{{Short description|Form of arthritis caused by degeneration of joints}} {{Use dmy dates|date=December 2023}} {{Use American English|date=September 2025}} {{cs1 config |name-list-style=vanc|display-authors=3}} {{Infobox medical condition (new) | name = Osteoarthritis | image = Heberden-Arthrose.JPG | alt = Photograph of elderly person's hands depicting hard knobs described in caption | caption = The formation of hard knobs at the middle finger joints (known as Bouchard's nodes) and at the farthest joints of the fingers (known as Heberden's nodes) is a common feature of osteoarthritis in the hands. | pronounce = {{IPAc-en|ˌ|ɒ|s|t|i|oʊ|ɑːr|ˈ|θ|r|aɪ|t|ɪ|s}} | field = Rheumatology, orthopedics | synonyms = Arthrosis, osteoarthrosis, degenerative arthritis, degenerative joint disease | symptoms = Joint pain, stiffness, joint swelling, decreased range of motion<ref name=NIH2015/> | complications = | onset = Over years<ref name=NIH2015/> | duration = | causes = Connective tissue disease, previous joint injury, abnormal joint or limb development, inherited factors<ref name=NIH2015/><ref name=Lancet2015/> | risks = Overweight, legs of different lengths, job with high levels of joint stress<ref name=NIH2015/><ref name=Lancet2015/> | diagnosis = Based on symptoms, supported by other testing<ref name=NIH2015/> | differential = | prevention = | treatment = Exercise, efforts to decrease joint stress, support groups, pain medications, joint replacement<ref name=NIH2015/><ref name=Lancet2015/><ref name=OARSI2014/> | medication = | prognosis = | frequency = 237{{nbsp}}million / 3.3% (2015)<ref name=GBD2015Pre/> | deaths = }} '''Osteoarthritis''' is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone.<ref>{{cite book | vauthors = Arden N, Blanco F, Cooper C, Guermazi A, Hayashi D, Hunter D, Javaid MK, Rannou F, Roemer FW, Reginster JY | title=Atlas of Osteoarthritis | date = 2015 | publisher = Springer | isbn = 978-1-910315-16-3 | page = 21 | url = https://books.google.com/books?id=qT1FBgAAQBAJ&pg=PA21 | url-status = live | archive-url = https://web.archive.org/web/20170908174334/https://books.google.com/books?id=qT1FBgAAQBAJ&pg=PA21 | archive-date = 8 September 2017 }}</ref><ref>{{cite web |date=27 July 2020 |title=A National Public Health Agenda for Osteoarthritis 2020 |url=https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf |website=U.S. Centers for Disease Control and Prevention (CDC) }}</ref> 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.<ref>{{cite journal | vauthors = Hunter DJ, Bierma-Zeinstra S | title = Osteoarthritis | journal = Lancet | volume = 393 | issue = 10182 | pages = 1745–1759 | date = April 2019 | pmid = 31034380 | doi = 10.1016/S0140-6736(19)30417-9 | bibcode = 2019Lanc..393.1745H }}</ref><ref name="Katz 2021">{{cite journal |last1=Katz |first1=Jeffrey N. |last2=Arant |first2=Kaetlyn R. |last3=Loeser |first3=Richard F. |title=Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review |journal=JAMA |date=9 February 2021 |volume=325 |issue=6 |pages=568–578 |doi=10.1001/jama.2020.22171|pmid=33560326|pmc=8225295 |bibcode=2021JAMA..325..568K }}</ref> The most common symptoms are joint pain and stiffness.<ref name=NIH2015/> Usually the symptoms progress slowly over years.<ref name=NIH2015/> Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs.<ref name=NIH2015/> 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.<ref name=NIH2015/> The symptoms can interfere with work and normal daily activities.<ref name=NIH2015/> Unlike some other types of arthritis, only the joints, not internal organs, are affected.<ref name=NIH2015/>
Possible causes include previous joint injury, abnormal joint or limb development, and inherited factors.<ref name=NIH2015/><ref name=Lancet2015/> Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress.<ref name=NIH2015/><ref name=Lancet2015/><ref name=SBU2016 /> Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes.<ref name=Berenbaum2013>{{cite journal | vauthors = Berenbaum F | title = Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!) | journal = Osteoarthritis and Cartilage | volume = 21 | issue = 1 | pages = 16–21 | date = January 2013 | pmid = 23194896 | doi = 10.1016/j.joca.2012.11.012 | title-link = doi | bibcode = 2013OsCar..21...16B | doi-access = free }}</ref> It develops as cartilage is lost and the underlying bone becomes affected.<ref name=NIH2015/> As pain may make it difficult to exercise, muscle loss may occur.<ref name=Lancet2015>{{cite journal | vauthors = Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ | title = Osteoarthritis | journal = Lancet | volume = 386 | issue = 9991 | pages = 376–387 | date = July 2015 | pmid = 25748615 | doi = 10.1016/S0140-6736(14)60802-3 | bibcode = 2015Lanc..386..376G | s2cid = 208792655 }}</ref><ref name=NICE>{{cite web |vauthors=Conaghan P |title=Osteoarthritis – Care and management in adults |url=http://www.nice.org.uk/guidance/cg177/evidence/full-guideline-191761309 |format=PDF |date=2014 |archive-url=https://web.archive.org/web/20151222152555/http://www.nice.org.uk/guidance/cg177/evidence/full-guideline-191761309 |archive-date=22 December 2015 |access-date=21 October 2015 }}</ref> Diagnosis is typically based on signs and symptoms, with medical imaging and other tests used to support or rule out other problems.<ref name=NIH2015/> In contrast to rheumatoid arthritis, in osteoarthritis the joints do not become hot or red.<ref name=NIH2015/>
Treatment includes exercise, decreasing joint stress such as by rest or use of a cane, support groups, and pain medications.<ref name=NIH2015/><ref name=OARSI2014>{{cite journal | vauthors = McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M | title = OARSI guidelines for the non-surgical management of knee osteoarthritis | journal = Osteoarthritis and Cartilage | volume = 22 | issue = 3 | pages = 363–388 | date = March 2014 | pmid = 24462672 | doi = 10.1016/j.joca.2014.01.003 | title-link = doi | doi-access = free }}</ref> <ref>{{Cite journal |last1=Manning |first1=M R |last2=Eanelli |first2=T R |date=April 29, 2026 |title=Low-Dose Radiation for Knee Osteoarthritis: A Case Report |url=https://www.cureus.com/articles/475480-low-dose-radiation-for-knee-osteoarthritis-a-case-report#!/ |journal=Cureus |volume=18 |issue=4 |doi=10.7759/cureus.107955 |doi-access=free }}</ref>Weight loss may help in those who are overweight.<ref name=NIH2015/> Pain medications may include paracetamol (acetaminophen) as well as NSAIDs such as naproxen or ibuprofen.<ref name=NIH2015>{{cite web|title=Osteoarthritis|url=https://www.niams.nih.gov/health-topics/osteoarthritis|publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=10 April 2026|date=September 2023}}</ref> Long-term opioid use is not recommended due to lack of information on benefits as well as risks of addiction and other side effects.<ref name=NIH2015/><ref name=OARSI2014/> Joint replacement surgery may be an option if there is ongoing disability despite other treatments.<ref name=Lancet2015/> 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.<ref name="Katz 2021" />
Osteoarthritis is the most common form of arthritis, affecting about 237{{nbsp}}million people or 3.3% of the world's population as of 2015.<ref name=GBD2015Pre>{{cite journal | vauthors = ((GBD 2015 Disease and Injury Incidence and Prevalence Collaborators)) | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref><ref name=Mar2014>{{cite journal | vauthors = March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, Buchbinder R, Vos T, Woolf AD | title = Burden of disability due to musculoskeletal (MSK) disorders | journal = Best Practice & Research. Clinical Rheumatology | volume = 28 | issue = 3 | pages = 353–366 | date = June 2014 | pmid = 25481420 | doi = 10.1016/j.berh.2014.08.002 }}</ref> It becomes more common as people age.<ref name=NIH2015/> Among those over 60 years old, about 10% of males and 18% of females are affected.<ref name=Lancet2015/> Osteoarthritis is the cause of about 2% of years lived with disability.<ref name=Mar2014/> 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.<ref name="Katz 2021" /> {{TOC limit}}
==Signs and symptoms== thumb|alt=Outline of female body indicating most affected areas|Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), neck, lower back, knees, and hips. 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).<ref name="Katz 2021"/> 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.<ref name="Katz 2021"/> 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.<ref>{{cite journal | vauthors = Sinusas K | title = Osteoarthritis: diagnosis and treatment | journal = American Family Physician | volume = 85 | issue = 1 | pages = 49–56 | date = January 2012 | pmid = 22230308 | url = https://www.aafp.org/afp/2012/0101/p49.html }}</ref> Some people report increased pain associated with cold temperature, high humidity, or a drop in barometric pressure, but studies have had mixed results.<ref name="pmid22124595">{{cite journal | vauthors = de Figueiredo EC, Figueiredo GC, Dantas RT | title = Influence of meteorological elements on osteoarthritis pain: a review of the literature | language = pt | journal = Revista Brasileira de Reumatologia | volume = 51 | issue = 6 | pages = 622–628 | date = December 2011 | pmid = 22124595 | doi = 10.1590/S0482-50042011000600008 | trans-title = Influence of meteorological elements on osteoarthritis pain: a review of the literature | title-link = doi | doi-access = free }}</ref>
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.<ref name=NIH2015/>
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.<ref>{{cite web|url=http://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/dxc-20262053|title=Bunions: Symptoms and causes|publisher=Mayo Clinic|date=8 November 2016|access-date=20 April 2017|url-status=live|archive-url=https://web.archive.org/web/20170421102330/http://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/dxc-20262053|archive-date=21 April 2017 }}</ref>
==Causes== Damage from mechanical stress with insufficient self-repair by joints is believed to be the primary cause of osteoarthritis.<ref name=Brandt2009/> 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.<ref name=Brandt2009>{{cite journal | vauthors = Brandt KD, Dieppe P, Radin E | title = Etiopathogenesis of osteoarthritis | journal = The Medical Clinics of North America | volume = 93 | issue = 1 | pages = 1–24, xv | date = January 2009 | pmid = 19059018 | doi = 10.1016/j.mcna.2008.08.009 | s2cid = 28990260 }}</ref> The risk of osteoarthritis increases with aging, history of joint injury, or family history of osteoarthritis.<ref>{{Cite journal |last1=Veronese |first1=Nicola |last2=Stubbs |first2=B. |last3=Solmi |first3=M. |last4=Smith |first4=T.O. |last5=Reginster |first5=J.-Y. |last6=Maggi |first6=S. |date=March 2018 |title=Osteoarthritis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative |journal=The Journal of Nutrition, Health and Aging |volume=22 |issue=3 |pages=371–376 |doi=10.1007/s12603-017-0941-0 |pmid=29484350 |pmc=12275612 |issn=1279-7707}}</ref> However exercise, including running in the absence of injury, has not been found to increase the risk of knee osteoarthritis.<ref name=Bosomworth09>{{cite journal | vauthors = Bosomworth NJ | title = Exercise and knee osteoarthritis: benefit or hazard? | journal = Canadian Family Physician | volume = 55 | issue = 9 | pages = 871–878 | date = September 2009 | pmid = 19752252 | pmc = 2743580 }}</ref><ref>{{cite journal | vauthors = Timmins KA, Leech RD, Batt ME, Edwards KL | title = Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis | journal = The American Journal of Sports Medicine | volume = 45 | issue = 6 | pages = 1447–1457 | date = May 2017 | pmid = 27519678 | doi = 10.1177/0363546516657531 | s2cid = 21924096 | url = http://eprints.lincoln.ac.uk/id/eprint/23789/1/23789%20Timminsetal_RunningOAreview_AJSM_submitted.pdf | access-date = 15 July 2023 | archive-date = 30 March 2023 | archive-url = https://web.archive.org/web/20230330181156/http://eprints.lincoln.ac.uk/id/eprint/23789/1/23789%20Timminsetal_RunningOAreview_AJSM_submitted.pdf }}</ref> Nor has cracking one's knuckles been found to play a role.<ref name="pmid21383216">{{cite journal | vauthors = Deweber K, Olszewski M, Ortolano R | title = Knuckle cracking and hand osteoarthritis | journal = Journal of the American Board of Family Medicine | volume = 24 | issue = 2 | pages = 169–174 | year = 2011 | pmid = 21383216 | doi = 10.3122/jabfm.2011.02.100156 | title-link = doi | doi-access = free }}</ref>
