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Osteoarthritis
Also known as OA
Key points about osteoarthritis
Osteoarthritis is the most common type of arthritis.
Changes that affect all parts of a joint cause pain, swelling, and stiffness.
Joints commonly affected are knees, hips, thumbs and fingers.
Osteoarthritis affects people of all ages.
Exercise, healthy eating and drinking, and other treatments can help with mobility, pain and joint health.
Osteoarthritis is the most common type of arthritis. Changes in joints cause pain, swelling, and stiffness.
Changes affect all parts of the joint including cartilage (the slippery tissue that covers the ends of bones), joint linings, ligaments and muscles.
Joints commonly affected are knees, hips, thumbs and fingers.
Osteoarthritis affects people of all ages and is more common in those who are older.
You are more likely to develop osteoarthritis if you are less active, have a joint injury, or are overweight.
Exercise and healthy eating and drinking, with other treatments, can help:
improve mobility and daily functioning
reduce pain and flares, and
improve joint health.
This brief video explains how osteoarthritis affects all parts of a joint.
Video: Understanding osteoarthritis
This video may take a few moments to load.
(OsteoArthritis Knowledge, NZ, 2020)
Changes with osteoarthritis affect all parts of a joint.
Cartilage is a firm rubbery material that covers the end of each bone and provides a smooth, slippery surface for movement. Cartilage change and loss is one part of osteoarthritis.
Bone ends can become thicker and extend at joint edges (bony swelling).
Joint linings can become inflamed and thickened.
Muscles that support and move the joint can become weaker.
Nerves can become more sensitive.
These changes can reduce movement and result in pain.
Osteoarthritis most commonly affects the knee joint, followed by the hip, and then other joints such as the small joints of the hands and base of the thumb.
Previously, osteoarthritis was thought to be a result of joint use during a person’s lifetime. But researchers now recognise that several factors lead to its development, including:
Being overweight over a long period of time.
Joint injury, eg, a fracture or the joint repeatedly giving way (when it buckles or collapses).
Infection in the joint or bone.
Some forms of osteoarthritis do run in families, especially the form that affects the finger joints. However, in general, heredity is not a major reason for having osteoarthritis. The precise causes and mechanisms leading to osteoarthritis are still unknown.
Osteoarthritis develops slowly over many years. It's often very mild and may not cause many symptoms. It can stay stable over long periods or get better. Sometimes, however, the symptoms are more pronounced and may include any or all of the following:
Pain and stiffness
Joint pain can increase with use of the joint. It doesn't mean there's increased damage to the joint.
Stiffness usually occurs more when the joint has been rested (not moved enough).
Swelling
Swelling occurs when irritation of the joint lining (synovial membrane) causes the production of extra joint fluid – just as your eye produces tears when it's irritated. But in the joint, the extra fluid can't escape as easily, and so it causes swelling.
This most often occurs in the knees.
Creaking or cracking
Joints can be noisy at any age. Noises are not a big deal and don't mean you're causing damage. Creaking or cracking sensations with joint movement often happen when soft tissues move past each other.
Bony growths
As a result of the changes in the affected joint, the ends of the bones can change shape, forming bony growths called osteophytes.
These may be felt as hard and bony swellings. They're especially apparent when osteoarthritis affects your finger joints.
Muscle weakness
Your joint may feel unstable, as if it's about to give way (collapse or buckle).
If you have osteoarthritis, these symptoms can make it difficult for you to carry out many of your regular activities. Symptoms can also cause sleep problems, anxiety, depression, tiredness or fatigue.
If you're concerned about symptoms of osteoarthritis, see your healthcare provider or physiotherapist. The sooner osteoarthritis is diagnosed the sooner you can start doing things that reduce pain, maintain mobility and improve your health and joint health.
See your healthcare provider immediately if you develop any of the following:
Sudden pain, redness, swelling, and tenderness in a joint.
Pain in the joint that's so severe that you can't weight bear on the joint, eg, when standing or walking.
You knee joint locks and you can't overcome this.
Pain that doesn't improve (or gets worse) when you rest the joint.
