Diagnosis and Treatment of Osteoarthritis

By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer. Medical review by The DLHA Team

How is osteoarthritis diagnosed?

To make a diagnosis of osteoarthritis, your healthcare provider will obtain a detailed history from you with special attention to the onset and duration of your condition, your past medical history, your family history, what medications you are taking, etc. Following this, your provider will conduct a comprehensive physical examination on you and pay particular attention to your bones, muscles and joints (i.e., the musculoskeletal system). At the end of the process your provider is better able to confidently make a clinical diagnosis of osteoarthritis and may send you for imaging and other test in support of the clinical diagnosis.

When obtained from you, the following information makes the diagnosis of OA more probable: [6]

• Your pain that gets worse with movement and gets better with rest 

• You are above 45 years in age

• Your early morning stiffness goes away in less than 30 minutes

• You have restricted range of motion

• You have expansion of the bony joints

What diagnostic tests may be performed in osteoarthritis?

1. Imaging Tests

Radiological imaging tests like X-ray, CT, MRI and Ultrasound scans may be helpful in the diagnosis and management of osteoarthritis. [6]

The results of the imaging tests may not always match the severity of the disease and may not also identify the early stages of the condition.

However, X-rays of the affected joint can reveal signs of osteoarthritis (OA), like bone spurs (osteophytes), joint space narrowing, hardening of the bone beneath the cartilage (subchondral sclerosis), and cysts.

While an MRI isn’t always needed to diagnose OA, it can detect it earlier than standard X-rays.

Ultrasound can also help identify bone spurs, fluid buildup, and inflammation linked to OA.

2. Blood tests 

The following blood tests are commonly performed in patients with osteoarthritis (OA) in support of the nature and cause of the condition: [6]

• Complete blood count (CBC)
• ESR (Erythrocyte Sedimentation Rate)
• Rheumatoid factor and Antinuclear antibody (These are usually normal in OA but may be done to rule out non-OA causes of arthritis.

If the synovial fluid is available, a white blood cell count of less than 2000/microL, mostly made up of non-inflammatory cells will support an OA diagnosis.

How is osteoarthritis treated?

The main goals of osteoarthritis (OA) treatment are to reduce pain and prevent functional loss.

Treatment typically involves both medications and non-medication (conservative) approaches.

For mild symptoms, non-medications care alone (i.e., lifestyle changes and physical/occupational therapies) may be enough, but more severe cases usually require a combination of medication, lifestyle changes and therapies.

Non-medication therapy

Key components of non-medication therapy include: 

• Avoiding activities that strain the joint

• Physical therapy for strengthening exercises

• Occupational therapy

• Weight loss

• Use of assistive devices like braces, splints, canes, or crutches to reduce joint stress

Weight loss is especially important for overweight or obese individuals, as losing even one pound can reduce the load on the knee by three to six times.

Physical therapy can be very helpful in teaching patients proper exercises and how to use assistive devices like canes. Doctors should regularly recommend exercise programs that include both resistance and aerobic training, as these have been shown to reduce pain and improve physical function. Mechanical devices like orthotics or realignment knee braces can help correct misaligned joints.

Medication therapy

For the medical treatment of OA, options include oral, topical, and/or injectable medications like:

• Non-steroidal anti-inflammatory drugs (NSAIDs): These medications can help reduce inflammation and relieve pain. Examples include Ibuprofen, Naproxen and Diclofenac.

• Acetaminophen (Paracetamol): This medication can help with mild to moderate pain.  

• Opioids: These are painkillers used to help relieve severe pain (e.g., Codeine, Hydrocodone, Oxycodone, Tramadol, etc.) 

• Antidepressants like Duloxetine: This medication is also usually used to treat chronic pain of osteoarthritis pain.  

• Topical creams, rubs, or sprays: These can be applied to the skin over sore joints to relieve pain (e.g. Capsaicin cream, Menthol rubs and sprays, etc.). 

• Corticosteroids: These are anti-inflammatory drugs that may be taken by mouth or injected into the joint to provide short to moderate term relief of pain.  

• Hyaluronic acid substitutes: These are injected into the knee to improve joint lubrication and nutrition, with consequent relief of pain. 

As patients respond differently to medications, finding the right medication to relieve osteoarthritis often involves some trial and error.

When non-medication and medication approaches fail to work for knee or hip OA, surgery may be the next option. [6]

Surgery

The following considerations are factored into the decision to pursue surgery for osteoarthritis (OA):

• The severity/stage of OA

• The patient’s age

• Activity level

• Existence of comorbid disorders and

• Degree of impairment of knee function.

When is surgery necessary for osteoarthritis?

Surgery is recommended when your symptoms are so significant as to limit your activities of daily living and quality of life. [7] It is also recommended to correct any joint deformity and or delay further worsening of the disease. [7]

Radiological findings alone, such as joint space narrowing or osteophytes, do not justify surgery.

The timing of surgery should be based on the patient’s level of discomfort and radiological evidence of OA. Surgery should be delayed only if there is increasing knee instability related to OA.

Conclusion

Many people suffer from osteoarthritis OA, a common ailment that becomes worse with age. OA is characterised by pain, stiffness, and occasionally swelling as a result of the deterioration of the protecting cartilage in your joints over time. Although OA has no known cure, there are numerous management techniques. You can lessen symptoms and enhance your quality of life by engaging in regular exercise, keeping a healthy weight, and following your doctor's recommendations for drugs or therapies. It's critical to consult a healthcare professional if you suspect osteoarthritis to receive the best diagnosis and course of treatment. You can enjoy active, meaningful lives with osteoarthritis if you receive proper care.

References 

1. NIH. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis. [Internet]. Last reviewed Sept 2023. [Cited 2024 Aug 7]. Available from here.

2. Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage. 2022 Feb;30(2):184–95. doi: 10.1016/j.joca.2021.04.020. Available from here.

3. Hsu H, Siwiec RM. Knee osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Last updated 2023 June 26. [Cited 2024 Aug 7]. Available from here.

4. World Health Organization. (WHO) Osteoarthritis [Internet]. 2023. July 14. [Cited 2024 Aug 11]. Available from here.

5. He Y, Li Z, Alexander PG, Ocasio-Nieves BD, Yocum L, Lin H, et al. Pathogenesis of osteoarthritis: risk factors, regulatory pathways in chondrocytes, and experimental models. Biology. 2020; 9(8):194. Doi: 10.3390/biology9080194. Available from here.

6. Sen R, Hurley JA. Osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 7]. Last updated 2023 February 20. Available from here

7. Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis. 2011;2011:454873. doi: 10.1155/2011/454873. Available from here.

Published: September 4, 2024

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