===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.<ref name="Katz 2021"/><ref name="pmid11360143">{{cite journal | vauthors = Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C | title = Knee osteoarthritis and obesity | journal = International Journal of Obesity and Related Metabolic Disorders | volume = 25 | issue = 5 | pages = 622–627 | date = May 2001 | pmid = 11360143 | doi = 10.1038/sj.ijo.0801585 | title-link = doi | doi-access = free }}</ref> Osteoarthritis of the hips and knees is twice as common in those with obesity.<ref name="Katz 2021" /> 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.<ref name=NIH2015/><ref name="pmid21481553">{{cite journal | vauthors = Tanamas SK, Wijethilake P, Wluka AE, Davies-Tuck ML, Urquhart DM, Wang Y, Cicuttini FM | title = Sex hormones and structural changes in osteoarthritis: a systematic review | journal = Maturitas | volume = 69 | issue = 2 | pages = 141–156 | date = June 2011 | pmid = 21481553 | doi = 10.1016/j.maturitas.2011.03.019 }}</ref> Women also tend to have more severe symptoms and imaging findings for hip and knee osteoarthritis as compared to men.<ref name="Katz 2021"/> Conflicting evidence exists for the differences in hip and knee osteoarthritis in African Americans and Caucasians.<ref>{{cite journal | vauthors = Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF | title = Osteoarthritis: new insights. Part 1: the disease and its risk factors | journal = Annals of Internal Medicine | volume = 133 | issue = 8 | pages = 635–646 | date = October 2000 | pmid = 11033593 | doi = 10.7326/0003-4819-133-8-200010170-00016 | title-link = doi | doi-access = free }}</ref>
====Occupational==== {{See also|Occupational disease|Occupational injury}} 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).<ref name=SBU2016>{{cite report|vauthors=Vingård E, Englund M, Järvholm B, Svensson O, Stenström K, Brolund A, Hall C, Kedebring T, Kirkeskov L, Nordin M|others=Graphic design by Anna Edling|title=Occupational Exposures and Osteoarthritis: A systematic review and assessment of medical, social and ethical aspects|url=https://www.sbu.se/en/publications/sbu-assesses/occupational-exposures-and-osteoarthritis/|access-date=8 April 2018|department=SBU Assessments|publisher=Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)|location=Stockholm|date=1 September 2016|page=1|docket=253 (in Swedish)}}</ref> With hip osteoarthritis, in particular, increased risk of development over time was found among those who work in bent or twisted positions.<ref name=SBU2016 /> 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.<ref name=SBU2016 /> Women and men have similar occupational risks for the development of osteoarthritis.<ref name=SBU2016 />
===Secondary=== {{multiple image|caption_align=center|header_align=center | footer = Secondary osteoarthritis of the ankle (due to an old bone fracture) in an 82-year-old woman | image1 = Secondary osteoarthritis Ankle P.png | width1 = 168 | alt1 = Lateral X-ray scan of ankle with secondary osteoarthritis | caption1 = Lateral | image2 = Secondary osteoarthritis Ankle F.png | width2 = 104 | alt2 = Frontal X-ray scan of ankle with secondary osteoarthritis | caption2 = Frontal }} Certain medical conditions or injuries can increase the risk of osteoarthritis: * Alkaptonuria<ref>{{cite journal | vauthors = Ranganath LR, Jarvis JC, Gallagher JA | title = Recent advances in management of alkaptonuria (invited review; best practice article) | journal = Journal of Clinical Pathology | volume = 66 | issue = 5 | pages = 367–373 | date = May 2013 | pmid = 23486607 | doi = 10.1136/jclinpath-2012-200877 | s2cid = 24860734 }}</ref> * Congenital disorders of joints<ref>{{cite web|title=Birth Defects: Condition Information|url=https://www.nichd.nih.gov/health/topics/birthdefects/conditioninfo/Pages/default.aspx|archive-url=https://web.archive.org/web/20130127132417/https://www.nichd.nih.gov/health/topics/birthdefects/conditioninfo/Pages/default.aspx|archive-date=27 January 2013|website=www.nichd.nih.gov|date=September 2017 |access-date=8 December 2017}}</ref> * 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.<ref>{{cite journal | vauthors = King KB, Rosenthal AK | title = The adverse effects of diabetes on osteoarthritis: update on clinical evidence and molecular mechanisms | journal = Osteoarthritis and Cartilage | volume = 23 | issue = 6 | pages = 841–850 | date = June 2015 | pmid = 25837996 | pmc = 5530368 | doi = 10.1016/j.joca.2015.03.031 }}</ref> * Ehlers-Danlos syndrome * Injury to joints or ligaments (such as the ACL)<ref name="Blalock 2015">{{cite journal |last1=Blalock |first1=Darryl |last2=Miller |first2=Andrew |last3=Tilley |first3=Michael |last4=Wang |first4=Jinxi |title=Joint Instability and Osteoarthritis |journal=Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders |date=January 2015 |volume=8 |article-number=CMAMD.S22147 |doi=10.4137/CMAMD.S22147 |pmid=25741184 |pmc=4337591 }}</ref> * Ligamentous deterioration or instability<ref name="Blalock 2015"/> * Marfan syndrome * Obesity * Joint infection<ref>{{cite web|title=Arthritis, Infectious|url=https://rarediseases.org/rare-diseases/arthritis-infectious/|website=NORD (National Organization for Rare Disorders)|access-date=19 July 2017|date=2009|url-status=live|archive-url=https://web.archive.org/web/20170221081703/https://rarediseases.org/rare-diseases/arthritis-infectious/|archive-date=21 February 2017}}</ref><ref>{{cite journal | vauthors = Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML | title = Approach to septic arthritis | journal = American Family Physician | volume = 84 | issue = 6 | pages = 653–660 | date = September 2011 | pmid = 21916390 }}</ref><ref>{{cite journal | vauthors = El-Sobky T, Mahmoud S | title = Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills | journal = EFORT Open Reviews | volume = 6 | issue = 7 | pages = 584–592 | date = July 2021 | pmid = 34377550 | pmc = 8335954 | doi = 10.1302/2058-5241.6.200155 | title-link = doi | doi-access = free }}</ref>
==Pathophysiology== {{multiple image|caption_align=center|header_align=center |width = 200 |direction = vertical |image1 = 0910 Oateoarthritis Hip B.png |alt1 = Annotated illustration of healthy hip joint |caption1 = Healthy hip joint |image2 = 0910 Oateoarthritis Hip A.png |alt2 = Annotated illustration of hip joint with osteoarthritis |caption2 = Hip joint with osteoarthritis<ref>{{cite web|title = Synovial Joints| date=25 April 2013 |url = http://cnx.org/contents/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22@7.30:59/Synovial-Joints|publisher = OpenStax CNX|access-date = 14 October 2015|url-status = live|archive-url = https://web.archive.org/web/20160106193658/http://cnx.org/contents/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22%407.30%3A59/Synovial-Joints|archive-date = 6 January 2016 }}</ref> }} 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.<ref name="pmid25182679">{{cite journal | vauthors = Sanchez-Adams J, Leddy HA, McNulty AL, O'Conor CJ, Guilak F | title = The mechanobiology of articular cartilage: bearing the burden of osteoarthritis | journal = Current Rheumatology Reports | volume = 16 | issue = 10 | article-number = 451 | date = October 2014 | pmid = 25182679 | pmc = 4682660 | doi = 10.1007/s11926-014-0451-6 }}</ref><ref name="Maroudas A 1976">{{cite journal | vauthors = Maroudas AI | title = Balance between swelling pressure and collagen tension in normal and degenerate cartilage | journal = Nature | volume = 260 | issue = 5554 | pages = 808–809 | date = April 1976 | pmid = 1264261 | doi = 10.1038/260808a0 | s2cid = 4214459 | bibcode = 1976Natur.260..808M }}</ref> Collagen fibres exert the compressive force, whereas the Gibbs–Donnan effect and cartilage proteoglycans create osmotic pressure which tends to draw water in.<ref name="Maroudas A 1976"/>
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.<ref name="Bollet AJ 1966">{{cite journal | vauthors = Bollet AJ, Nance JL | title = Biochemical Findings in Normal and Osteoarthritic Articular Cartilage. II. Chondroitin Sulfate Concentration and Chain Length, Water, and Ash Content | journal = The Journal of Clinical Investigation | volume = 45 | issue = 7 | pages = 1170–1177 | date = July 1966 | pmid = 16695915 | pmc = 292789 | doi = 10.1172/JCI105423 }}</ref><ref name="Brocklehurst R 1984">{{cite journal | vauthors = Brocklehurst R, Bayliss MT, Maroudas A, Coysh HL, Freeman MA, Revell PA, Ali SY | title = The composition of normal and osteoarthritic articular cartilage from human knee joints. With special reference to unicompartmental replacement and osteotomy of the knee | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 66 | issue = 1 | pages = 95–106 | date = January 1984 | pmid = 6690447 | doi = 10.2106/00004623-198466010-00013 }}</ref><ref name="Chou MC 2009">{{cite journal | vauthors = Chou MC, Tsai PH, Huang GS, Lee HS, Lee CH, Lin MH, Lin CY, Chung HW | title = Correlation between the MR T2 value at 4.7 T and relative water content in articular cartilage in experimental osteoarthritis induced by ACL transection | journal = Osteoarthritis and Cartilage | volume = 17 | issue = 4 | pages = 441–447 | date = April 2009 | pmid = 18990590 | doi = 10.1016/j.joca.2008.09.009 | title-link = doi | doi-access = free }}</ref><ref name="Grushko G 1989">{{cite journal | vauthors = Grushko G, Schneiderman R, Maroudas A | title = Some biochemical and biophysical parameters for the study of the pathogenesis of osteoarthritis: a comparison between the processes of ageing and degeneration in human hip cartilage | journal = Connective Tissue Research | volume = 19 | issue = 2–4 | pages = 149–176 | year = 1989 | pmid = 2805680 | doi = 10.3109/03008208909043895 }}</ref><ref name="Mankin HJ 1975">{{cite journal | vauthors = Mankin HJ, Thrasher AZ | title = Water content and binding in normal and osteoarthritic human cartilage | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 57 | issue = 1 | pages = 76–80 | date = January 1975 | pmid = 1123375 | doi = 10.2106/00004623-197557010-00013 }}</ref> This increase occurs because whilst there is an overall loss of proteoglycans (and thus a decreased osmotic pull),<ref name="Brocklehurst R 1984"/><ref name="Venn M 1977">{{cite journal | vauthors = Venn M, Maroudas A | title = Chemical composition and swelling of normal and osteoarthrotic femoral head cartilage. I. Chemical composition | journal = Annals of the Rheumatic Diseases | volume = 36 | issue = 2 | pages = 121–129 | date = April 1977 | pmid = 856064 | pmc = 1006646 | doi = 10.1136/ard.36.2.121 }}</ref> it is outweighed by a loss of collagen.<ref name="Maroudas A 1976"/><ref name="Venn M 1977"/>
Other structures within the joint can also be affected.<ref>{{cite journal | vauthors = Madry H, Luyten FP, Facchini A | title = Biological aspects of early osteoarthritis | journal = Knee Surgery, Sports Traumatology, Arthroscopy | volume = 20 | issue = 3 | pages = 407–422 | date = March 2012 | pmid = 22009557 | doi = 10.1007/s00167-011-1705-8 | s2cid = 31367901 }}</ref> The ligaments within the joint become thickened and fibrotic, and the menisci can become damaged and wear away.<ref>{{cite journal | vauthors = Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A | title = Meniscus pathology, osteoarthritis and the treatment controversy | journal = Nature Reviews. Rheumatology | volume = 8 | issue = 7 | pages = 412–419 | date = May 2012 | pmid = 22614907 | doi = 10.1038/nrrheum.2012.69 | s2cid = 7725467 }}</ref> 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).<ref>{{cite journal | vauthors = Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, Zheng MH | title = Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes | journal = Arthritis Research & Therapy | volume = 15 | issue = 6 | page = 223 | year = 2013 | pmid = 24321104 | pmc = 4061721 | doi = 10.1186/ar4405 | doi-access = free }}</ref> All these changes can cause problems functioning. The pain in an osteoarthritic joint has been related to thickened synovium<ref>{{cite journal | vauthors = Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT | title = Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis | journal = The Journal of Rheumatology | volume = 28 | issue = 6 | pages = 1330–1337 | date = June 2001 | pmid = 11409127 }}</ref> and to subchondral bone lesions.<ref>{{cite journal | vauthors = Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR | title = The association of bone marrow lesions with pain in knee osteoarthritis | journal = Annals of Internal Medicine | volume = 134 | issue = 7 | pages = 541–549 | date = April 2001 | pmid = 11281736 | doi = 10.7326/0003-4819-134-7-200104030-00007 | s2cid = 53091266 }}</ref>
