Osteoarthritis is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, with an estimated 240 million people worldwide having activity-limiting osteoarthritis. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs. The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs, the knee and hip joints, and the joints of the neck and lower back. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.
Possible causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost and the underlying bone becomes affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms, with medical imaging and other tests used to support or rule out other problems. In contrast to rheumatoid arthritis, in osteoarthritis the joints do not become hot or red.
Treatment includes exercise, decreasing joint stress such as by rest or use of a cane, support groups, and pain medications. Weight loss may help in those who are overweight. Pain medications may include paracetamol (acetaminophen) as well as NSAIDs such as naproxen or ibuprofen. Long-term opioid use is not recommended due to lack of information on benefits as well as risks of addiction and other side effects. Joint replacement surgery may be an option if there is ongoing disability despite other treatments. More than 90% of hip and knee joint replacements are due to osteoarthritis. An artificial hip or knee joint typically lasts more than 20 years.
Osteoarthritis is the most common form of arthritis, affecting about 237million people or 3.3% of the world's population as of 2015. It becomes more common as people age. Among those over 60 years old, about 10% of males and 18% of females are affected. Osteoarthritis is the cause of about 2% of years lived with disability. Those with osteoarthritis of the hips or knees (the most commonly affected large joints) have a 20% increased risk of mortality, possibly due to reduced activity levels.
Signs and symptoms
The main symptom of osteoarthritis is pain, causing loss of ability and often stiffness. The pain is typically made worse by prolonged activity and relieved by rest. Stiffness is most common in the morning, and typically lasts less than thirty minutes after beginning daily activities, but may return after periods of inactivity (such as prolonged sitting). Pain with ascending/descending stairs or getting in or out of a car or the bath is associated with osteoarthritis of the patellofemoral joint (the joint behind the kneecap), as this joint is stressed with knee flexion. Osteoarthritis can cause a crackling noise (called "crepitus") when the affected joint is moved, especially the shoulder and knee joints. A person may also complain of joint locking and joint instability. These symptoms would affect their daily activities due to pain and stiffness. Some people report increased pain associated with cold temperature, high humidity, or a drop in barometric pressure, but studies have had mixed results.
Osteoarthritis commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although any joint in the body can be affected. As osteoarthritis progresses, movement patterns (such as gait), are typically affected.
In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. Osteoarthritis of the toes may be a factor causing formation of bunions.
Causes Damage from mechanical stress with insufficient self-repair by joints is believed to be the primary cause of osteoarthritis. Sources of this stress may include misalignments of bones caused by congenital or pathogenic causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and impairment of peripheral nerves, leading to sudden or uncoordinated movements. The risk of osteoarthritis increases with aging, history of joint injury, or family history of osteoarthritis. However exercise, including running in the absence of injury, has not been found to increase the risk of knee osteoarthritis. Nor has cracking one's knuckles been found to play a role.
Primary
The development of osteoarthritis is correlated with a history of previous joint injury and with obesity, especially with respect to the hips and knees. Osteoarthritis of the hips and knees is twice as common in those with obesity. Changes in sex hormone levels may play a role in the development of osteoarthritis, as it is more prevalent among post-menopausal women than among men of the same age. Women also tend to have more severe symptoms and imaging findings for hip and knee osteoarthritis as compared to men. Conflicting evidence exists for the differences in hip and knee osteoarthritis in African Americans and Caucasians.
Occupational
Increased risk of developing knee and hip osteoarthritis was found among those who work with manual handling (e.g., lifting), have physically demanding work, walk at work, and have climbing tasks at work (e.g., climb stairs or ladders). With hip osteoarthritis, in particular, increased risk of development over time was found among those who work in bent or twisted positions. For knee osteoarthritis, in particular, increased risk was found among those who work in a kneeling or squatting position, experience heavy lifting in combination with a kneeling or squatting posture, and work standing up. Women and men have similar occupational risks for the development of osteoarthritis.
Secondary
Certain medical conditions or injuries can increase the risk of osteoarthritis: Alkaptonuria Congenital disorders of joints Diabetes doubles the risk of having a joint replacement due to osteoarthritis, and people with diabetes have joint replacements at a younger age than those without diabetes. Ehlers–Danlos syndrome Injury to joints or ligaments (such as the ACL) Ligamentous deterioration or instability Marfan syndrome Obesity Joint infection
Pathophysiology
While osteoarthritis is a degenerative joint disease that may cause gross cartilage loss and morphological damage to other joint tissues, more subtle biochemical changes occur in the earliest stages of osteoarthritis progression. The water content of healthy cartilage is finely balanced by compressive force driving water out and hydrostatic and osmotic pressure drawing water in. Collagen fibres exert the compressive force, whereas the Gibbs–Donnan effect and cartilage proteoglycans create osmotic pressure which tends to draw water in.
However, during the onset of osteoarthritis, the collagen matrix becomes more disorganized, and there is a decrease in proteoglycan content within cartilage. The breakdown of collagen fibers results in a net increase in water content. This increase occurs because whilst there is an overall loss of proteoglycans (and thus a decreased osmotic pull), it is outweighed by a loss of collagen.
Other structures within the joint can also be affected. The ligaments within the joint become thickened and fibrotic, and the menisci can become damaged and wear away. Menisci can be completely absent by the time a person undergoes a joint replacement. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces in the absence of the menisci. The subchondral bone volume increases and becomes less mineralized (hypo mineralization). All these changes can cause problems functioning. The pain in an osteoarthritic joint has been related to thickened synovium and to subchondral bone lesions.
The inflammation of the joint lining (synovium) in osteoarthritis is characterized by involving macrophages via activation of the innate immune system (as compared to T-cell activation in the joint lining of people with rheumatoid arthritis). Pro-inflammation cytokines in osteoarthritis stimulate matrix metalloproteinases which leads to degradation and remodeling of the joint. Tissue damage or degradation of the articular cartilage or synovium leads to further release of inflammatory cytokines, driving the process.
Diagnosis
Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis (increased bone formation around the joint), subchondral cyst formation, and osteophytes. The combination of knee pain and osteophytes on x-ray or hip pain and osteophytes on x-ray, has good sensitivity and specificity for the diagnosis of osteoarthritis of those joints. X-rays may not correlate with the findings on physical examination or with the degree of pain, especially in the early course of osteoarthritis, where imaging findings may be relatively normal.
In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints. These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropathies.
Classification
Several classification systems are used for the gradation of osteoarthritis: WOMAC scale, taking into account pain, stiffness and functional limitation. Kellgren-Lawrence grading scale for osteoarthritis of the knee. It uses only projectional radiography features. Tönnis classification for osteoarthritis of the hip joint, also using only projectional radiography features.
Management
Lifestyle modification (such as weight loss and exercise) and pain medications are the mainstays of treatment. Acetaminophen (also known as paracetamol) and NSAIDs (available as oral or topical formulations) are first line pain medications for symptomatic treatment of osteoarthritis. Medications that alter the course of the disease have not been found as of 2025. For overweight people, weight loss may help relieve pain due to hip arthritis. Recommendations include modification of risk factors through weight loss, increasing physical activity or exercise, healthy diet, management of contributing co-morbidities and adjustment of occupational factors that may contribute to osteoarthritis.
Successful management of the condition is often made more difficult by differing priorities and poor communication between clinicians and people with osteoarthritis. Realistic treatment goals can be achieved by developing a shared understanding of the condition, actively listening to patient concerns, avoiding medical jargon, and tailoring treatment plans to the patient's needs. Recent research suggests that remote peer mentorship may help to improve self-management among people with hip or knee osteoarthritis who are experiencing socioeconomic disadvantage.
Exercise