These symptoms could be signs of more serious conditions, eg, a fracture, infection in the joint or bone, or other forms of arthritis (eg, rheumatoid arthritis).
Your healthcare provider will ask about what you're able to do and what makes your pain worse. A physical examination will be carried out with close attention to your affected joints. There are no specific blood tests for osteoarthritis, but tests may be done to exclude other types of arthritis.
X-rays are not needed to diagnose osteoarthritis but may be helpful in some instances. It's likely that any changes you see on X-ray took place slowly over a long time and will change only slowly in the future. X-rays can't tell you how long the joint has looked this way or what this means for the future. X-ray findings don't align with the amount of pain or impairment someone experiences.
Treatments for osteoarthritis can help with:
reducing your pain
increasing your ability to work or do activities you enjoy
reducing how often your joints become more inflamed and painful (flares)
improving your health and the health of your joint.
Your healthcare provider or physiotherapist is likely to advise an approach that takes into account the severity of your osteoarthritis, which joints are affected, your symptoms, other medical problems, your age, occupation and everyday activities.
Video: Knee pain info
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(CHESM Thorlene, Australia, 2020)
Changes to your lifestyle
How you manage day-to-day activities can make a big difference to how osteoarthritis affects you. Most of the loss of mobility in the early stages of osteoarthritis can be reversed with a programme of exercises, and dietary change if necessary.
Regular exercise is one of the best treatments to reduce pain and stiffness, reduce your use of medicines, improve muscle strength, balance, mood and quality of life.
Eating and drinking well is great for your whole health as well as your joint health.
If you're overweight, weight loss of approximately 10% can result in symptom improvement comparable to the effect of joint replacement surgery.
Medicine for osteoarthritis focuses mainly on pain relief. Exercise has been found to reduce osteoarthritis pain as much as most medicines (but without the side effects).
If you're taking medicines for pain, it's best to try lower risk medicines first (eg, paracetamol, anti-inflammatory creams, gels or sprays). If these don't provide enough relief, other medicines (eg, NSAIDs) may be considered – usually for a short period to reduce the risk of side effects. Steroid injections may be recommended for some people.
Paracetamol
Paracetamol has a low risk of side effects when used at the recommended dose of 4 grams per day (8 x 500 mg tablets, or 6 x 665 mg tablets per day).
You may need lower doses (3 grams per day) if you're dehydrated, weigh less than 50 kilograms, have liver problems or drink a lot of alcohol.
Taking paracetamol at regular times (every 6 hours) is likely to be most helpful, although some people may prefer to use it as needed, only when the pain arises.
If paracetamol doesn't provide enough pain relief when used alone, it can be combined with other pain relief options like NSAIDs.
When taking paracetamol it's important to:
avoid any over-the-counter products that contain paracetamol, such as cold and flu medicines
use dosing aids (eg, pillboxes) to assist with taking the correct doses at the correct times. Taking your paracetamol dose too soon after the previous dose, or taking more than your daily limit, can cause serious liver problems.
Non-steroidal anti-inflammatory (NSAID) creams or gels
NSAID creams or gels (eg, diclofenac and ibuprofen) can be bought over-the-counter from your pharmacy. They're not subsidised – you have to pay the full price.
These are used by applying a small amount of the cream or gel to the affected joint 3 to 4 times daily.
You're likely to feel improvements in your symptoms within the first week of treatment, and there may be further improvements in the following weeks.
Using creams or gels can cause side effects such as stomach bleeding but the risk is lower than when taking NSAID tablets or capsules. The main side effects of NSAID gels or sprays are redness or itching on the affected area.
Capsaicin cream
Capsaicin cream is another example of topical pain relief. It's available on prescription with special approval.
Apply a small amount of cream to the affected joint 4 times daily. You may get a burning sensation which eases quickly.
It’s important to wash your hands after applying capsaicin cream to avoid transfer to other areas such as the eyes and mouth.
You may require treatment for 1 to 2 weeks before you experience a reduction in pain. You can then reduce applications to twice a day.
Talk to your doctor or pharmacist about whether capsaicin cream is suitable for you. Read more about capsaicin.
