RELATED STORIES • Osteoarthritis: Causes in younger adults? • Acupuncture: Sharp answers to pointed questions • Thalidomide: New uses for notorious drug • Prolotherapy: An effective treatment for chronic pain? • Arthritis pain quiz: Are you controlling your arthritis symptoms? • Arthritis pain: Tips for managing housework • Glucosamine supplements: Can they rebuild cartilage? • Yucca: Can it relieve arthritis symptoms? • MSM for arthritis pain: Any harm in long-term use? • Are COX-2 drugs safe for you? An interview with a Mayo Clinic specialist • Degenerative changes in the spine: Is it arthritis? • Weather and joint pain: Any connection? • Arthritis: How is it diagnosed? • Osteoarthritis drugs in development FITNESS & NUTRITION Bones/Joints/Muscles • Juvenile rheumatoid arthritis • Osteoarthritis • Rheumatoid arthritis • Bursitis • Fibromyalgia • Gout • Lupus • Osteoporosis • Sjogren's syndrome • Tendinitis • Trigger finger • Achilles tendon rupture • Back pain • Hip fracture • Rotator cuff injury • Scoliosis • Muscular dystrophy • Dislocation • Shin splints • Bunions • Muscle cramp • Polymyositis • Dermatomyositis • Sprains and strains • TMJ disorders • Scleroderma • Osgood-Schlatter disease • Frozen shoulder • Polymyalgia rheumatica • Baker's cyst • Flatfeet • Morton's neuroma • Tennis elbow • Psoriatic arthritis • Hammertoe and mallet toe • Ankylosing spondylitis • Paget's disease of bone • Reactive arthritis • Metatarsalgia • Plantar fasciitis • Spinal stenosis • Sciatica • Marfan syndrome • Neck pain • Septic arthritis • Knee pain • Stress fractures • CREST syndrome • Dislocated shoulder • Patellar tendinitis • Costochondritis • Bone spurs • Avascular necrosis • Legg-Calve-Perthes disease • Water on the knee • Mixed connective tissue disease • Kyphosis • De Quervain's tenosynovitis • Cervical spondylosis • Thumb arthritis • Ehlers-Danlos syndrome • Golfer's elbow • Pseudogout • Sacroiliitis • Dupuytren's contracture • Achilles tendinitis • Diffuse idiopathic skeletal hyperostosis (DISH) • Osteochondritis dissecans • Osteomyelitis • Ganglion cysts • Chondromalacia patella • Chronic exertional compartment syndrome • Adult Still's disease • Rickets • Growth plate fractures • Greenstick fractures

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Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis is characterized by the breakdown of joint cartilage and may affect any joint in your body, including those in your fingers, hips, knees, lower back and feet. Initially osteoarthritis may strike only one joint. But if your fingers are affected, multiple hand joints may become arthritic.

The word "arthritis" is a blend of the Greek words "arthron," for joint, and "itis," for inflammation. In other words, arthritis literally means "joint inflammation." Although arthritis is often referred to as one disease, it's not. Arthritis has more than 100 forms and is common cause of disability.

There's no cure for osteoarthritis, but available treatments can relieve pain and help you remain active. In addition, how well you live with osteoarthritis often depends on your behaviors and attitude. If you actively manage your osteoarthritis, you may be able to gain control over your pain.

Osteoarthritis often develops slowly, and some people may not experience any signs or symptoms. However, osteoarthritis can cause the following signs and symptoms:

• Pain in a joint during or after use, or after a period of inactivity
• Discomfort in a joint before or during a change in the weather
• Swelling and stiffness in a joint, particularly after using it
• Bony lumps on the middle or end joints of your fingers or the base of your thumb
• Loss of joint flexibility

The acute pain of early osteoarthritis often tends to fade within a year of its appearance, but it may return if you overuse the affected joint — this is especially true of fingers affected by osteoarthritis.

Areas osteoarthritis typically affects include:

• Fingers. Bony knobs called nodes can enlarge your finger joints, creating a gnarled appearance. Early in the course of the disease, your joints may feel painful or stiff and numb. Eventually, the pain often subsides, leaving just bony nodes that affect the mobility of the joints at the end of your fingers. These nodes tend to run in families and affect more women than men.
• Spine. Slow deterioration of disks between the bones along your spine can lead to back and neck pain and stiffness.
• Weight-bearing joints. The parts of your body that bear the majority of your weight — your hips, knees and feet — are more susceptible to osteoarthritis. As cartilage slowly deteriorates over the years, you can develop chronic pain or varying amounts of discomfort when you stand and walk. Swelling also may occur, especially in your knees.

Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis to affect your jaw, shoulder, elbows, wrists or ankles.

With osteoarthritis the problem lies in the cartilage that cushions the ends of bones in your joints. Over time, the cartilage deteriorates, and its smooth surface roughens. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone — causing the ends of your bones to become damaged and your joints to become painful.