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).<ref name="Katz 2021"/> 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.<ref name="Katz 2021"/>
==Diagnosis== {{Synovial fluid analysis}} Diagnosis is made with reasonable certainty based on history and clinical examination.<ref name="pmid19762361">{{cite journal | vauthors = Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, Herrero-Beaumont G, Kirschner S, Leeb BF, Lohmander LS, Mazières B, Pavelka K, Punzi L, So AK, Tuncer T, Watt I, Bijlsma JW | title = EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis | journal = Annals of the Rheumatic Diseases | volume = 69 | issue = 3 | pages = 483–489 | date = March 2010 | pmid = 19762361 | doi = 10.1136/ard.2009.113100 | s2cid = 12319076 | url = http://ard.bmj.com/cgi/content/short/ard.2009.113100v1 }}</ref><ref name="pmid12180735">{{cite journal | vauthors = Bierma-Zeinstra SM, Oster JD, Bernsen RM, Verhaar JA, Ginai AZ, Bohnen AM | title = Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care | journal = The Journal of Rheumatology | volume = 29 | issue = 8 | pages = 1713–1718 | date = August 2002 | pmid = 12180735 }}</ref> 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.<ref>{{MerckManual|04|034|e||Osteoarthritis (OA): Joint Disorders}}</ref> 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.<ref name="Katz 2021" /> 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.<ref name="Phillips">{{cite journal |vauthors=Phillips CR, Brasington RD |title=Osteoarthritis treatment update: Are NSAIDs still in the picture? |journal=Journal of Musculoskeletal Medicine |volume=27 |issue=2 |year=2010 |url=http://www.musculoskeletalnetwork.com/display/article/1145622/1517357 |archive-url=https://web.archive.org/web/20100212105652/http://www.musculoskeletalnetwork.com/display/article/1145622/1517357 |archive-date=12 February 2010 |access-date=9 February 2010 }}</ref>
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.<ref>{{cite web |url=https://www.uptodate.com/contents/osteoarthritis-symptoms-and-diagnosis-beyond-the-basics |title=Patient information: Osteoarthritis symptoms and diagnosis (Beyond the Basics) | vauthors = Kalunian KC |year=2013 |publisher=UpToDate |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20100922013032/http://www.uptodate.com/patients/content/topic.do?topicKey=~77ll0j9jfS9fuD |archive-date=22 September 2010 }}</ref> These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropathies.<ref name="pmid2242058">{{cite journal | vauthors = Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Gray R | title = The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand | journal = Arthritis and Rheumatism | volume = 33 | issue = 11 | pages = 1601–1610 | date = November 1990 | pmid = 2242058 | doi = 10.1002/art.1780331101 | title-link = doi | doi-access = free }}</ref>
<gallery> File:Osteo of the hand.jpg|Severe osteoarthritis and osteopenia of the carpal joint and 1st carpometacarpal joint File:Gonarthrose-Knorpelaufbrauch.jpg|MRI of osteoarthritis in the knee, with characteristic narrowing of the joint space File:Osteoarthritis left knee.jpg|Primary osteoarthritis of the left knee. Note the osteophytes, narrowing of the joint space (arrow), and increased subchondral bone density (arrow). File:Damaged cartilage Danish sow.png|Damaged cartilage from sows. (a) cartilage erosion (b) cartilage ulceration (c) cartilage repair (d) osteophyte (bone spur) formation. File:Primary osteoarthrosis (2) at knee joint.jpg|Histopathology of osteoarthrosis of a knee joint in an elderly female File:Primary osteoarthrosis (5) at knee joint.jpg|Histopathology of osteoarthrosis of a knee joint in an elderly female File:Health joint.png|In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues. File:Joint with severe osteoathritis.png|With osteoarthritis, the cartilage becomes worn away. Spurs grow out from the edge of the bone, and synovial fluid increases. Altogether, the joint feels stiff and sore. File:Osteoarthritis.png|Osteoarthritis File:Osteoarthritis -- Smart-Servier (cropped).jpg|Bone (left) and clinical (right) changes of the hand in osteoarthritis </gallery>
===Classification=== {{Further|Radiographic classification of osteoarthritis}} Several classification systems are used for the gradation of osteoarthritis: * WOMAC scale, taking into account pain, stiffness and functional limitation.<ref>{{cite journal | vauthors = Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J, Goenaga JI, Arenaza JC | title = Health-related quality of life and appropriateness of knee or hip joint replacement | journal = Archives of Internal Medicine | volume = 166 | issue = 2 | pages = 220–226 | date = January 2006 | pmid = 16432092 | doi = 10.1001/archinte.166.2.220 | title-link = doi | doi-access = free }}</ref> * 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.<ref>{{cite web|url=http://www.preventivehip.org/hip-scores/tonnis-classification|title=Tönnis Classification of Osteoarthritis by Radiographic Changes|publisher=Society of Preventive Hip Surgery|access-date=13 December 2016|archive-url=https://web.archive.org/web/20161220135616/http://www.preventivehip.org/hip-scores/tonnis-classification|archive-date=20 December 2016}}</ref>
[[File:Erosive osteoarthritis with gull-wing appearance, with seagull.jpg|thumb|X-ray of erosive osteoarthritis of the fingers, also zooming in on two joints with the typical "gull-wing" appearance]]
==Management== thumb|right|alt=Illustration of example strengthening, aerobic conditioning, and range of motion exercises|Some kinds of exercise recommended for osteoarthritis 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.<ref name="Katz 2021" /><ref name=Cochrane10>{{cite journal | vauthors = Flood J | title = The role of acetaminophen in the treatment of osteoarthritis | journal = The American Journal of Managed Care | volume = 16 | issue = Suppl Management | pages = S48–S54 | date = March 2010 | pmid = 20297877 | url = http://www.ajmc.com/publications/supplement/2010/A278_10mar_Pain/A278_2010mar_Flood/ | url-status = live | df = dmy-all | archive-url = https://web.archive.org/web/20150322234341/http://www.ajmc.com/publications/supplement/2010/a278_10mar_pain/a278_2010mar_flood | archive-date = 22 March 2015 }} {{open access}}</ref><ref name=Leo2019>{{cite journal | vauthors = Leopoldino AO, Machado GC, Ferreira PH, Pinheiro MB, Day R, McLachlan AJ, Hunter DJ, Ferreira ML | title = Paracetamol versus placebo for knee and hip osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | article-number = CD013273 | date = February 2019 | pmid = 30801133 | pmc = 6388567 | doi = 10.1002/14651858.cd013273 }}</ref> Medications that alter the course of the disease have not been found as of 2025.<ref name="Katz 2021" /><ref name="Disease-modifying drugs in osteoart">{{cite journal | vauthors = Oo WM, Yu SP, Daniel MS, Hunter DJ | title = Disease-modifying drugs in osteoarthritis: current understanding and future therapeutics | journal = Expert Opinion on Emerging Drugs | volume = 23 | issue = 4 | pages = 331–347 | date = December 2018 | pmid = 30415584 | doi = 10.1080/14728214.2018.1547706 | s2cid = 53284022 }}</ref> For overweight people, weight loss may help relieve pain due to hip arthritis.<ref name="Hip Osteoarthritis 2009"/> 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.<ref>{{cite journal | vauthors = Georgiev T, Angelov AK | title = Modifiable risk factors in knee osteoarthritis: treatment implications | journal = Rheumatology International | volume = 39 | issue = 7 | pages = 1145–1157 | date = July 2019 | pmid = 30911813 | doi = 10.1007/s00296-019-04290-z | s2cid = 85493753 }}</ref>
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.<ref>{{cite journal |date=23 June 2022 |title=How to improve discussions about osteoarthritis in primary care |url=https://evidence.nihr.ac.uk/alert/discussions-about-osteoarthritis-in-primary-care/ |journal=NIHR Evidence |language=en |doi=10.3310/nihrevidence_51244|s2cid=251782088 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Vennik J, Hughes S, Smith KA, Misurya P, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Dambha-Miller H, Morrison L, Leydon G, Everitt H, Bishop FL | title = Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography | journal = Patient Education and Counseling | volume = 105 | issue = 7 | pages = 1865–1877 | date = July 2022 | pmid = 35125208 | doi = 10.1016/j.pec.2022.01.009 | s2cid = 246314113 | doi-access = free }}</ref> 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.<ref>{{Cite journal |last1=Anderson |first1=Anna M. |last2=Lavender |first2=Elizabeth |last3=Mason |first3=Samantha |last4=Eckersley |first4=Linda |last5=Barry |first5=Susan |last6=Daffu-O'Reilly |first6=Amrit |last7=Green |first7=Heidi |last8=Conner |first8=Mark |last9=McHugh |first9=Gretl A. |date=2025 |title=Adapting an Osteoarthritis Peer Mentorship Intervention for Remote Delivery to People Experiencing Socioeconomic Disadvantage: A Multi-Method Approach |journal=Health Expectations |language=en |volume=28 |issue=2 |article-number=e70245 |doi=10.1111/hex.70245 |pmid=40165602 |issn=1369-7625 |pmc=11959151}}</ref><ref>{{Cite web |last1=Lavender |first1=E. C. |last2=Mason |first2=S. J. |last3=Anderson |first3=A. M. |last4=McHugh |first4=G. A. |date=2025-07-14 |title=Remote Osteoarthritis Peer Mentorship for Socioeconomically Underserved People (RaMIgO): Final Project Report |url=https://eprints.whiterose.ac.uk/id/eprint/228889/ |access-date=2025-07-15 |website=eprints.whiterose.ac.uk |language=en |doi=10.48785/100/349}}</ref>
===Exercise === Weight loss in those who are overweight or obese and exercise provide long-term benefit and are recommended in all people with osteoarthritis.<ref name="pmid19207981">{{cite journal | vauthors = Hunter DJ, Eckstein F | title=Exercise and osteoarthritis | journal= Journal of Anatomy | volume=214 | issue=2 | pages=197–207 | year=2009 | doi= 10.1111/j.1469-7580.2008.01013.x | pmc=2667877 | pmid=19207981}}</ref> Weight loss and exercise are the most safe and effective long-term treatments, in contrast to short-term treatments which usually have risk of long-term harm.<ref name="pmid30961569">{{cite journal | vauthors = Charlesworth J, Fitzpatrick J, Orchard J | title=Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee | journal= BMC Musculoskeletal Disorders | volume=20 | issue=1 | article-number=151| year=2019 | doi= 10.1186/s12891-019-2525-0 | doi-access=free | pmc=6454763 | pmid=30961569}}</ref> Therapeutic exercise programs, such as aerobics and walking, may reduce pain and improve physical functioning for up to 6 months after the end of the program.<ref>{{Cite journal |last1=Lawford |first1=Belinda J. |last2=Hall |first2=Michelle |last3=Hinman |first3=Rana S. |last4=Van der Esch |first4=Martin |last5=Harmer |first5=Alison R. |last6=Spiers |first6=Libby |last7=Kimp |first7=Alex |last8=Dell'Isola |first8=Andrea |last9=Bennell |first9=Kim L. |date=2024-12-03 |title=Exercise for osteoarthritis of the knee |journal=The Cochrane Database of Systematic Reviews |volume=2024 |issue=12 |article-number=CD004376 |doi=10.1002/14651858.CD004376.pub4 |issn=1469-493X |pmc=11613324 |pmid=39625083}}</ref>
High-impact exercise can increase the risk of joint injury, whereas low or moderate-impact exercise, such as walking or swimming, is safer for people with osteoarthritis.<ref name="pmid19207981" />
