AT A GLANCE: Osteoarthritis is the most common form of arthritis, causing joint pain, stiffness and reduced mobility as cartilage gradually tears down over time. Here are four key things you will learn about osteoarthritis from Alexey Fomin, MD, PhD, a rheumatologist with Hattiesburg Clinic:
- Osteoarthritis is the most common form of arthritis and is caused by the gradual breakdown of cartilage that cushions the joints.
- With osteoarthritis, knees, hips, hands and spine are most often affected and can lead to pain, stiffness, swelling and reduced range of motion.
- Age, prior joint injuries, repetitive stress, excess weight and genetics can all increase the risk of developing osteoarthritis.
- Treatment of osteoarthritis focuses on managing symptoms and preserving mobility, often through exercise, weight management, physical therapy and pain relief options.
Before joint pain and stiffness begin to interfere with daily activities, osteoarthritis often develops gradually over time. As the most common form of arthritis, osteoarthritis affects millions of people and occurs when the protective cartilage that cushions joints wears down, making movement more difficult and sometimes painful. While there is no cure, early diagnosis, lifestyle changes and treatment can help people manage symptoms, stay active and maintain their quality of life.
The AMA’s What Doctors Want Patients to Know™ series gives physicians a platform to share what they want patients to understand about today’s healthcare headlines.
In this installment, Alexey Fomin, MD, PhD, a rheumatologist at Hattiesburg Clinic The Arthritis Center - West, took time to discuss what patients should know about osteoarthritis.
Hattiesburg Clinic is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Osteoarthritis is a common disease
“What I usually explain to my patients is that osteoarthritis is pretty common,” Dr. Fomin said, noting that “one in seven adults in the United States actually has osteoarthritis. It is a common disease and it’s one of the leading causes of disability.”
With osteoarthritis, “we are talking about the regular wear and tear changes in the joints. These changes most often affect weight-bearing joints such as the lower back, hips, knees and feet. The joints in the hands are also frequently affected because we rely on them for daily activities,” Dr. Fomin said.
“We predominantly see women rather than men with osteoarthritis, and it is one of the most common diseases after 45 years old,” he said.
Symptoms of osteoarthritis start with pain
With osteoarthritis, a main symptom is “pain at the beginning of the day. That’s what we call starting pain,” Dr. Fomin said. “When you wake up, you may notice pain and stiffness in the joint. As you begin moving and using the joint, it tends to loosen up and feel better.”
“In the morning and at the start of activity, there is pain,” he said. “But as the day goes on and you continue using the joint, the pain often returns. The more stress you put on the joint, the more discomfort you may experience.”
“Morning stiffness associated with osteoarthritis typically does not last long,” Dr. Fomin said. “It’s usually about 15 to 30 minutes, but it can still be quite painful.”
“Other symptoms may include a reduced range of motion, as well as grinding, clicking or popping sensations in the joint. Some people find that a hot shower or warm water helps loosen up stiff joints and improves movement,” he added.
Genetics can play a role in osteoarthritis
Osteoarthritis “is not just mechanical damage and degeneration. Sometimes osteoarthritis appears as early as age 40, while some women in their 70s or 80s have no issues and their joints still look great,” Dr. Fomin said. “So, it’s not simply a matter of age or getting older. Rather, it results from a combination of different factors.”
For example, “osteoarthritis is influenced in part by genetics,” he said. “If you have strong cartilage and a favorable genetic makeup, your joints are more likely to stay healthy. But if there is a family history of early osteoarthritis, your risk of developing the condition is higher.”
Your risk for osteoarthritis also depends on use of joints
“Osteoarthritis also depends on how much you use your joints. If your job is not physically demanding and you spend most of your time working in an office, you may be less likely to develop significant arthritis,” Dr. Fomin said. “But in physically demanding jobs, such as construction or factory work, we sometimes see younger people who use their hands extensively and experience joint degeneration.”
“So, osteoarthritis is influenced by how much you use your joints, as well as genetics and other factors,” he said. “Some people who eat a healthy diet and stay physically active have relatively few joint problems, while others who pay less attention to diet and exercise may experience more issues.
“This is especially true for weight-bearing joints—the more weight those joints have to support, the greater the stress and wear on them,” Dr. Fomin added.
Erosive osteoarthritis is bad joint destruction
“There is one type of osteoarthritis that behaves differently,” Dr. Fomin said. “It is called erosive osteoarthritis, and it primarily affects the hands, causing significant joint damage.”
“On X-rays, we often see severe cartilage loss and extensive bone erosion,” he explained. “It can resemble autoimmune arthritis, but it is actually a degenerative condition.”
