Diagnosis
During the physical examination, the doctor will carefully examine the affected joint, check for pain with palpation, swelling or redness, and test the range of motion of the joint. The doctor can also recommend imaging diagnostics and laboratory tests.
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Tests by images
Images of the affected joint can be obtained by imaging tests. For example:
- X-rays Cartilage can not be seen on x-rays, but cartilage loss is identified by narrowing the space between the bones of the joint. On an x-ray, you can also see osteophytes around a joint. Some people can get evidence of osteoarthritis by x-ray before presenting symptoms.
- Magnetic resonance (MR). MRI uses radio waves and a powerful magnetic field to produce detailed images of bones and soft tissues, including cartilage. MRI is usually not needed to diagnose osteoarthritis, but it may help provide more information in complex cases.
Laboratory analysis
Analyzing your blood or joint fluid can help confirm the diagnosis.
- Blood test. While there is no blood test for osteoarthritis, certain tests can help rule out other causes for joint pain, such as rheumatoid arthritis.
- Analysis of joint fluid. The doctor may use a needle to remove fluid from the affected joint. Examining and analyzing the joint fluid can determine whether there is inflammation and whether the pain is caused by gout or an infection.
Treatment
Currently, the hidden process of osteoarthritis can not be reversed but, in general, the symptoms can be effectively treated through changes in lifestyle, physiotherapy and other types of therapy, as well as medications and surgery. In general, exercising and having a healthy weight are the most important ways to treat osteoarthritis. The doctor may also recommend the following:
Medicines
The symptoms of osteoarthritis, especially pain, can be improved with certain medications, such as the following:
- Paracetamol. Paracetamol (Tylenol, others) has been shown to be effective in people with osteoarthritis and with mild to moderate pain. Taking a higher than the recommended dose of paracetamol can cause liver damage.
- Non-steroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, including ibuprofen (Advil, Motrin IB and others) and naproxen sodium (Aleve and others), taken at the recommended doses, usually relieve the pain of osteoarthritis. The most potent NSAIDs, available by prescription, can also reduce inflammation slightly along with pain relief.
- NSAIDs can cause upset stomach, cardiovascular problems, bleeding problems and damage to the liver and kidneys. Topical NSAIDs have fewer side effects and can relieve pain just as well.
- Duloxetine (Cymbalta). This medication is usually used as an antidepressant, but it is also approved to treat chronic pain, including the pain of osteoarthritis.
Therapy
- Physiotherapy. A physiotherapist can work with you to create an individualized exercise program that will strengthen the muscles around the joints, increase range of motion and reduce pain. Gentle exercises that you do regularly on your own, such as swimming or walking, can be equally effective.
- Occupational therapy An occupational therapist can help you discover ways to do everyday tasks or do your job without adding extra effort to the already painful joint. For example, if you have osteoarthritis, a toothbrush with a large handle can make you brush your teeth more easily. If you have arthrosis in your knees, a bench under the shower could relieve the pain associated with standing.
- Taichi and yoga. These movement therapies include stretching and gentle exercises combined with deep breathing. Many people use these therapies to reduce stress in their lives, and research suggests that tai chi and yoga can reduce the pain of osteoarthritis and improve movement. If the instructor in charge has the corresponding knowledge, these therapies are safe. Avoid movements that cause joint pain.
Surgery and other procedures
- Illustration of knee osteotomy
- Knee osteotomy
- Illustration of a hip affected by osteoarthritis before and after hip replacement
- Artificial hip
- Images of a knee before and after replacement surgery
- Knee comparisons
If conservative treatments do not help you, you can consider procedures such as the following:
- Cortisone injections Injections of corticosteroid medications can relieve pain in the joint. During this procedure, the doctor numbs the area around the joint, places a needle in the space inside the joint, and injects the medication. The number of cortisone injections you can receive per year is usually limited to three or four injections, because the medication can worsen the damage to the joint over time.
- Injections for lubrication. Hyaluronic acid injections can relieve pain by providing some cushioning in the knee, although, in some investigations, it is suggested that these injections do not relieve pain more than a placebo. Hyaluronic acid is similar to a component that is normally found in the fluid of the joint.
- Realignment of bones. If osteoarthritis has damaged one side of the knee more than the other, an osteotomy may be helpful. In a knee osteotomy, the surgeon cuts the bone above or below the knee and removes or adds a piece of bone. In this way, the body weight of the worn part of the knee is transferred to the other part.