The exact cause of osteoarthritis isn't known. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Some scientists believe the cartilage damage may be due to a mechanical stress that results in an imbalance of enzymes released from the cartilage cells or from the lining of the joint. When balanced, these enzymes allow for the natural breakdown and regeneration of cartilage. But too much of the enzymes can cause the joint cartilage to break down faster than it's rebuilt. The exact cause of this enzyme imbalance is unclear.

Your body goes to work repairing the damage, but the repairs may be inadequate, resulting instead in growth of new bone along the sides of the existing bone, which produces prominent lumps, most noticeable on hands and feet. Each of the steps in this repair process produces pain. The pain and tenderness over the bony lumps may be most marked early in the course of the disease and less evident later on.

Osteoarthritis commonly occurs in the fingers, neck or lower back. Hips and knees also are frequently affected because they bear most of your weight. You can have chronic pain or varying amounts of discomfort when you stand and walk. Swelling also may occur, especially in your knees.

The exact causes of osteoarthritis are unclear, but these factors increase your risk:

• Being 45 years old or older
• Being female
• Having certain hereditary conditions, including defective cartilage and malformed joints
• Having joint injuries caused by physical activity or sports
• Being obese
• Having diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis, gout or pseudogout
• Having weak thigh (quadriceps) muscles, which may lead you to develop osteoarthritis in your knees

If you have swelling or stiffness in your joints that lasts for more than two weeks, seek medical advice. If your doctor determines that you have osteoarthritis, he or she can work with you to develop a pain management and treatment plan. Also seek medical advice if you experience side effects from arthritis medications, such as nausea, abdominal discomfort, black or tarry stools, constipation, and drowsiness.

Your doctor may use a variety of methods to diagnose osteoarthritis, including a physical examination, blood tests and certain imaging techniques. Doctors use blood tests to diagnose or rule out specific types of arthritis. Fluid may be withdrawn from a joint for analysis (joint aspiration).

Imaging techniques may include X-rays, bone scans, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans and arthrography — an image taken after dye has been injected into your joint. Imaging techniques can reveal bone spurs, worn-down cartilage and loss of joint space, indicating the presence of osteoarthritis.

The major complication of osteoarthritis is pain. The degree of pain can vary greatly, from being a mild inconvenience to being debilitating. Although arthritis doesn't go away, for many people the acute pain of early osteoarthritis often diminishes within a year. However, it can return if you overuse affected joints. Your doctor can help you determine how to adjust your activities to reduce stress on those joints. People with very painful osteoarthritic joints may require joint replacement surgery for pain relief.

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. Your doctor may recommend a combination of treatments that may include medication, self-care, physical therapy and occupational therapy. In some cases, surgical procedures may be necessary.

Medications
Medications are used to treat the pain and mild inflammation of osteoarthritis and to improve your joints' functioning. They include both topical medications and oral medications. Over-the-counter (OTC) medications may be sufficient to treat milder osteoarthritis, but stronger prescription medications also are available.

• Topical pain relievers. Various OTC products are available as creams, gels, ointments and sprays to temporarily relieve arthritis pain. Products containing the pain reliever trolamine salicylate include Aspercreme and Sportscreme. Products containing one or more of the counterirritant medications methyl salicylate, menthol and camphor include Icy Hot and Ben-Gay. Capsaicin, a cream made from the seeds of hot chili peppers, may relieve pain in joints close to your skin surface, such as your fingers, knees and elbows.
• Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain but doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask your doctor for guidance on limiting or abstaining from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you're taking it.
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) work in two ways. They relieve pain (such as from osteoarthritis and sore muscles), and they fight inflammation (such as from rheumatoid arthritis). NSAIDs range from OTC aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — which are also available at higher dosages by prescription — to others that are only available by prescription, such as ketoprofen (Orudis), diclofenac (Cataflam, Voltaren) and nabumetone (Relafen). NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.
• COX-2 inhibitors. Considered as effective for managing pain and inflammation as other NSAIDs, COX-2 inhibitors — such as celecoxib (Celebrex) — may not have the same stomach-damaging effects. But side effects may include fluid retention and causing or exacerbating high blood pressure. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.
• Tramadol. Tramadol (Ultram) is a centrally acting analgesic that's available by prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects — such as stomach ulcers and bleeding — than those of NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in combination with acetaminophen to increase pain relief.
• Antidepressants. Independent of their antidepressant properties, antidepressants, especially tricyclics, can help reduce chronic pain. Some people with arthritis also experience symptoms of depression. Antidepressant medications can treat the sleep disturbance that can accompany arthritis. Antidepressants used for arthritis pain and nonrestorative sleep include amitriptyline and nortriptyline (Pamelor, Aventyl).
• Injections of pain relievers. Occasionally, your doctor may suggest injecting a joint space with a corticosteroid, which can offer some pain relief and reduce inflammation. Injecting hyaluronic acid derivatives into knee joints (viscosupplementation) can relieve pain from osteoarthritis. Hyaluronic acid is a component of joint fluid, and hylan G-F20 (Synvisc) and sodium hyaluronate (Hyalgan, Supartz, Nuflexxa) are derivatives made from cockscomb.

