Osteoarthritis: symptoms, pain relief and a video doctor visit

Osteoarthritis is a joint disease in which the tissues of the joint break down over time. It is the most common form of arthritis, and many people simply call it "arthritis" or "wear and tear" of the joints.

It mostly affects the hands, knees, hips, neck and lower back. The risk rises with age, extra weight, past joint injuries or surgery, jobs with repetitive kneeling, squatting or heavy lifting, and family history.

It is not the same as rheumatoid arthritis, an autoimmune disease that usually affects both hands or both wrists at once and causes morning stiffness that lasts more than an hour.

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The most common symptoms are:

• Joint pain when you use the joint or put weight on it
• Stiffness when you get up or after sitting still, lasting under 30 minutes
• Swelling of the joint
• Less movement: stairs or getting up from a chair get harder
• A grinding or scraping noise in the knee when you move it
• In advanced cases, pain at rest or at night

Exercise comes first. NICE recommends therapeutic exercise for everyone with osteoarthritis (strengthening the muscles around the joint plus aerobic activity), and weight loss when needed. Pain may increase a little at first; with consistency, exercise reduces pain and improves movement. Walking, swimming and water exercise are good options.

Medicines, used carefully. NICE recommends a topical anti-inflammatory (a gel or cream applied to the skin) first for knee osteoarthritis, and considering one for other joints. If that is not enough, the doctor may consider an oral anti-inflammatory (an NSAID such as ibuprofen or naproxen) at the lowest dose for the shortest time. NSAIDs can cause stomach ulcers and bleeding, affect the kidneys and raise the risk of heart attack or stroke; check before using them if you have high blood pressure, heart or kidney disease, or past ulcers. That is why a gel is preferred first in older adults.

In dengue season: fever with joint pain can be dengue or chikungunya. Do not take ibuprofen or aspirin until dengue is ruled out; the CDC recommends acetaminophen. Read dengue warning signs.

Osteoarthritis or rheumatoid arthritis? If morning stiffness lasts more than an hour, or the same joints hurt and swell on both sides of your body (both hands, for example), the doctor gives you a lab order for a lab near you (for example rheumatoid factor, anti-CCP, sed rate and C-reactive protein) and, if needed, we refer you to rheumatology. Blood tests do not diagnose osteoarthritis, but they help rule out other causes.

If a single joint suddenly turns hot, red and swollen, it may be gout or an infection; get seen soon. If the pain is in your shoulder, see shoulder pain; if many joints hurt at once, see joint pain.

What you do every day matters as much as medicine:

• Move every day: walk, swim or exercise in water, without forcing the joint.
• Strengthen your leg muscles to protect your knees and hips.
• If you carry extra weight, losing some reduces the load on your knees, hips and feet.
• Use a cane in the hand opposite the sore leg if it helps you walk.
• Heat before exercise to loosen stiffness, and ice wrapped in a towel afterwards if the joint swells.
• Use over-the-counter pain relievers as the label directs; do not take more than 4 grams of acetaminophen a day.

For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.

• A hot, red, very swollen joint with fever (possible joint infection)
• A fall or blow with a deformed joint, or you cannot put weight on the leg
• Vomiting blood or material like coffee grounds, or black stools, while taking anti-inflammatories
• Chest pain, shortness of breath, or sudden weakness or trouble speaking