Moderate exercise may be beneficial with respect to pain and function in those with osteoarthritis of the knee and hip.<ref name="pmid23253613">{{cite journal | vauthors = Hagen KB, Dagfinrud H, Moe RH, Østerås N, Kjeken I, Grotle M, Smedslund G | title = Exercise therapy for bone and muscle health: an overview of systematic reviews | journal = BMC Medicine | volume = 10 | article-number = 167 | date = December 2012 | pmid = 23253613 | pmc = 3568719 | doi = 10.1186/1741-7015-10-167 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S | title = Exercise for osteoarthritis of the hip | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 4 | article-number = CD007912 | date = April 2014 | pmid = 24756895 | doi = 10.1002/14651858.CD007912.pub2 | pmc = 10898220 }}</ref><ref name=":0">{{cite journal | vauthors = Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N, Stansfield C, Oliver S | title = Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | article-number = CD010842 | date = April 2018 | pmid = 29664187 | pmc = 6494515 | doi = 10.1002/14651858.CD010842.pub2 }}</ref> These exercises should occur at least three times per week, under supervision, and focused on specific forms of exercise found to be most beneficial for this form of osteoarthritis.<ref name="pmid24574223">{{cite journal | vauthors = Juhl C, Christensen R, Roos EM, Zhang W, Lund H | title = Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials | journal = Arthritis & Rheumatology | volume = 66 | issue = 3 | pages = 622–636 | date = March 2014 | pmid = 24574223 | doi = 10.1002/art.38290 | s2cid = 24620456 | title-link = doi | doi-access = free }}</ref>
While some evidence supports certain physical therapies, evidence for a combined program is limited.<ref name="pmid23128863">{{cite journal | vauthors = Wang SY, Olson-Kellogg B, Shamliyan TA, Choi JY, Ramakrishnan R, Kane RL | title = Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review | journal = Annals of Internal Medicine | volume = 157 | issue = 9 | pages = 632–644 | date = November 2012 | pmid = 23128863 | doi = 10.7326/0003-4819-157-9-201211060-00007 | s2cid = 17423569 }}</ref> Providing clear advice, making exercises enjoyable, and reassuring people about the importance of doing exercises may lead to greater benefit and more participation.<ref name=":0" /> Some evidence suggests that supervised exercise therapy may improve exercise adherence,<ref>{{cite journal | vauthors = Jordan JL, Holden MA, Mason EE, Foster NE | title = Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2010 | issue = 1 | article-number = CD005956 | date = January 2010 | pmid = 20091582 | pmc = 6769154 | doi = 10.1002/14651858.cd005956.pub2 }}</ref> with knee osteoarthritis, supervised exercise has shown the best results.<ref name="pmid24574223" />
===Physical measures=== There is not enough evidence to determine the effectiveness of massage therapy.<ref name=nahin/> The evidence for manual therapy is inconclusive.<ref>{{cite journal | vauthors = French HP, Brennan A, White B, Cusack T | title = Manual therapy for osteoarthritis of the hip or knee – a systematic review | journal = Manual Therapy | volume = 16 | issue = 2 | pages = 109–117 | date = April 2011 | pmid = 21146444 | doi = 10.1016/j.math.2010.10.011 }}</ref> A 2015 review indicated that aquatic therapy is safe, effective, and can be an adjunct therapy for knee osteoarthritis.<ref>{{cite journal | vauthors = Lu M, Su Y, Zhang Y, Zhang Z, Wang W, He Z, Liu F, Li Y, Liu C, Wang Y, Sheng L, Zhan Z, Wang X, Zheng N | title = Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis | journal = Zeitschrift für Rheumatologie | volume = 74 | issue = 6 | pages = 543–552 | date = August 2015 | pmid = 25691109 | doi = 10.1007/s00393-014-1559-9 | s2cid = 19135129 }}</ref> Among people with hip and knee osteoarthritis, water exercise may reduce pain and disability, and increase quality of life in the short term.<ref>{{cite journal | vauthors = Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, Lund H | title = Aquatic exercise for the treatment of knee and hip osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | article-number = CD005523 | date = March 2016 | pmid = 27007113 | pmc = 9942938 | doi = 10.1002/14651858.CD005523.pub3 | hdl-access = free | hdl = 11250/2481966 }}</ref> Hydrotherapy might also be an advantage in the management of pain, disability, and quality of life.<ref>{{cite journal | vauthors = Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, Lund H | title = Aquatic exercise for the treatment of knee and hip osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | article-number = CD005523 | date = March 2016 | pmid = 27007113 | pmc = 9942938 | doi = 10.1002/14651858.CD005523.pub3 }}</ref>
Functional, gait, and balance training have been recommended to address impairments of position sense, balance, and strength in individuals with lower extremity arthritis, as these can contribute to a higher rate of falls in older individuals.<ref name="pmid15517643">{{cite journal | vauthors = Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR | title = Physiological risk factors for falls in older people with lower limb arthritis | journal = The Journal of Rheumatology | volume = 31 | issue = 11 | pages = 2272–2279 | date = November 2004 | pmid = 15517643 }}</ref><ref>{{cite journal | vauthors = Barbour KE, Stevens JA, Helmick CG, Luo YH, Murphy LB, Hootman JM, Theis K, Anderson LA, Baker NA, Sugerman DE | title = Falls and fall injuries among adults with arthritis – United States, 2012 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 63 | issue = 17 | pages = 379–383 | date = May 2014 | pmid = 24785984 | pmc = 4584889 }}</ref> For people with hand osteoarthritis, exercises may provide small benefits for improving hand function, reducing pain, and relieving finger joint stiffness.<ref>{{cite journal | vauthors = Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, Hagen KB | title = Exercise for hand osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD010388 | date = January 2017 | pmid = 28141914 | pmc = 6464796 | doi = 10.1002/14651858.CD010388.pub2 }}</ref>
A study showed that there is low-quality evidence that weak knee extensor muscles increase the risk of knee osteoarthritis. Strengthening of the knee extensors could prevent knee osteoarthritis.<ref>{{cite journal | vauthors = Øiestad BE, Juhl CB, Culvenor AG, Berg B, Thorlund JB | title = Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46 819 men and women | journal = British Journal of Sports Medicine | volume = 56 | issue = 6 | pages = 349–355 | date = March 2022 | pmid = 34916210 | doi = 10.1136/bjsports-2021-104861 | hdl = 11250/2839290 | hdl-access = free }}</ref>
Lateral wedge insoles and neutral insoles do not appear to be useful in osteoarthritis of the knee.<ref name="pmid23612781">{{cite journal | vauthors = Penny P, Geere J, Smith TO | title = A systematic review investigating the efficacy of laterally wedged insoles for medial knee osteoarthritis | journal = Rheumatology International | volume = 33 | issue = 10 | pages = 2529–2538 | date = October 2013 | pmid = 23612781 | doi = 10.1007/s00296-013-2760-x | s2cid = 20664287 }}</ref><ref name="pmid23989797">{{cite journal | vauthors = Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT | title = Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis | journal = JAMA | volume = 310 | issue = 7 | pages = 722–730 | date = August 2013 | pmid = 23989797 | pmc = 4458141 | doi = 10.1001/jama.2013.243229 }}</ref><ref name=Cochrane2015>{{cite journal | vauthors = Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM | title = Braces and orthoses for treating osteoarthritis of the knee | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 3 | article-number = CD004020 | date = March 2015 | pmid = 25773267 | pmc = 7173742 | doi = 10.1002/14651858.CD004020.pub3 | s2cid = 35262399 }}</ref> Knee braces may help,<ref>{{cite journal | vauthors = Page CJ, Hinman RS, Bennell KL | title = Physiotherapy management of knee osteoarthritis | journal = International Journal of Rheumatic Diseases | volume = 14 | issue = 2 | pages = 145–151 | date = May 2011 | pmid = 21518313 | doi = 10.1111/j.1756-185X.2011.01612.x | s2cid = 41951368 }}</ref> but their usefulness has also been disputed.<ref name=Cochrane2015 />
===Thermotherapy=== For pain management, heat can be used to relieve stiffness, and cold can relieve muscle spasms and pain.<ref name="url_Mayo Clinic">{{cite web |url=http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/lifestyle-home-remedies/con-20014749 |title=Osteoarthritis Lifestyle and home remedies |publisher=Mayo Clinic |url-status=live |archive-url=https://web.archive.org/web/20160125115050/http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/lifestyle-home-remedies/con-20014749 |archive-date=25 January 2016 }}</ref> The use of ice or cold packs may be beneficial; however, further research is needed.<ref name=Brosseau2002>{{cite journal | vauthors = Brosseau L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G, Tugwell P | title = Thermotherapy for treatment of osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2003 | issue = 4 | article-number = CD004522 | date = 2003 | pmid = 14584019 | pmc = 6669258 | doi = 10.1002/14651858.CD004522 }}</ref> A 2003 Cochrane review of 7 studies between 1969 and 1999 found ice massage to be of significant benefit in improving range of motion and function, though not necessarily relief of pain.<ref name="pmid14584019">{{cite journal | vauthors = Brosseau L, Yonge KA, Tugwell P | title=Thermotherapy for treatment of osteoarthritis | journal=The Cochrane Database of Systematic Reviews | volume=2003 | issue=4 | article-number=CD004522 | year=2003 | doi=10.1002/14651858.CD004522 | pmc=6669258 | pmid=14584019}}</ref> Cold packs could decrease swelling, but hot packs did not affect swelling.<ref name="pmid14584019" /> Heat therapy could increase circulation, thereby reducing pain and stiffness, but with the risk of inflammation and edema.<ref name="pmid14584019" /> Another review found no evidence of benefit from placing hot packs on joints.<ref name=Brosseau2002 />
===Medication=== {| class="wikitable" style="float:right; width:30em; border:solid 1px #999; margin:0 0 1em 1em" |- ! colspan=3 style="background:#cee"| Treatment recommendations by risk factors |- ! GI risk ! CVD risk ! Option |- | Low | Low | NSAID, or paracetamol<ref name="BBDNSAIDs">{{cite web | url=https://www.consumerreports.org/cro/2013/07/treating-pain-with-nsaid-medications/index.htm | title=Pain Relief with NSAID Medications | work=Consumer Reports | date=January 2016 | access-date=6 August 2019 | url-status=live | archive-url=https://web.archive.org/web/20190421142800/https://www.consumerreports.org/cro/2013/07/treating-pain-with-nsaid-medications/index.htm | archive-date=21 April 2019 }}</ref> |- | Moderate | Low | Paracetamol, or low dose NSAID with antacid<ref name="BBDNSAIDs"/> |- | Low | Moderate | Paracetamol, or low-dose aspirin with an antacid<ref name="BBDNSAIDs"/> |- | Moderate | Moderate |Low dose paracetamol, aspirin, and antacid. Monitoring for abdominal pain or black stool.<ref name="BBDNSAIDs"/> |}
====By mouth==== The pain medication paracetamol (acetaminophen) or NSAIDs are first line treatments for osteoarthritis related pain.<ref name="Katz 2021" /><ref name="Cochrane10"/><ref name="OARSI2007">{{cite journal | vauthors = Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P | title = OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence | journal = Osteoarthritis and Cartilage | volume = 15 | issue = 9 | pages = 981–1000 | date = September 2007 | pmid = 17719803 | doi = 10.1016/j.joca.2007.06.014 | title-link = doi | doi-access = free }}</ref> With paracetamol, pain relief does not differ according to dosage.<ref name=Leo2019/> However, a 2015 review found acetaminophen to have only a small short-term benefit with some concerns on abnormal results for liver function test.<ref>{{cite journal | vauthors = Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, McLachlan AJ, Ferreira ML | title = Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials | journal = BMJ | volume = 350 | article-number = h1225 | date = March 2015 | pmid = 25828856 | pmc = 4381278 | doi = 10.1136/bmj.h1225 }}</ref> For mild to moderate symptoms effectiveness of acetaminophen is similar to non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, though for more severe symptoms, NSAIDs may be more effective.<ref name=Cochrane10/> NSAIDs are associated with greater side effects such as gastrointestinal bleeding.<ref name=Cochrane10/>
Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) are equally effective when compared to nonselective NSAIDs, and have lower rates of adverse gastrointestinal effects, but higher rates of cardiovascular disease such as myocardial infarction.<ref name="pmid18405470">{{cite journal | vauthors = Chen YF, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, Taylor RS | title = Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation | journal = Health Technology Assessment | volume = 12 | issue = 11 | pages = 1–278, iii | date = April 2008 | pmid = 18405470 | doi = 10.3310/hta12110 | title-link = doi | doi-access = free }}</ref> They are also more expensive than non-specific NSAIDs.<ref>{{cite journal | vauthors = Wielage RC, Myers JA, Klein RW, Happich M | title = Cost-effectiveness analyses of osteoarthritis oral therapies: a systematic review | journal = Applied Health Economics and Health Policy | volume = 11 | issue = 6 | pages = 593–618 | date = December 2013 | pmid = 24214160 | doi = 10.1007/s40258-013-0061-x | s2cid = 207482912 }}</ref> Benefits and risks vary in individuals and need consideration when making treatment decisions,<ref>{{cite journal | vauthors = van Walsem A, Pandhi S, Nixon RM, Guyot P, Karabis A, Moore RA | title = Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis | journal = Arthritis Research & Therapy | volume = 17 | issue = 1 | article-number = 66 | date = March 2015 | pmid = 25879879 | pmc = 4411793 | doi = 10.1186/s13075-015-0554-0 | doi-access = free }}</ref> and further unbiased research comparing NSAIDS and COX-2 selective inhibitors is needed.<ref>{{cite journal | vauthors = Puljak L, Marin A, Vrdoljak D, Markotic F, Utrobicic A, Tugwell P | title = Celecoxib for osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD009865 | date = May 2017 | pmid = 28530031 | pmc = 6481745 | doi = 10.1002/14651858.CD009865.pub2 }}</ref> The COX-2 selective inhibitor rofecoxib was removed from the market in 2004, as cardiovascular events were associated with long term use.<ref>{{cite journal | vauthors = Garner SE, Fidan DD, Frankish R, Maxwell L | title = Rofecoxib for osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2005 | issue = 1 | article-number = CD005115 | date = January 2005 | pmid = 15654705 | pmc = 8864971 | doi = 10.1002/14651858.CD005115 }}</ref>
Education is helpful in self-management of arthritis, and can provide coping methods leading to about 20% more pain relief when compared to NSAIDs alone.<ref name="Hip Osteoarthritis 2009">{{cite journal | vauthors = Cibulka MT, White DM, Woehrle J, Harris-Hayes M, Enseki K, Fagerson TL, Slover J, Godges JJ | title = Hip pain and mobility deficits – hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association | journal = The Journal of Orthopaedic and Sports Physical Therapy | volume = 39 | issue = 4 | pages = A1–25 | date = April 2009 | pmid = 19352008 | pmc = 3963282 | doi = 10.2519/jospt.2009.0301 }}</ref>
Failure to achieve the desired pain relief in osteoarthritis after two weeks of therapy should trigger reassessment of dosage and pain medication.<ref>{{cite journal | vauthors = Karabis A, Nikolakopoulos S, Pandhi S, Papadimitropoulou K, Nixon R, Chaves RL, Moore RA | title = High correlation of VAS pain scores after 2 and 6 weeks of treatment with VAS pain scores at 12 weeks in randomised controlled trials in rheumatoid arthritis and osteoarthritis: meta-analysis and implications | journal = Arthritis Research & Therapy | volume = 18 | article-number = 73 | date = March 2016 | pmid = 27036633 | pmc = 4818534 | doi = 10.1186/s13075-016-0972-7 | doi-access = free }}</ref> Opioids by mouth, including both weak opioids such as tramadol and stronger opioids, are also often prescribed. Their appropriateness is uncertain, and opioids are often recommended only when first-line therapies have failed or are contraindicated.<ref name="OARSI2014"/><ref>{{cite journal | vauthors = Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P | title = American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee | journal = Arthritis Care & Research | volume = 64 | issue = 4 | pages = 465–474 | date = April 2012 | pmid = 22563589 | doi = 10.1002/acr.21596 | s2cid = 11711160 | title-link = doi | doi-access = free }}</ref> This is due to their small benefit and relatively large risk of side effects.<ref name="ReferenceB">{{cite journal | vauthors = da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, Jüni P | title = Oral or transdermal opioids for osteoarthritis of the knee or hip | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | article-number = CD003115 | date = September 2014 | pmid = 25229835 | doi = 10.1002/14651858.CD003115.pub4 | pmc = 10993204 | s2cid = 205168274 }}</ref><ref name=":4">{{cite journal | vauthors = Toupin April K, Bisaillon J, Welch V, Maxwell LJ, Jüni P, Rutjes AW, Husni ME, Vincent J, El Hindi T, Wells GA, Tugwell P | title = Tramadol for osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD005522 | date = May 2019 | pmid = 31132298 | pmc = 6536297 | doi = 10.1002/14651858.CD005522.pub3 | collaboration = Cochrane Musculoskeletal Group }}</ref> The use of tramadol likely does not improve pain or physical function and likely increases the incidence of adverse side effects.<ref name=":4" /> Oral steroids are not recommended in the treatment of osteoarthritis.<ref name=OARSI2007/>
Use of the antibiotic doxycycline orally for treating osteoarthritis is not associated with clinical improvements in function or joint pain and long term use is associated with a high risk of side effects.<ref name=Nuesch2012>{{cite journal | vauthors = da Costa BR, Nüesch E, Reichenbach S, Jüni P, Rutjes AW | title = Doxycycline for osteoarthritis of the knee or hip | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | article-number = CD007323 | date = November 2012 | issue = 11 | pmid = 23152242 | doi = 10.1002/14651858.CD007323.pub3 | pmc = 11491192 }}</ref>
A 2018 meta-analysis found that oral collagen supplementation for the treatment of osteoarthritis reduces stiffness, but does not improve pain and functional limitation.<ref>{{cite journal | vauthors = García-Coronado JM, Martínez-Olvera L, Elizondo-Omaña RE, Acosta-Olivo CA, Vilchez-Cavazos F, Simental-Mendía LE, Simental-Mendía M | title = Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials | journal = International Orthopaedics | volume = 43 | issue = 3 | pages = 531–538 | date = March 2019 | pmid = 30368550 | doi = 10.1007/s00264-018-4211-5 | s2cid = 53080408 }}</ref>
====Topical==== There are several NSAIDs available for topical use, including diclofenac, which may provide symptomatic relief of osteoarthritis.<ref name="Katz 2021" /><ref name="pmid27103611">{{cite journal | vauthors = Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA | title = Topical NSAIDs for chronic musculoskeletal pain in adults | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | article-number = CD007400 | date = April 2016 | pmid = 27103611 | pmc = 6494263 | doi = 10.1002/14651858.CD007400.pub3 }}</ref> Recessed joints (joints located deep within the body, rather than near the skin surface, such as the hips) may be less responsive to treatment with topical therapies.<ref name="Katz 2021" /> Transdermal opioid pain medications are not typically recommended in the treatment of osteoarthritis.<ref name="ReferenceB"/> The use of topical capsaicin to treat osteoarthritis is controversial, as some reviews found benefit<ref name=Silva2011/><ref name="pmid19856319">{{cite journal | vauthors = Cameron M, Gagnier JJ, Little CV, Parsons TJ, Blümle A, Chrubasik S | title = Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis | journal = Phytotherapy Research | volume = 23 | issue = 11 | pages = 1497–1515 | date = November 2009 | pmid = 19856319 | doi = 10.1002/ptr.3007 | hdl-access = free | s2cid = 43530618 | hdl = 2027.42/64567 }}</ref> while others did not.<ref name=PM09>{{cite journal | vauthors = Altman R, Barkin RL | title = Topical therapy for osteoarthritis: clinical and pharmacologic perspectives | journal = Postgraduate Medicine | volume = 121 | issue = 2 | pages = 139–147 | date = March 2009 | pmid = 19332972 | doi = 10.3810/pgm.2009.03.1986 | s2cid = 20975564 }}</ref>
====Joint injections==== [[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|Ultrasound-guided hip joint injection: A skin mark is made to mark the optimal point of entry for the needle.<ref name="YeapRobinson2017">{{cite journal | vauthors = Yeap PM, Robinson P | title = Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin | journal = Journal of the Belgian Society of Radiology | volume = 101 | issue = Suppl 2 | article-number = 6 | date = December 2017 | pmid = 30498802 | pmc = 6251072 | doi = 10.5334/jbr-btr.1371 | doi-access = free }}<br />[https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License (CC-BY 4.0)]</ref>]] Intra-articular injections of steroids, hyaluronic acid, or platelet-rich plasma may be used for pain relief in people with knee osteoarthritis.<ref>{{cite journal | vauthors = Charlesworth J, Fitzpatrick J, Perera NK, Orchard J | title = Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee | journal = BMC Musculoskeletal Disorders | volume = 20 | issue = 1 | article-number = 151 | date = April 2019 | pmid = 30961569 | pmc = 6454763 | doi = 10.1186/s12891-019-2525-0 | doi-access = free }}</ref>
Local drug delivery by intra-articular injection may be more effective and safer in terms of increased bioavailability, less systemic exposure and reduced adverse events.<ref>{{cite journal | vauthors = Oo WM, Liu X, Hunter DJ | title = Pharmacodynamics, efficacy, safety and administration of intra-articular therapies for knee osteoarthritis | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 15 | issue = 12 | pages = 1021–1032 | date = December 2019 | pmid = 31709838 | doi = 10.1080/17425255.2019.1691997 | s2cid = 207946424 }}</ref> Several intra-articular medications for symptomatic treatment are available.<ref name="Katz 2021" />
===== Steroids ===== Joint injection of glucocorticoids (such as hydrocortisone) may provide short-term pain relief of a few weeks to a few months,<ref name="Katz 2021" /><ref>{{cite journal | vauthors = Arroll B, Goodyear-Smith F | title = Corticosteroid injections for osteoarthritis of the knee: meta-analysis | journal = BMJ | volume = 328 | issue = 7444 | page = 869 | date = April 2004 | pmid = 15039276 | pmc = 387479 | doi = 10.1136/bmj.38039.573970.7C }}</ref> or may have no effect.<ref name="juni">{{cite journal | vauthors = Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR | title = Intra-articular corticosteroid for knee osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 10 | article-number = CD005328 | date = October 2015 | pmid = 26490760 | pmc = 8884338 | doi = 10.1002/14651858.CD005328.pub3 }}</ref> Generally, the quality of research on the use of steroid injections to relieve knee osteoarthritis pain has been poor.<ref name=juni/> A 2015 Cochrane review found that intra-articular corticosteroid injections of the knee did not benefit quality of life and had no effect on knee joint space; clinical effects one to six weeks after injection could not be determined clearly due to this low quality of research.<ref name=juni/> A 2015 review reported negative effects of intra-articular corticosteroid injections at higher doses.<ref>{{cite journal | vauthors = Wernecke C, Braun HJ, Dragoo JL | title = The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review | journal = Orthopaedic Journal of Sports Medicine | volume = 3 | issue = 5 | article-number = 2325967115581163 | date = May 2015 | pmid = 26674652 | pmc = 4622344 | doi = 10.1177/2325967115581163 }}</ref>
===== Hyaluronic acid ===== The highest quality studies for hyaluronic acid injections of the hip and knee only showed a minor benefit.<ref name="Katz 2021" /> In other studies, injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis,<ref name="Rutjes12">{{cite journal | vauthors = Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S | title = Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 157 | issue = 3 | pages = 180–191 | date = August 2012 | pmid = 22868835 | doi = 10.7326/0003-4819-157-3-201208070-00473 | s2cid = 5660398 | hdl = 11380/1286620 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Jevsevar D, Donnelly P, Brown GA, Cummins DS | title = Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 97 | issue = 24 | pages = 2047–2060 | date = December 2015 | pmid = 26677239 | doi = 10.2106/jbjs.n.00743 }}</ref> but did increase risk of further pain.<ref name="Rutjes12" /> In ankle osteoarthritis, evidence is unclear.<ref>{{cite journal | vauthors = Witteveen AG, Hofstad CJ, Kerkhoffs GM | title = Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 10 | article-number = CD010643 | date = October 2015 | pmid = 26475434 | pmc = 9254328 | doi = 10.1002/14651858.CD010643.pub2 | quote = It is unclear if there is a benefit or harm for HA as treatment for ankle OA }}</ref>