NSAID tablets or capsules
Common examples of NSAIDs include ibuprofen (Ibugesic®, I-Profen®, Nurofen®), diclofenac (Voltaren®), naproxen (Noflam®, Naprosyn®) and celecoxib (Celebrex®).
These are useful if you have ongoing pain and discomfort despite treatment with paracetamol, and have severe symptoms or a flare.
NSAIDs are effective in reducing the signs of inflammation including redness, warmth, swelling and pain.
They can cause serious side effects, eg, stomach bleeding, increased risk of heart attacks and stroke, and kidney problems. They're not suitable for everyone and they're not usually recommended as a long-term treatment. However, some people may need to take them on an ongoing basis.
Check with your healthcare provider or pharmacist to see if NSAIDs are suitable for you. They should be used at the lowest possible dose for the shortest possible time. Read more about the safe use of NSAIDs.
Steroid injection into the joints
These are also called intra-articular corticosteroid injections. Examples include triamcinolone, dexamethasone and methylprednisolone.
These steroids are given as injections into the painful joint.
They may provide short-term pain relief, usually for a month, but they don't improve joint function or stiffness.
They're used for treating flares.
Repeating steroid injections every 3 months doesn't reduce pain and may cause increased cartilage loss. Regular steroid injections are not recommended.
Injections into the joints have a very small risk of causing infection.
Opioids
Opioid medicines (eg, codeine or tramadol) are not recommended for managing pain from osteoarthritis. Opioids are no better than other pain-relieving medicines for improving your ability to do your daily activities. They may provide small improvements in pain and function but these need to be balanced against the side effects. Side effects include falls, drowsiness, constipation and addiction. Read more about opioid painkillers.
Complementary or alternative therapies
Complementary or alternative treatments are not usually recommended in the treatment of osteoarthritis, due to a lack of evidence to show that they help. Some people may find them beneficial but it's not always clear how they're working. Some products may interfere with prescribed medicines. It's a good idea to talk to your healthcare provider or pharmacist if you're thinking about using any of these.
Manual therapy (eg, stretching, soft tissue and/or joint mobilisation and/or manipulation) may improve pain or function over the short term for some people.
Heat or cooling, eg, a hot bath or cooling pack on the affected joint.
Glucosamine, chondroitin and fish oil have been suggested for use in osteoarthritis. The evidence suggests that fish oil doesn't help people with osteoarthritis. Glucosamine or chondroitin may reduce pain to a small degree that is not enough for most people, and the effect is only short-term.
If you're considering the use of complementary or alternative treatments, it's important to consider the risks, benefits and costs. Read more about the considerations of using complementary or alternative therapy.
Surgery
If your joint changes, pain and disability are all severe and a comprehensive management programme including the above measures isn't helping, a joint replacement may be necessary. See: knee replacement and hip replacement.
Here are some New Zealand Sign Language osteoarthritis videos produced by Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, NZ.
These videos are NZSL translations of Healthify pages on osteoarthritis.
On this page, you can find videos about:
Osteoarthritis – overview
How does osteoarthritis affect joints?
What causes osteoarthritis?
What are the symptoms of osteoarthritis?
Video: Osteoarthritis – overview
This video may take a few moments to load.
(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, NZ, 2022)
The following links have more information about osteoarthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
A pain in the foot – Rupesh Puna(external link) Goodfellow Unit, 2020 Rupesh Puna discusses foot pain throughout the lifespan. He uses a case-based approach highlighting four common conditions: Sever’s disease, Morton’s neuroma, plantar fasciitis and osteoarthritis of the foot.
Osteoarthritis – Dan Exeter(external link) Goodfellow Unit, 2016 Dr Dan Exeter talks about non-surgical management of osteoarthritis. Dan is a sport and exercise physician based at Axis Sports Medicine clinic in Auckland. He is medical director for Athletics New Zealand and a senior lecturer at the University of Auckland.
Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.
Reviewed by: Dr Ben Darlow, Musculoskeletal Physiotherapy Specialist Wellington, Senior Lecturer and researcher, Department of Primary Health Care and General Practice, University of Otago, Wellington
