What is Osteoarthritis?
Osteoarthritis is the gradual breakdown of cartilage and change in the underlying bone of a joint. It causes pain that worsens with use and improves with rest, brief morning stiffness under thirty minutes, and reduced movement — most often in the knees, hips, hands and spine. It is manageable, and exercise is the most effective single treatment.
Also called: OA, degenerative joint disease, wear and tear arthritis
Who gets Osteoarthritis?
It becomes more common with age and affects women more than men after 50. Key risk factors are obesity — which loads the knees mechanically and also drives inflammation — previous joint injury or surgery, occupations involving repeated squatting, kneeling or heavy lifting, and family history, which is particularly strong for hand osteoarthritis. Knee osteoarthritis is very common in India, and squatting and floor-sitting postures contribute.
What are the symptoms of Osteoarthritis?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Joint pain that worsens with activity and through the day, easing with rest
- Morning stiffness lasting less than thirty minutes
- Stiffness after sitting still that eases within a few minutes of moving
- Grating, clicking or crunching in the joint
- Reduced range of movement
- Bony swelling and knobbly enlargement of the finger joints, particularly the end joints
- Giving way or instability in the knee
- Difficulty with stairs, squatting, or getting up from a low chair
- Pain at night in advanced disease
How is Osteoarthritis diagnosed?
Osteoarthritis is diagnosed clinically in a person over 45 with activity-related joint pain and morning stiffness under thirty minutes — imaging is not required to make the diagnosis.
X-rays show joint space narrowing, bone spurs and other changes, but they correlate poorly with symptoms: severe X-ray changes can cause little pain, and significant pain can occur with mild changes. X-rays are used mainly when surgery is being considered or the picture is unclear.
Blood tests are normal and are done to exclude inflammatory arthritis rather than to confirm osteoarthritis. Prolonged morning stiffness, swelling that is warm and soft rather than bony, or involvement of the wrists and knuckles points away from osteoarthritis.
How is Osteoarthritis treated?
Exercise is the most effective treatment and the most consistently under-used. Strengthening the muscles around the joint — quadriceps for the knee, hip abductors for the hip — reduces pain and improves function, and the benefit is comparable to medication. It needs to be maintained; stopping loses the gain.
Weight reduction has a large effect on knee and hip osteoarthritis: every kilogram lost removes several kilograms of load from the knee with each step.
For pain: topical anti-inflammatory gels first, particularly for knees and hands; oral anti-inflammatories at the lowest effective dose for short periods; and paracetamol, which helps some patients modestly.
Corticosteroid injection gives short-term relief for a flare, particularly useful for getting someone started on exercise.
Joint replacement is highly effective for advanced hip and knee disease that limits daily life despite these measures, and is not a last resort to be delayed indefinitely.
Glucosamine and chondroitin have not shown consistent benefit in good-quality trials and are not routinely recommended.
Living with Osteoarthritis
Osteoarthritis progresses slowly and unpredictably, and periods of worse pain do not necessarily mean the joint is deteriorating. Walking aids, appropriate footwear, adapting how tasks are done, and avoiding deep squatting where the knees are affected all preserve function. The most important message is that activity is protective rather than harmful: the joint does not wear out faster from use, and inactivity accelerates the decline.
When should you see a rheumatologist?
A rheumatology opinion is useful when the diagnosis is uncertain, when there is swelling, warmth or prolonged morning stiffness suggesting inflammatory arthritis, or when pain is not controlled by exercise, weight management and simple measures.
Common questions about Osteoarthritis
Will exercise wear my joints out faster?
No — the opposite. Appropriate exercise strengthens the muscles supporting the joint and reduces pain, and inactivity accelerates decline. This is one of the most consistently useful things you can do, and one of the most commonly avoided.
Do glucosamine supplements work?
Good-quality trials have not shown consistent benefit, and they are not routinely recommended. Exercise, weight management and topical anti-inflammatories have far better evidence behind them.
My X-ray looks terrible but I have little pain. Should I worry?
No. X-ray changes correlate poorly with symptoms. Treatment is guided by pain and function, not by the appearance of the film.
When should I consider knee replacement?
When pain and loss of function limit daily life despite exercise, weight management and medication — not on the basis of the X-ray alone. Modern joint replacement is very effective, and delaying indefinitely while function declines makes recovery harder.
How is this different from rheumatoid arthritis?
Osteoarthritis worsens with activity and causes brief morning stiffness; it is usually asymmetrical and produces bony rather than soft swelling. Rheumatoid arthritis is worse after rest, causes stiffness lasting over thirty minutes, and produces warm, soft, symmetrical swelling of the small joints.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.