===== Platelet-rich plasma ===== The effectiveness of injections of platelet-rich plasma (PRP) is unclear; there are suggestions that such injections improve function but not pain, and are associated with increased risk.{{vague|date=May 2015}}<ref>{{cite journal | vauthors = Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J | title = The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis | journal = Arthroscopy | volume = 29 | issue = 12 | pages = 2037–2048 | date = December 2013 | pmid = 24286802 | doi = 10.1016/j.arthro.2013.09.006 }}</ref><ref>{{cite journal | vauthors = Rodriguez-Merchan EC | title = Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis | journal = The Archives of Bone and Joint Surgery | volume = 1 | issue = 1 | pages = 5–8 | date = September 2013 | pmid = 25207275 | pmc = 4151401 }}</ref> A 2014 Cochrane review of studies involving PRP found the evidence to be insufficient.<ref>{{cite journal | vauthors = Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC | title = Platelet-rich therapies for musculoskeletal soft tissue injuries | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 4 | article-number = CD010071 | date = April 2014 | pmid = 24782334 | pmc = 6464921 | doi = 10.1002/14651858.CD010071.pub3 | bibcode = 2014CDaSR201410071M }}</ref>
===Radiotherapy=== Low-dose radiotherapy has been shown to improve pain and mobility of affected joints, primarily in extremities. It is approximately 70–90% effective, with minimal side effects.<ref>{{Cite journal |last1=Dove |first1=Austin P. H. |last2=Cmelak |first2=Anthony |last3=Darrow |first3=Kaleb |last4=McComas |first4=Kyra N. |last5=Chowdhary |first5=Mudit |last6=Beckta |first6=Jason |last7=Kirschner |first7=Austin N. |date=2022-10-01 |title=The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review |url=https://www.redjournal.org/article/S0360-3016(22)00357-1/pdf |journal=International Journal of Radiation Oncology, Biology, Physics |volume=114 |issue=2 |pages=203–220 |doi=10.1016/j.ijrobp.2022.04.029 |issn=1879-355X |pmid=35504501}}</ref>
===Ablation of knee sensory nerves=== {{See also|Radiofrequency ablation#Knees}}
Radiofrequency ablation of sensory knee nerves, also called ''genicular neurotomy'' or ''genicular RFA'', is an outpatient procedure used to reduce pain from knee osteoarthritis.<ref name="kidd">{{cite journal |vauthors=Kidd VD, Strum SR, Strum DS, Shah J |title=Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How |journal=JBJS Essential Surgical Techniques |volume=9 |issue=1 |pages=e10 |date=March 2019 |pmid=31333900 |pmc=6635137 |doi=10.2106/JBJS.ST.18.00016}}</ref><ref name="tran-22">{{cite journal |vauthors=Tran A, Reiter DA, Cruz AR, Gonzalez FM |title=Genicular Nerve Ablation Review Using Cooled-Radiofrequency Nerve Ablation |journal=Seminars in Interventional Radiology |volume=39 |issue=2 |pages=130–137 |date=April 2022 |pmid=35781999 |pmc=9246497 |doi=10.1055/s-0042-1745797}}</ref><ref name="conger">{{cite journal |vauthors=Conger A, Gililland J, Anderson L, Pelt CE, Peters C, McCormick ZL |title=Genicular Nerve Radiofrequency Ablation for the Treatment of Painful Knee Osteoarthritis: Current Evidence and Future Directions |journal=Pain Medicine|volume=22 |issue=Suppl 1 |pages=S20–S23 |date=July 2021 |pmid=34308957 |doi=10.1093/pm/pnab129 |url=https://academic.oup.com/painmedicine/article/22/Supplement_1/S20/6328220}}</ref>
In the procedure for genicular RFA, a guide cannula is first directed under local anesthesia and imaging (ultrasound or fluoroscopy) to each target genicular nerve, then the radiofrequency electrode is passed through the cannula, and the electrode tip is heated to about {{cvt|80|C|F}} for one minute to cauterize a small segment of the nerve.<ref name=kidd/> The heat destroys that segment of the nerve, which is prevented from sending pain signals to the brain.<ref name=kidd/>
As of 2023, reviews of clinical outcomes indicated that efficacy for reducing knee pain was achieved by ablating three or more branches of the genicular nerve (one of the articular branches of the tibial nerve).<ref name=kidd/><ref name=conger/><ref name="tran-23">{{cite journal | doi=10.1007/s00256-022-04058-w | title=Review of cooled radiofrequency ablation utilization for the treatment of symptomatic advanced knee arthritis and total knee arthroplasty | date=2023 | last1=Tran | first1=Andrew | last2=Gonzalez | first2=Felix M. | journal=Skeletal Radiology | volume=52 | issue=5 | pages=941–949 | pmid=35462577|url=https://link.springer.com/article/10.1007/s00256-022-04058-w| url-access=subscription }}</ref> Other sources indicate 4–5 genicular nerve targets may be justified for ablation to optimize pain relief,<ref name=tran-22/><ref name=conger/> while a 2022 analysis indicated that as many as 10 genicular nerve targets for RFA would produce better long-term relief of knee pain.<ref>{{cite journal|title=How I Do It: Genicular Nerve Radiofrequency Ablation|vauthors=Greco G, Torres J, Kohan L|journal=ASRA News |date=2022|doi=10.52211/asra020122.006|url=https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2022/02/07/how-i-do-it-genicular-nerve-radiofrequency-ablation|url-access=subscription}}</ref>
Knee pain relief of 50% or more following genicular RFA may last from several months to two years,<ref name=kidd/><ref name=tran-23/> and can be repeated by the same outpatient procedure when pain recurs.<ref name=kidd/>
Injection of phenol may be used as a neurolytic treatment of sensory knee nerves to relieve chronic pain from knee osteoarthritis.<ref name="tay">{{cite journal |vauthors=Tay MR, Mittal N, Yao S, Farag J |title=Chemical neurolysis of genicular nerves for chronic non-cancer knee pain: a scoping review |journal=Pain Medicine |volume=26 |issue=2 |pages=76–89 |date=February 2025 |pmid=39475441 |doi=10.1093/pm/pnae109 |url=https://academic.oup.com/painmedicine/article/26/2/76/7852839|url-access=subscription }}</ref>
===Surgery===
==== Bone fusion ==== Arthrodesis (fusion) of the bones may be an option in some types of osteoarthritis. An example is ankle osteoarthritis, in which ankle fusion may be used in severe cases not responsive to other therapies.<ref name="pmid32940217">{{cite journal | vauthors = Manke E, Yeo Eng Meng N, Rammelt S | title = Ankle Arthrodesis – a Review of Current Techniques and Results | journal = Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca | volume = 87 | issue = 4 | pages = 225–236 | date = 2020 | pmid = 32940217 | doi = 10.55095/achot2020/035 | s2cid = 221770606 | doi-access = free }}</ref><ref name="Shibuya 2020">{{cite journal |last1=Shibuya |first1=Naohiro |last2=McAlister |first2=Jeffery E. |last3=Prissel |first3=Mark A. |last4=Piraino |first4=Jason A. |last5=Joseph |first5=Robert M. |last6=Theodoulou |first6=Michael H. |last7=Jupiter |first7=Daniel C. |title=Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis |journal=The Journal of Foot and Ankle Surgery |date=September 2020 |volume=59 |issue=5 |pages=1019–1031 |doi=10.1053/j.jfas.2019.10.007 |pmid=32778440 }}</ref>
==== Joint replacement ==== If the impact of symptoms of osteoarthritis on quality of life is significant and more conservative management is ineffective, joint replacement surgery may be used. Evidence supports joint replacement for both knees and hips as it is both clinically effective<ref name="pmid19057730">{{cite journal | vauthors = Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG | title = Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review | journal = Canadian Journal of Surgery | volume = 51 | issue = 6 | pages = 428–436 | date = December 2008 | pmid = 19057730 | pmc = 2592576 }}</ref><ref name="pmid22398175">{{cite journal | vauthors = Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ | title = Knee replacement | journal = Lancet | volume = 379 | issue = 9823 | pages = 1331–1340 | date = April 2012 | pmid = 22398175 | doi = 10.1016/S0140-6736(11)60752-6 | s2cid = 28484710 }}</ref> and cost-effective.<ref>{{cite journal | vauthors = Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR | title = Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis | journal = The Bone & Joint Journal | volume = 95-B | issue = 1 | pages = 115–121 | date = January 2013 | pmid = 23307684 | doi = 10.1302/0301-620X.95B1.29835 }}</ref><ref>{{cite journal | vauthors = Daigle ME, Weinstein AM, Katz JN, Losina E | title = The cost-effectiveness of total joint arthroplasty: a systematic review of published literature | journal = Best Practice & Research. Clinical Rheumatology | volume = 26 | issue = 5 | pages = 649–658 | date = October 2012 | pmid = 23218429 | pmc = 3879923 | doi = 10.1016/j.berh.2012.07.013 }}</ref>
People who underwent total knee replacement had improved quality of life, were feeling better compared to those who did not have surgery, and may have short- and long-term benefits for quality of life in terms of pain and function.<ref>{{cite journal | vauthors = Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M | title = Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative | journal = BMJ | volume = 356 | article-number = j1131 | date = March 2017 | pmid = 28351833 | pmc = 6284324 | doi = 10.1136/bmj.j1131 }}</ref><ref>{{cite journal | vauthors = Shan L, Shan B, Suzuki A, Nouh F, Saxena A | title = Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis | language = en-US | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 97 | issue = 2 | pages = 156–168 | date = January 2015 | pmid = 25609443 | doi = 10.2106/JBJS.M.00372 }}</ref> The risk of death within the first 90 days after hip and knee replacements is less than 1%.<ref name="Katz 2021" /> The risk of serious complications (such as prosthetic joint infections which may require removal of the artificial joint, blood clots, joint dislocations) is less than 5% after hip or knee replacements.<ref name="Katz 2021" /> 90% of people with a hip replacement and 80% of those with a knee replacement reported little or no arthritis related pain after the procedure.<ref name="Katz 2021" /> Less than 10% of artificial knees and less than 20% of artificial hips required replacements over 20 years after the initial surgery.<ref name="Katz 2021" /> Arthroscopic debridement of the knee, also known as "joint resurfacing" is not recommended for the treatment of knee osteoarthritis and has a limited role in people who have osteoarthritis with a meniscal tear who have failed other treatments.<ref name="Katz 2021" />
==== Shoulder replacement ==== For people who have shoulder osteoarthritis and do not respond to medications, surgical options include a shoulder hemiarthroplasty (replacing a part of the joint) and a total shoulder arthroplasty (replacing the joint).<ref>{{cite journal | vauthors = Singh JA, Sperling J, Buchbinder R, McMaken K | title = Surgery for shoulder osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 10 | article-number = CD008089 | date = October 2010 | pmid = 20927773 | doi = 10.1002/14651858.CD008089.pub2 }}</ref><ref name=":2">{{cite journal | vauthors = Al Mana L, Rajaratnam K | title = Cochrane in CORR®: Shoulder Replacement Surgery For Osteoarthritis And Rotator Cuff Tear Arthropathy | journal = Clinical Orthopaedics and Related Research | volume = 478 | issue = 11 | pages = 2431–2433 | date = November 2020 | pmid = 33055541 | pmc = 7571914 | doi = 10.1097/CORR.0000000000001523 }}</ref> Demand for this treatment is expected to increase by 750% by the year 2030.<ref name=":2" /> There are different options for shoulder replacement surgeries, however there is a lack of evidence in the form of high-quality randomized controlled trials to determine which type of shoulder replacement surgery is most effective in different situations, what are the risks involved with different approaches, or how the procedure compares to other treatment options.<ref name=":2" /><ref name=":5">{{cite journal | vauthors = Craig RS, Goodier H, Singh JA, Hopewell S, Rees JL | title = Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 4 | article-number = CD012879 | date = April 2020 | pmid = 32315453 | pmc = 7173708 | doi = 10.1002/14651858.CD012879.pub2 }}</ref> There is some low-quality evidence that indicates that when comparing total shoulder arthroplasty over hemiarthroplasty, no large clinical benefit was detected in the short term.<ref name=":5" /> It is not clear if the risk of harm differs between total shoulder arthroplasty and a hemiarthroplasty approach.<ref name=":5" />