“Unlike standard wear-and-tear osteoarthritis, it features an inflammatory component that actively breaks down cartilage and leads to central bone erosion. It mainly affects the finger joints,” Dr. Fomin said.
Osteoarthritis requires a clinical diagnosis
“Osteoarthritis is often a clinical diagnosis, which means blood tests and X-rays are not always necessary,” Dr. Fomin said. “In many cases, the diagnosis can be made by listening to the patient’s symptoms and performing a physical examination. Bloodwork may then be used to help rule out other types of arthritis.”
“An X-ray mainly helps us assess the extent of joint damage,” he said. “Patients often report having joint pain for a long time that may have started intermittently, like at the beginning of the day, but gradually became more constant.”
“During the physical exam, the joint may appear enlarged because of bone spur growth, which can cause some deformity,” Dr. Fomin said. “You may also notice a decreased range of motion. By combining the patient’s history with the physical findings, you can often make the diagnosis.”
Treatment of osteoarthritis is mainly supportive
“Unfortunately, we do not currently have highly effective medications to treat osteoarthritis, so treatment is primarily supportive,” Dr. Fomin said. “By supportive, I mean that there is no medication available that can slow the progression of the disease or reverse the damage that has already occurred. Our focus is on managing symptoms.”
“For patients with osteoarthritis affecting weight-bearing joints, lifestyle changes are often an important part of treatment,” he said. “We encourage patients to lose weight through physical activity and healthy eating because the more weight a joint has to support, the more damage is likely to occur.”
As a first-line treatment, “we typically start with a pain medication such as acetaminophen,” Dr. Fomin said. “It is available over the counter and patients may use up to 4,000 milligrams per day.”
“If that doesn’t work, we can use nonsteroidal anti-inflammatory medications,” he said. “These medications can help reduce joint pain and stiffness. Unfortunately, they can also cause side effects, including stomach irritation, kidney problems and increased blood pressure.”
Dr. Fomin also noted that many supplements marketed for joint health such as glucosamine, chondroitin, turmeric and omega-3 fatty acids, remain popular among patients.
“Some patients tell us these supplements help and make their joints feel much better,” he said. “But scientifically speaking, multiple studies have not shown strong evidence that they provide significant benefit.”
“Steroid injections into the joint can sometimes help relieve pain as well,” Dr. Fomin said. “We also strongly recommend physical therapy to strengthen the muscles surrounding the joint. Surgery is generally considered a last resort for treating osteoarthritis.”
You can live a normal life with osteoarthritis
“If you compare osteoarthritis with inflammatory arthritis, such as rheumatoid arthritis, which can cause severe joint deformities and significantly impair joint function, osteoarthritis is generally less severe,” Dr. Fomin said. “Although it can cause joint problems and discomfort, it tends to progress very slowly, making it easier for many people to live with.”
“Osteoarthritis usually does not cause the same degree of functional impairment seen with other forms of arthritis, so the overall prognosis is often better,” he said. “At the same time, because we do not have treatments that can stop or reverse the disease, it can sometimes lead to permanent disability.”
Prevent osteoarthritis with lifestyle changes
Preventing osteoarthritis “is all about your lifestyle,” Dr. Fomin said. That includes “eating a healthy diet and exercising regularly.”
“But if osteoarthritis runs in your family, it can be more difficult to prevent it from developing,” he said. Even so, it is important to “exercise regularly, eat healthy and maintain a healthy body weight.”
With osteoarthritis, listen to your body
“First of all, it’s important to understand what is causing your joint symptoms. If you don’t know what is behind the pain, it can create anxiety,” Dr. Fomin said. “Some patients come into our office worried that they are going to become completely disabled. We have to reassure them that osteoarthritis is a slow-moving process and, for most people, it is not going to have that level of impact.”
“The second thing is that it all comes down to lifestyle,” he said. “Try to stay active, but at the same time avoid overusing your joints. For example, if you have knee pain or hand pain, it may not be a good idea to move heavy furniture or take on physically demanding projects such as home renovations.”
“Sometimes patients tell us their joints are feeling better, so they start running or doing other high-impact activities,” Dr. Fomin said. “But that may not help in the long run. You have to listen to your body. If your pain is increasing, it is probably a sign that you need to rest the joint.”
Visit your doctor if osteoarthritis is interfering with your daily routine
“If osteoarthritis has started to interfere with your daily routine and you’re no longer able to do the things you normally do, it’s a good idea to see your doctor,” Dr. Fomin said. “If it affects your work or your ability to carry out activities at home, you should definitely talk to your doctor about it.”
“Joint swelling is not typically associated with osteoarthritis and may be a sign of inflammatory arthritis, so it should be evaluated by a doctor,” he said. “You should also seek medical attention if you begin experiencing joint pain at night.”
