Osteoarthritis

Osteoarthritis might best be considered the result of general wear and tear. It can occur from injuries, overuse, and age. It results from a loss of cartilage, which ordinarily provides cushioning for the bones in the joints. With the loss of cartilage, inflammation occurs when the joints are used. In turn, the inflammation leads to pain, swelling, and stiffness. Osteoarthritis most commonly occurs in the hips, knees, ankles and feet.

Osteoarthritis is commonly considered to be the cause of pain in joints, such in the knees or hips. Surprizingly, however, the correlation between pain and osteoarthritic changes as identified on scans is poor. Recent scientific evidences indicates that pain in the joints is more apt to be due to both osteoarthic changes in the joints and central sensitization.¹ 

Patients often mistake osteoarthritis for rheumatoid arthritis. While each condition causes inflammation and pain in the joints, the two types of arthritis are different. Rheumatoid arthritis occurs when the immune system mistakes healthy cartilage for being diseased, and consequently attacks the cartilage of the joints. Over time, the immune system erodes the cartilage. This loss of cartilage causes inflammation and subsequently pain, swelling, and stiffness. In osteoarthritis, the immune system has no such role. Indeed, there is no disease process at all which erodes the cartilage in osteoarthritis. The loss of cartilage in osteoarthritis comes simply from the wear and tear of injuries, use, and age over time.

Is there a cure for osteoarthritis?

Osteoarthritis is a chronic condition. Chronic health conditions are conditions that have no cure. As such, chronic conditions typically last indefinitely. However, it is not considered terminal as it does not cause death.

Therapies & Procedures for osteoarthritis

In the absence of a cure, patients and their healthcare providers typically pursue therapies with the goals of reducing pain and increasing the ability to do more things in life. In our healthcare system, patients can commonly get many different therapies and procedures for osteoarthritis. Common treatments for osteoarthritis are anti-inflammatory medications, physical therapy, injection therapies, arthroscopic and joint replacement surgeries, and chronic pain rehabilitation programs.

Some of these therapies and procedures have been shown in research to be helpful in reducing pain and increasing functioning. Others have been shown to be unhelpful, even though they are done quite a bit in our healthcare system.

Anti-inflammatory medications

Anti-inflammatory medications are likely the most commonly used medication for osteoarthritis. Anti-inflammatory medications (as well as acetaminophen) have been shown to be mildly effective in reducing pain.^2, 3 

Physical therapy

Physical therapy is also commonly used to treat osteoarthritis. Physical therapy is proven beneficial in reducing pain for osteoarthritis of the knee⁴ and the hip.⁵ 

Injection therapies

Many patients also try cortisone injections into the osteoarthritic joint. Research shows that cortisone injections are, on average, mildly helpful in reducing pain for one to two weeks.^{6, 7} 

Hyaluronan injections are also sometimes used to treat osteoarthritis of the knee. The outcome research for hyaluronan injections is mixed: some studies show no benefit,^{8, 9} whereas other studies show a small benefit.^{10, 11} 

Arthroscopic and joint replacement surgeries

Arthroscopic knee surgeries are often performed for osteoarthritis of the knee. Despite the frequency with which they are pursued, arthroscopic knee surgeries have consistently been shown to be ineffective on average.^{12, 13} 

Total knee and total hip replacement surgeries are commonly pursued for patients with advanced forms of osteoarthritis. These surgeries are largely effective in reducing pain and increasing quality of life, though many patients will continue to have some level of pain.^{14, 15, 16} 

Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are also a common therapy for patients with osteoarthritis, among other types of chronic pain. They are not a cure, but rather help patients to live well despite having chronic pain of osteoarthritis. Chronic pain rehabilitation programs focus on reducing pain, returning to work or other life activities, reducing the use of pain medications, and reducing the need for obtaining healthcare services. It is an intensive, interdisciplinary approach that combines lifestyle changes, coping skills training, and medication management. Research consistently shows that for the goals of reducing pain, returning to work, and reducing the need for pain medications, these programs are highly effective.^{17, 18, 19} 

References

1. Arendt-Nielsen, L. (2017). Joint pain: More to it than just structural damage? Pain, 158, S66-S73.

2. Bradley, J. D., Brandt, K. D., Katz, B. P., Kalasinski, L. A., & Ryan, S. I. (1991). Comparison of anti-inflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. New England Journal of Medicine, 325, 87-91.