==== Other surgical options ==== Osteotomy may be useful in people with knee osteoarthritis, but has not been well studied, and it is unclear whether it is more effective than non-surgical treatments or other types of surgery.<ref>{{cite journal | vauthors = Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM, Verhaar JA | title = Osteotomy for treating knee osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | article-number = CD004019 | date = December 2014 | pmid = 25503775 | pmc = 7173694 | doi = 10.1002/14651858.CD004019.pub4 }}</ref><ref name=":3" /> Arthroscopic surgery is largely not recommended, as it does not improve outcomes in knee osteoarthritis,<ref>{{cite journal | vauthors = Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM | title = A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative | journal = Seminars in Arthritis and Rheumatism | volume = 43 | issue = 6 | pages = 701–712 | date = June 2014 | pmid = 24387819 | doi = 10.1016/j.semarthrit.2013.11.012 }}</ref><ref>{{cite journal | vauthors = Katz JN, Brownlee SA, Jones MH | title = The role of arthroscopy in the management of knee osteoarthritis | journal = Best Practice & Research. Clinical Rheumatology | volume = 28 | issue = 1 | pages = 143–156 | date = February 2014 | pmid = 24792949 | pmc = 4010873 | doi = 10.1016/j.berh.2014.01.008 }}</ref> and may result in harm.<ref>{{cite journal | vauthors = Thorlund JB, Juhl CB, Roos EM, Lohmander LS | title = Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms | journal = BMJ | volume = 350 | article-number = h2747 | date = June 2015 | pmid = 26080045 | pmc = 4469973 | doi = 10.1136/bmj.h2747 }}</ref> It is unclear whether surgery is beneficial in people with mild to moderate knee osteoarthritis.<ref name=":3">{{cite journal | vauthors = Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, Price AJ | title = Surgical interventions for symptomatic mild to moderate knee osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 7 | article-number = CD012128 | date = July 2019 | pmid = 31322289 | pmc = 6639936 | doi = 10.1002/14651858.CD012128.pub2 }}</ref>
===Unverified treatments===
====Glucosamine and chondroitin==== The effectiveness of glucosamine is controversial.<ref>{{cite journal | vauthors = Burdett N, McNeil JD | title = Difficulties with assessing the benefit of glucosamine sulphate as a treatment for osteoarthritis | journal = International Journal of Evidence-Based Healthcare | volume = 10 | issue = 3 | pages = 222–226 | date = September 2012 | pmid = 22925619 | doi = 10.1111/j.1744-1609.2012.00279.x }}</ref> Reviews have found it to be equal to<ref>{{cite journal | vauthors = Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S | title = Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis | journal = BMJ | volume = 341 | article-number = c4675 | date = September 2010 | pmid = 20847017 | pmc = 2941572 | doi = 10.1136/bmj.c4675 }}</ref><ref>{{cite journal | vauthors = Wu D, Huang Y, Gu Y, Fan W | title = Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials | journal = International Journal of Clinical Practice | volume = 67 | issue = 6 | pages = 585–594 | date = June 2013 | pmid = 23679910 | doi = 10.1111/ijcp.12115 | s2cid = 24251411 }}</ref> or slightly better than placebo.<ref>{{cite report | vauthors = | title = Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review | volume = 38 | date = Oct 2011 | pmid = 22091473 | url = https://www.ncbi.nlm.nih.gov/books/NBK65646/ | url-status = live | publisher = Agency for Healthcare Research and Quality (AHRQ) | series = Comparative Effectiveness Reviews | archive-url = https://web.archive.org/web/20130310223140/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016485/ | archive-date = 10 March 2013 }}</ref><ref>{{cite journal | vauthors = Miller KL, Clegg DO | title = Glucosamine and chondroitin sulfate | journal = Rheumatic Disease Clinics of North America | volume = 37 | issue = 1 | pages = 103–118 | date = February 2011 | pmid = 21220090 | doi = 10.1016/j.rdc.2010.11.007 | quote = The best current evidence suggests that the effect of these supplements, alone or in combination, on OA pain, function, and radiographic change is marginal at best. }}</ref> A difference may exist between glucosamine sulfate and glucosamine hydrochloride, with glucosamine sulfate showing a benefit and glucosamine hydrochloride not.<ref>{{cite journal | vauthors = Rovati LC, Girolami F, Persiani S | title = Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties | journal = Therapeutic Advances in Musculoskeletal Disease | volume = 4 | issue = 3 | pages = 167–180 | date = June 2012 | pmid = 22850875 | pmc = 3400104 | doi = 10.1177/1759720X12437753 }}</ref> The evidence for glucosamine sulfate affecting osteoarthritis progression is somewhat unclear and if present likely modest.<ref>{{cite journal | vauthors = Gregory PJ, Fellner C | title = Dietary supplements as disease-modifying treatments in osteoarthritis: a critical appraisal | journal = P & T | volume = 39 | issue = 6 | pages = 436–452 | date = June 2014 | pmid = 25050057 | pmc = 4103717 }}</ref> The Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effect is observed after six months<ref>{{cite journal | vauthors = Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P | title = OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines | journal = Osteoarthritis and Cartilage | volume = 16 | issue = 2 | pages = 137–162 | date = February 2008 | pmid = 18279766 | doi = 10.1016/j.joca.2007.12.013 | title-link = doi | doi-access = free }}</ref> and the National Institute for Health and Care Excellence no longer recommends its use.<ref name=NICE/> Despite the difficulty in determining the efficacy of glucosamine, it remains a treatment option.<ref name=Hen2012>{{cite journal | vauthors = Henrotin Y, Mobasheri A, Marty M | title = Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis? | journal = Arthritis Research & Therapy | volume = 14 | issue = 1 | page = 201 | date = January 2012 | pmid = 22293240 | pmc = 3392795 | doi = 10.1186/ar3657 | doi-access = free }}</ref> The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends glucosamine sulfate and chondroitin sulfate for knee osteoarthritis.<ref>{{cite journal | vauthors = Bruyère O, Cooper C, Pelletier JP, Branco J, Luisa Brandi M, Guillemin F, Hochberg MC, Kanis JA, Kvien TK, Martel-Pelletier J, Rizzoli R, Silverman S, Reginster JY | title = An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) | journal = Seminars in Arthritis and Rheumatism | volume = 44 | issue = 3 | pages = 253–263 | date = December 2014 | pmid = 24953861 | doi = 10.1016/j.semarthrit.2014.05.014 | title-link = doi | doi-access = free | hdl = 10362/145650 | hdl-access = free }}</ref> Its use as a therapy for osteoarthritis is usually safe.<ref name=Hen2012/><ref>{{cite journal | vauthors = Vangsness CT, Spiker W, Erickson J | title = A review of evidence-based medicine for glucosamine and chondroitin sulfate use in knee osteoarthritis | journal = Arthroscopy | volume = 25 | issue = 1 | pages = 86–94 | date = January 2009 | pmid = 19111223 | doi = 10.1016/j.arthro.2008.07.020 }}</ref>
A 2015 Cochrane review of clinical trials of chondroitin found that most were of low quality, but that there was some evidence of short-term improvement in pain and few side effects; it does not appear to improve or maintain the health of affected joints.<ref name="pmid25629804">{{cite journal | vauthors = Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ | title = Chondroitin for osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD005614 | date = January 2015 | pmid = 25629804 | pmc = 4881293 | doi = 10.1002/14651858.CD005614.pub2 | veditors = Singh JA }}</ref>
====Supplements==== Avocado–soybean unsaponifiables (ASU) is an extract made from avocado oil and soybean oil<ref name=Cochrane2014>{{cite journal | vauthors = Cameron M, Chrubasik S | title = Oral herbal therapies for treating osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 5 | article-number = CD002947 | date = May 2014 | pmid = 24848732 | pmc = 4494689 | doi = 10.1002/14651858.CD002947.pub2 }}</ref> sold under many brand names worldwide as a dietary supplement<ref>{{cite journal | vauthors = Christiansen BA, Bhatti S, Goudarzi R, Emami S | title = Management of Osteoarthritis with Avocado/Soybean Unsaponifiables | journal = Cartilage | volume = 6 | issue = 1 | pages = 30–44 | date = January 2015 | pmid = 25621100 | pmc = 4303902 | doi = 10.1177/1947603514554992 }}</ref> and as a prescription drug in France.<ref>{{cite web|title=Piascledine|url=http://www.has-sante.fr/portail/upload/docs/application/pdf/2013-07/piascledine_ct_9142.pdf|publisher=Haute Autorité de santé|date=25 July 2013|url-status=live|archive-url=https://web.archive.org/web/20161230085855/http://www.has-sante.fr/portail/upload/docs/application/pdf/2013-07/piascledine_ct_9142.pdf|archive-date=30 December 2016 }}</ref> A 2014 Cochrane review found that while ASU might help relieve pain in the short term for some people with osteoarthritis, it does not appear to improve or maintain the health of affected joints.<ref name=Cochrane2014/> The review noted a high-quality, two-year clinical trial comparing ASU to chondroitin {{ndash}} which has uncertain efficacy in osteoarthritis {{ndash}} with no difference between the two agents.<ref name=Cochrane2014/> The review also found there is insufficient evidence of ASU safety.<ref name=Cochrane2014/>
Only a few moderate-quality studies of ''Boswellia serrata'' showed small improvements in pain and function.<ref name=Cochrane2014/> Curcumin<ref>{{cite journal | vauthors = Wang Z, Singh A, Jones G, Winzenberg T, Ding C, Chopra A, Das S, Danda D, Laslett L, Antony B | title = Efficacy and Safety of Turmeric Extracts for the Treatment of Knee Osteoarthritis: a Systematic Review and Meta-analysis of Randomised Controlled Trials | journal = Current Rheumatology Reports | volume = 23 | issue = 2 | article-number = 11 | date = January 2021 | pmid = 33511486 | doi = 10.1007/s11926-020-00975-8 | s2cid = 231724282 | url = https://figshare.com/articles/journal_contribution/22998386 }}</ref> and s-adenosyl methionine (SAMe)<ref name=Silva2011/><ref name="nahin">{{cite journal | vauthors = Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ | title = Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States | journal = Mayo Clinic Proceedings | volume = 91 | issue = 9 | pages = 1292–1306 | date = September 2016 | pmid = 27594189 | pmc = 5032142 | doi = 10.1016/j.mayocp.2016.06.007 }}</ref> showed little effect in improving pain. A 2009 Cochrane review recommended against the routine use of SAMe, as there has not been sufficient high-quality clinical research to prove its effect.<ref>{{cite journal | vauthors = Rutjes AW, Nüesch E, Reichenbach S, Jüni P | title = S-Adenosylmethionine for osteoarthritis of the knee or hip | journal = The Cochrane Database of Systematic Reviews | volume = 2009 | issue = 4 | article-number = CD007321 | date = October 2009 | pmid = 19821403 | pmc = 7061276 | doi = 10.1002/14651858.CD007321.pub2 }}</ref>
