Understanding Osteoarthritis and How to Treat It
What exactly is causing that nagging knee, hip or hand pain? And how can you tell whether it is arthritis—or something else? These were among the questions explored on August 6 when more than 70 Health Advocates members joined Dr. Iris Navarro-Millan, Associate Professor of Medicine at Weill Cornell Medicine, for a presentation on osteoarthritis (OA). Dr. Navarro-Millan shared practical guidance on recognizing the symptoms of OA, distinguishing arthritis from other types of musculoskeletal pain, talking with your doctor and choosing evidence-based treatments.
Osteoarthritis is the most common form of arthritis, occurring when the cartilage that cushions the ends of bones within a joint breaks down over time. This can lead to pain, stiffness and decreased mobility. The hands, knees, hips and spine are the areas most commonly affected. While OA is often associated with aging, it can occur at different ages, particularly following an injury or with other risk factors. And although OA may sound like a minor consequence of getting older, it can have a major impact on everyday life—making it harder to shop, clean, exercise, prepare meals and participate in the activities we enjoy.
Not All Pain Is Arthritis
One of Dr. Navarro-Millan’s key messages was that where and how you experience pain matters. Musculoskeletal pain can come from the joint itself, from tissues surrounding the joint such as tendons, or from another area of the body. Joint pain often occurs with movement in multiple directions, while tendon problems may hurt primarily with a particular movement. Nerve-related pain can feel different, producing shooting or burning sensations, numbness or weakness. Swelling and tenderness can also occur with arthritis, although significant swelling is more commonly associated with inflammatory forms of arthritis, such as rheumatoid arthritis.
The location and pattern of pain can also provide clues about the type of OA. Hand OA may cause thumb pain, stiffness, reduced grip strength and bony enlargement. Knee OA typically becomes more painful with activity and improves with rest, with morning stiffness lasting up to about 30 minutes. Hip OA often causes pain in the groin that can extend into the thigh or even the knee—meaning that what feels like knee pain may actually originate in the hip. Spinal OA is particularly complicated and can cause significant disability. Changes to discs and joints can sometimes put pressure on nerves, resulting in shooting pain, numbness or weakness. New loss of bladder or bowel control accompanied by back symptoms is a medical emergency and requires immediate attention.
Make the Most of Your Doctor’s Visit
If you think you may have arthritis, come prepared to describe your pain as specifically as possible. Dr. Navarro-Millan recommended using the acronym OPQRST: Onset—when did it begin? Palliative—what makes it better or worse? Quality—what does it feel like? Radiation—does it travel anywhere? Severity—how bad is it? And Timing—when does it occur, and is it constant or intermittent? Your doctor will consider this information along with a physical examination and, when appropriate, imaging. Osteoarthritis is primarily diagnosed based on your symptoms and examination, although imaging may show characteristic changes such as narrowing of the joint space or bone spurs, known as osteophytes.
What Can You Do About Osteoarthritis?
The good news is that there are many effective ways to manage OA, and treatment should be tailored to each individual. Non-medication approaches are generally the first line of treatment and may include physical therapy, strengthening and flexibility exercises, Tai Chi, swimming and assistive devices such as splints or orthotics. Tai Chi can be especially beneficial because it may also improve balance, mood and sleep—and Health Advocates offers Tai Chi classes four times a week at no cost. When medication is appropriate, options can include topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and, for some people who cannot tolerate NSAIDs, duloxetine. Steroid injections may help with certain joints, including the knee and hip. Surgery, including hip or knee replacement, is generally reserved for more advanced OA when other treatments have not provided sufficient relief.
Dr. Navarro-Millan’s Key Takeaways
Know where your pain is coming from. Joint, tendon, nerve and referred pain can feel very different.
Pay attention to patterns. What makes your pain better or worse—and when it occurs—can help your doctor determine the cause.
Be specific with your doctor. Using OPQRST can help you provide the information your doctor needs to make an accurate diagnosis.
Start with non-medication treatments. Exercise, physical therapy, Tai Chi, swimming and appropriate assistive devices can all play an important role.
Treatment is not one-size-fits-all. Medications, injections and, when necessary, surgery can be considered based on your symptoms and individual circumstances.
You know your body best. As Dr. Navarro-Millan emphasized, patients are the experts on how their symptoms affect their daily lives. Working in partnership with your doctor can help you find the right approach to manage pain, maintain mobility and continue doing the things you enjoy.
Disclaimer: The material in this post is not intended as a substitute for professional medical advice, diagnosis or treatment and is provided for informational purposes only.