- Joint replacement In joint replacement surgery (arthroplasty), the surgeon removes damaged articular surfaces and replaces them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints can wear or loosen, so they may need to be replaced over time.
Lifestyle and home remedies
Changes in lifestyle can make a considerable difference in the symptoms of osteoarthritis. There are other home treatments that can help. Here are some steps you can try:
- Do exercise. Exercise can increase the strength and strength of the muscles that surround the joint, improving the stability of the joint. Try walking, biking or swimming. If you feel a new pain in the joint, suspend physical activity.
- If you feel a new pain for several hours after exercising, it is likely that you have demanded too much, but it does not mean that you have damaged yourself in an important way or that you should stop exercising. Simply resume physical activity one or two days later with a somewhat lower intensity level.
- Lose weight Obesity or even a little overweight increases the tension in the joints that support weight, for example, in the knees and hips. Even lowering a few pounds can relieve some of the pressure and reduce pain.
- Talk to a dietitian about healthy ways to lose weight. Most people combine changes in their diet with a greater amount of physical activity.
- It uses heat and cold to treat pain. Both heat and cold can relieve joint pain. In addition, heat relieves stiffness, and cold can relieve muscle spasms and pain.
- Capsaicin Using capsaicin (an active component of hot peppers) topically in a joint with arthritis may be an alternative for people who can not take nonsteroidal anti-inflammatory drugs (NSAIDs). It is possible that, to notice the benefits, it must be applied constantly between three and four times a day for several weeks. Make sure you wash your hands thoroughly after applying capsaicin cream.
- Apply over-the-counter pain relievers. The creams and gels that can be bought in pharmacies offer temporary relief from the pain of osteoarthritis. Some creams anesthetize pain by creating a sensation of heat or cold.
- Other creams contain medicines, for example, compounds similar to aspirin, which absorbs the skin. Analgesic creams offer better results if they are applied to joints near the surface of the skin, such as the knees and fingers.
- Immobilization devices and orthopedic insoles. The doctor may recommend orthotics and other devices that can help reduce pain when you're standing or walking. These devices can immobilize or hold the joint to help reduce the pressure on it.
- Knee bandage Elastic adhesive tape helps relieve the pain of knee osteoarthritis. Ask a doctor or physiotherapist to tell you what is the best way to attach the adhesive tape.
- Use assist devices. Assistive devices can ease your movements without putting too much stress on the aching joint. A cane could reduce the weight on one knee or hips when you walk. Take the cane in the opposite hand to the aching leg.
- Clamping and gripping tools can make work in the kitchen easier if you have arthrosis in your fingers. The doctor or occupational therapist can give you advice on what types of assistive devices can help you. You can also search for ideas in catalogs and pharmacies.
Alternative medicine
Various treatments of complementary and alternative medicine can help relieve the symptoms of osteoarthritis. The treatments that have shown promise for osteoarthritis include:
- Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in people with osteoarthritis of the knee. During an acupuncture session, needles as thin as a hair are inserted into precise points of the body.
- Glucosamine and chondroitin. The results of the studies have been disparate with regard to these nutritional supplements. In a few studies, benefits were found for people with osteoarthritis, while the majority indicate that these supplements do not work better than a placebo.
- Do not use glucosamine if you are allergic to shellfish. Glucosamine and chondroitin can interact with anticoagulants, such as warfarin, and cause bleeding problems.
- Unsaponifiable lipids of avocado and soy. This nutritional supplement, a blend of avocado and soybean oils, is widely used in Europe to treat osteoarthritis of the knee and hip. It acts as an anti-inflammatory, and as proven in some studies, can delay or even prevent damage to the joints.
Coping strategies and support
Changes in lifestyle and certain treatments are key to treating pain and disability, but another important component of treatment is your own perspective on life. Your ability to deal with problems despite the pain and disability caused by osteoarthritis often determines how much the disease will affect your daily life. Talk to your doctor if you feel frustrated, since he can give you ideas to deal with problems or refer you to someone who can help you.
Preparation for the consultation
While you may initially see your GP, he may refer you to a doctor who specializes in joint disorders (rheumatology) or orthopedic surgeries.
What can you do
You may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about health problems that you have had
- Information about the health problems of your parents or siblings
- All over-the-counter and prescription medications and dietary supplements you are taking, and doses
- Questions you want to ask the doctor
What to expect from the doctor
The doctor can ask you some of the following questions:
- When did your joint pain start?
- Is the pain continuous, or does it appear and disappear?
- Does any particular activity improve or worsen the pain?
- Have you ever injured this joint?