseases. The NIAMS Information
Clearinghouse is a public service sponsored by the
Institute that provides health information and
information sources. Additional information can be
found on the NIAMS Website at www.niams.nih.
gov. Information on bone and its disorders can be
obtained from the NIH Osteoporosis and Related
Bone Diseases ~ National Resource Center by calling
(toll free) 800624BONE (2663) or by visiting its
Web site at www.niams.nih.gov/bone.
U.S. Department of Health and
Human Services
Public Health Service
National Institutes of Health
National Institute of Arthritis and
Musculoskeletal and Skin Diseases

NIH Publication No. 064617

July 2002
Revised May 2006