Surgical or other procedures
Surgical procedures can help relieve disability and pain caused by osteoarthritis.

• Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint and replaces it with a plastic or metal device called a prosthesis. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. Joint replacement is most successful in large joints, such as hips and knees — these replacement joints last at least 20 years in about 80 percent of those who receive them. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it also can improve appearance and comfort and may improve your joint's mobility.
• Arthroscopic lavage and debridement. During arthroscopy, your surgeon makes a tiny incision in the area around your joint and then inserts a tubular instrument called an arthroscope. The arthroscope contains a light and a small camera, which projects an enlarged image of the interior of your joint onto a video monitor so that your surgeon can view it. Your surgeon may recommend performing lavage, debridement or both during arthroscopy. Lavage involves using saline to flush out blood, fluid or loose debris inside your joint. Debridement removes loose fragments of bone or cartilage inside your joint. These procedures may provide short-term pain relief and improved joint function for some people. However, recent studies have questioned their effectiveness for certain people with osteoarthritis, including those for whom knee pain is their only symptom and those with severe osteoarthritis.
• Repositioning bones. Surgeons can also reposition your bones to help correct deformities (osteotomy).
• Fusing bones. Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility.

Fortunately, you can relieve much of the discomfort associated with osteoarthritis through healthy-living strategies and self-care techniques, such as the following:

• Exercise regularly. Different types of exercise achieve different goals. Check with your doctor before beginning a regular exercise program. Your doctor may recommend working with a physical therapist who can design an exercise program to meet your specific needs, and who may also perform manual exercises that stretch and strengthen the muscles around your arthritic joints. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle using no resistance or do hand or arm exercises. Aquatic exercise is another option, and many health clubs with pools offer classes. If you don't have access to a pool, tai chi may be a good alternative. It teaches strengthening, range of motion exercises and relaxation techniques, and can improve balance. It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also don't hold your breath, as this can temporarily deprive your muscles of oxygen and tire them. Maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call your doctor.
• Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet — places where arthritis pain is commonly felt. Excess weight can also make joint surgery more difficult and risky.
• Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there's no special diet effective for treating arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse.
• Apply heat. Heat will ease your pain, relax tense, painful muscles and increase the regional flow of blood. You may find it especially helpful to apply heat before exercising. One of the easiest and most effective ways to apply heat is to take a 15-minute hot shower or bath. Other options are a hot pack, an electric heating pad on its lowest setting or a radiant heat lamp with a 250-watt reflector heat bulb. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.
• Choose appropriate footwear. Wearing comfortable cushioned shoes that properly support your weight is especially important if you have arthritis in your weight-bearing joints or back.
• Apply cold for occasional flare-ups. Cold may dull the sensation of pain during the first day or two. Cold also has a numbing effect and decreases muscle spasms. Don't use cold treatments if you have poor circulation or numbness.
• Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.
• Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.

Osteoarthritis can affect your everyday activities and overall quality of life. As a result, it's important to adopt coping strategies for dealing with the disease. You might consider the following:

• Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you're in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.
• Use assistive devices. Your painful knee may need a brace for support. You might also opt for a cane to take weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor's office for information on ordering the items that may help you the most.
• Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness — a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.
• Avoid grasping actions that strain your finger joints. For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully.
• Spread the weight of an object over several joints. Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.
• Take a break. Periodically relax and stretch.
• Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.
• Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

Because many complementary medicine methods haven't been studied extensively by researchers using mainstream scientific methods, it's difficult for the scientific community to evaluate their effectiveness and safety. And with much of today's research funding coming from the pharmaceutical industry, some "low-tech," nontraditional approaches to manage diseases such as arthritis may not get as much attention from the research community as they deserve. For these reasons, many Western physicians just don't know enough about these methods to endorse them. Nonetheless a growing body of evidence indicates that complementary medicine practices could have a role in treating and managing some diseases.

Common forms of complementary and alternative medicine for treatment of osteoarthritis include:

• Acupuncture
• Copper jewelry
• Homeopathy
• Magnets

Some studies have shown positive effects of nutritional supplements such as glucosamine and chondroitin sulfate preparations on osteoarthritis. Studies are ongoing in people who have osteoarthritis to compare results of using glucosamine with those of using chondroitin sulfate and of using a mixture of the two. Don't use glucosamine if you're allergic to shellfish. Glucosamine may raise your blood insulin level if you have diabetes. Chondroitin sulfate may affect blood levels of warfarin (Coumadin) if you're taking that medication.

Be careful when considering alternative therapies. Many are expensive, and some may be harmful. Before taking any complementary medications or dietary supplements, talk with your doctor to learn about potential dangers, particularly if you're taking other medications.