3. Bjordal, J. M., Ljunggren, A. E., Klovning, A., & Slordal, L. (2004). Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: Meta-analysis of randomized, placebo-controlled trials. British Medical Journal, 329, 1317-1323.

4. Jamtvedt, G., Dahm, K. T., Christie, A., Moe, R. H., Haavardholms, E., Holm, I., & Hagen, K. B. (2008). Physical therapy interventions for patients with osteoarthritis of the knee: An overview of systematic reviews. Physical Therapy, 88, 123-136.

5. Hernandez-Molina, G., Reichenbach, S., Zhang, B., Lavalley, M., Felson, D. T. (2008). Effect of therapeutic exercise on hip osteoarthritis pain: Results of a meta-analysis. Arthritis Care & Research, 59, 1221-1228.

6. Arroll, B., & Goodyear-Smith, F. (2004). Corticosteroid injections for osteoarthritis of the knee: Meta-analysis. British Medical Journal, 328, 869-874.

7. Bellamy N., Campbell, J., Welch, V., Gee, T. L., Bourne, R., & Wells, G. A. (2006). Intraarticular corticosteroid for treatment of osteoarthritis of the knee. [Cochrane Review]. In Cochrane Database of Systematic Reviews, 2006 (2). Retrieved April 13, 2012, from The Cochrane Library, Wiley Interscience.

8. Arrich, J, Piribauer, F., Mad, P., Schmid, D., Klaushofer, K., & Mullner, M. (2005). Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: Systematic review and meta-analysis. Canadian Medical Association Journal, 172, 1039-1043.

9. Karlsson, J., Sjogren, L. S., & Lohmander, L. S. (2002). Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis: A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology, 41, 1240-1248.

10. Lo, G. H., LaValley, M., McAlindon, T., & Felson, D. T. (2003). Intra-articular hyaluronic acid in treatment of knee osteoarthritis: A meta-analysis. Journal of the American Medical Association, 290, 3115-3121.

11. Bannuru, R. R., Natov, N. S., Obadan, I. E., Price, L. L., Schmid, C. H., & McAlindon, T. E. (2009). Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis Care & Research, 61, 1704-1711.

12. Kirkley, A., Birmingham, T. B., Litchfield, R. B., Giffin, R., Willits, K. R., Wong, C. J., Feagan, B. G., Donner, A., Griffin, S. H., D’Ascanio, L. M., Pope, J. E., & Fowler, P. J. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 359, 1097-1107.

13. Moseley, J. B., O’Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., Hollingsworth, J. C., Ashton, C. M., & Wray, N. P. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 347, 81-88.

14. Agency for Healthcare Research and Quality. (December, 2003). Total knee replacement. AHRQ Publication No. 04-E006-2. Washington DC: Government Printing Office. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/knee/knee.pdf

15. Chang, R. W., Pellissier, J. M., & Hazen, G. B. (1996). A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. Journal of the American Medical Association, 275, 858-865.

16. Rasanen, P., Paavolainen, P., Sintonen, H., Koivisto, A. M., Blom, M., Ryynanen, O. P., & Roine, R. P. (2007). Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthopaedica, 78, 108-115.

17. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

18. Hurley, M. V., Walsh, N. E., Mitchell, H., & Patel, A. (2012). Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial. Arthritis Care and Research, 64, 238-247.

19. Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain, 18, 355-365.

Date of publication: April 27, 2012

Date of last modification: August 7, 2017