A 2021 review found that hydroxychloroquine (HCQ) had no benefit in reducing pain and improving physical function in hand or knee osteoarthritis, and the off-label use of HCQ for people with osteoarthritis should be discouraged.<ref>{{cite journal | vauthors = Singh A, Kotlo A, Wang Z, Dissanayaka T, Das S, Antony B | title = Efficacy and safety of hydroxychloroquine in osteoarthritis: a systematic review and meta-analysis of randomized controlled trials | journal = The Korean Journal of Internal Medicine | volume = 37 | issue = 1 | pages = 210–221 | date = January 2022 | pmid = 33882635 | pmc = 8747931 | doi = 10.3904/kjim.2020.605 | doi-access = free }}</ref> There is no evidence for the use of colchicine for treating the pain of hand or knee arthritis.<ref name="Singh">{{cite journal | vauthors = Singh A, Molina-Garcia P, Hussain S, Paul A, Das SK, Leung YY, Hill CL, Danda D, Samuels J, Antony B | title = Efficacy and safety of colchicine for the treatment of osteoarthritis: a systematic review and meta-analysis of intervention trials | journal = Clinical Rheumatology | volume = 42 | issue = 3 | pages = 889–902 | date = March 2023 | pmid = 36224305 | pmc = 9935673 | doi = 10.1007/s10067-022-06402-w | doi-access = free }}</ref>
There is limited evidence to support the use of hyaluronan,<ref>{{cite journal | vauthors = Oe M, Tashiro T, Yoshida H, Nishiyama H, Masuda Y, Maruyama K, Koikeda T, Maruya R, Fukui N | title = Oral hyaluronan relieves knee pain: a review | journal = Nutrition Journal | volume = 15 | article-number = 11 | date = January 2016 | pmid = 26818459 | pmc = 4729158 | doi = 10.1186/s12937-016-0128-2 | doi-access = free }}</ref> methylsulfonylmethane,<ref name=Silva2011/> rose hip,<ref name=Silva2011>{{cite journal | vauthors = De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ | title = Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review | journal = Rheumatology | volume = 50 | issue = 5 | pages = 911–920 | date = May 2011 | pmid = 21169345 | doi = 10.1093/rheumatology/keq379 | title-link = doi | doi-access = free }}</ref> capsaicin,<ref name=Silva2011/> or vitamin D.<ref name=Silva2011/><ref>{{cite journal | vauthors = Hussain S, Singh A, Akhtar M, Najmi AK | title = Vitamin D supplementation for the management of knee osteoarthritis: a systematic review of randomized controlled trials | journal = Rheumatology International | volume = 37 | issue = 9 | pages = 1489–1498 | date = September 2017 | pmid = 28421358 | doi = 10.1007/s00296-017-3719-0 | s2cid = 23994681 }}</ref>
====Acupuncture and other interventions==== While acupuncture leads to improvements in pain relief, this improvement is small and may be of questionable importance.<ref>{{cite journal | vauthors = Lin X, Huang K, Zhu G, Huang Z, Qin A, Fan S | title = The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 98 | issue = 18 | pages = 1578–1585 | date = September 2016 | pmid = 27655986 | doi = 10.2106/jbjs.15.00620 }}</ref> Waiting list–controlled trials for peripheral joint osteoarthritis do show clinically relevant benefits, but these may be due to placebo effects.<ref name="pmid20091527">{{cite journal | vauthors = Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM | title = Acupuncture for peripheral joint osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD001977 | date = January 2010 | volume = 2010 | pmid = 20091527 | pmc = 3169099 | doi = 10.1002/14651858.CD001977.pub2 | veditors = Manheimer E }}</ref><ref>{{cite journal | vauthors = Manheimer E, Cheng K, Wieland LS, Shen X, Lao L, Guo M, Berman BM | title = Acupuncture for hip osteoarthritis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD013010 | date = May 2018 | pmid = 29729027 | pmc = 5984198 | doi = 10.1002/14651858.CD013010 }}</ref> Acupuncture does not seem to produce long-term benefits.<ref name="pmid18227323">{{cite journal | vauthors = Wang SM, Kain ZN, White PF | title = Acupuncture analgesia: II. Clinical considerations | journal = Anesthesia and Analgesia | volume = 106 | issue = 2 | pages = 611–21, table of contents | date = February 2008 | pmid = 18227323 | doi = 10.1213/ane.0b013e318160644d | url = http://www.mvclinic.es/wp-content/uploads/2008_Wang_Acupuncture-Analgesia_II_Clinical-Considerations.pdf | url-status = live | s2cid = 24912939 | archive-url = https://web.archive.org/web/20161227125348/http://www.mvclinic.es/wp-content/uploads/2008_Wang_Acupuncture-Analgesia_II_Clinical-Considerations.pdf | archive-date = 27 December 2016 }}</ref>
Electrostimulation techniques such as TENS have been used to treat osteoarthritis in the knee. However, there is no conclusive evidence to show that it reduces pain or disability.<ref name="pmid19821296">{{cite journal | vauthors = Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P | title = Transcutaneous electrostimulation for osteoarthritis of the knee | journal = The Cochrane Database of Systematic Reviews | volume = 2009 | issue = 4 | article-number = CD002823 | date = October 2009 | pmid = 19821296 | pmc = 7120411 | doi = 10.1002/14651858.CD002823.pub2 | veditors = Rutjes AW }}</ref> A Cochrane review of low-level laser therapy found unclear evidence of benefit,<ref>{{cite journal | vauthors = Brosseau L, Welch V, Wells G, DeBie R, Gam A, Harman K, Morin M, Shea B, Tugwell P | title = Low level laser therapy (Classes I, II and III) for treating osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD002046 | date = 2004 | pmid = 15266461 | doi = 10.1002/14651858.CD002046.pub2 | veditors = Brosseau L }} {{Retracted |doi=10.1002/14651858.cd002046.pub3|intentional=yes}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/17636694|date = April 2026}}{{better source|date=October 2024}} whereas another review found short-term pain relief for osteoarthritic knees.<ref>{{cite journal | vauthors = Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE | title = Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials | journal = BMC Musculoskeletal Disorders | volume = 8 | issue = 1 | article-number = 51 | date = June 2007 | pmid = 17587446 | pmc = 1931596 | doi = 10.1186/1471-2474-8-51 | doi-access = free }}</ref>
Further research is needed to determine if balneotherapy for osteoarthritis (mineral baths or spa treatments) improves a person's quality of life or ability to function.<ref>{{cite journal | vauthors = Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie RA, de Vet HC | title = Balneotherapy for osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD006864 | date = October 2007 | pmid = 17943920 | doi = 10.1002/14651858.CD006864 | hdl = 1765/75176 | hdl-access = free }}</ref>
There is low-quality evidence that therapeutic ultrasound may be beneficial for people with osteoarthritis of the knee; however, further research is needed to confirm and determine the degree and significance of this potential benefit.<ref>{{cite journal | vauthors = Rutjes AW, Nüesch E, Sterchi R, Jüni P | title = Therapeutic ultrasound for osteoarthritis of the knee or hip | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD003132 | date = January 2010 | pmid = 20091539 | doi = 10.1002/14651858.CD003132.pub2 | hdl = 11380/1286606 | hdl-access = free }}</ref> Therapeutic ultrasound is safe and reduces pain and improves physical function in knee osteoarthritis. While phonophoresis does not improve functions, it may offer greater pain relief than standard non-drug ultrasound.<ref>{{cite journal | vauthors = Wu Y, Zhu S, Lv Z, Kan S, Wu Q, Song W, Ning G, Feng S | title = Effects of therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis | journal = Clinical Rehabilitation | volume = 33 | issue = 12 | pages = 1863–1875 | date = December 2019 | pmid = 31382781 | doi = 10.1177/0269215519866494 | s2cid = 199452082 }}</ref>
There is weak evidence suggesting that electromagnetic field treatment may result in moderate pain relief; however, further research is necessary, and it is not known if electromagnetic field treatment can improve quality of life or function.<ref>{{cite journal | vauthors = Li S, Yu B, Zhou D, He C, Zhuo Q, Hulme JM | title = Electromagnetic fields for treating osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 12 | article-number = CD003523 | date = December 2013 | pmid = 24338431 | doi = 10.1002/14651858.CD003523.pub2 | pmc = 13080287 }}</ref>
==Epidemiology== [[File:Osteoarthritis world map - DALY - WHO2004.svg|thumb|alt=2004 global heat map of osteoarthritis-adjusted life year by country|Disability-adjusted life year for osteoarthritis per 100,000 inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009 }}</ref> {{Col-begin}} {{Col-break}} {{legend|#b3b3b3|no data}} {{legend|#ffff65|≤ 200}} {{legend|#fff200|200–220}} {{legend|#ffdc00|220–240}} {{legend|#ffc600|240–260}} {{legend|#ffb000|260–280}} {{legend|#ff9a00|280–300}} {{Col-break}} {{legend|#ff8400|300–320}} {{legend|#ff6e00|320–340}} {{legend|#ff5800|340–360}} {{legend|#ff4200|360–380}} {{legend|#ff2c00|380–400}} {{legend|#cb0000|≥ 400}} {{col-end}}]] Globally, {{as of|2010|lc=y}}, approximately 250{{nbsp}}million people had osteoarthritis of the knee (3.6% of the population).<ref name="cross2014"/><ref name=LancetEpi2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref> Hip osteoarthritis affects about 0.85% of the population.<ref name=cross2014>{{cite journal | vauthors = Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L | title = The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study | journal = Annals of the Rheumatic Diseases | volume = 73 | issue = 7 | pages = 1323–1330 | date = July 2014 | pmid = 24553908 | doi = 10.1136/annrheumdis-2013-204763 | s2cid = 37565913 }}</ref>
{{As of|2004}}, osteoarthritis globally causes moderate to severe disability in 43.4 million people.<ref>{{cite book |title=The Global Burden of Disease: 2004 Update |year=2008 |publisher=World Health Organization (WHO) |location=Geneva |isbn=978-92-4-156371-0 |page=35 |chapter=Table 9: Estimated prevalence of moderate and severe disability (millions) for leading disabling conditions by age, for high-income and low- and middle-income countries, 2004 |chapter-url=https://books.google.com/books?id=xrYYZ6Jcfv0C&pg=PA35}}</ref> Together, knee and hip osteoarthritis had a ranking for disability globally of 11th among 291 disease conditions assessed.<ref name=cross2014/>
=== Middle East and North Africa (MENA) === In the Middle East and North Africa from 1990 to 2019, the prevalence of people with hip osteoarthritis increased three{{ndash}}fold over the three decades, a total of 1.28 million cases.<ref>{{cite journal | vauthors = Hoveidaei AH, Nakhostin-Ansari A, Hosseini-Asl SH, Khonji MS, Razavi SE, Darijani SR, Citak M | title = Increasing burden of hip osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019 | journal = Archives of Orthopaedic and Trauma Surgery | volume = 143 | issue = 6 | pages = 3563–3573 | date = June 2023 | pmid = 36038782 | doi = 10.1007/s00402-022-04582-3 | s2cid = 251912479 }}</ref> It increased 2.88-fold, from 6.16 million cases to 17.75 million, between 1990 and 2019 for knee osteoarthritis.<ref>{{cite journal | vauthors = Hoveidaei AH, Nakhostin-Ansari A, Chalian M, Roshanshad A, Khonji MS, Mashhadiagha A, Pooyan A, Citak M | title = Burden of knee osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019 | journal = Archives of Orthopaedic and Trauma Surgery | date = April 2023 | volume = 143 | issue = 10 | pages = 6323–6333 | pmid = 37005934 | doi = 10.1007/s00402-023-04852-8 | s2cid = 257911199 }}</ref> Hand osteoarthritis in MENA also increased 2.7-fold, from 1.6 million cases to 4.3 million from 1990 to 2019.<ref>{{cite journal | vauthors = Hoveidaei AH, Nakhostin-Ansari A, Chalian M, Razavi SE, Khonji MS, Hosseini-Asl SH, Darijani SR, Pooyan A, LaPorte DM | title = Burden of Hand Osteoarthritis in the Middle East and North Africa (MENA): An Epidemiological Analysis From 1990 to 2019 | journal = The Journal of Hand Surgery | volume = 48 | issue = 3 | pages = 245–256 | date = March 2023 | pmid = 36710229 | doi = 10.1016/j.jhsa.2022.11.016 | s2cid = 256385406 }}</ref>
=== United States === {{As of|2012}}, osteoarthritis affected 52.5 million people in the United States, approximately 50% of whom were 65 years or older.<ref name=cdc2016>{{cite web|url=https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm|title=Arthritis-Related Statistics: Prevalence of Arthritis in the United States|publisher=U.S. Centers for Disease Control and Prevention (CDC) |date=9 November 2016|url-status=live|archive-url=https://web.archive.org/web/20161229100602/https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm|archive-date=29 December 2016 }}</ref> It is estimated that 80% of the population have radiographic evidence of osteoarthritis by age 65, although only 60% of those will have symptoms.<ref name=Green2001>{{cite journal | vauthors = Green GA | title = Understanding NSAIDs: from aspirin to COX-2 | journal = Clinical Cornerstone | volume = 3 | issue = 5 | pages = 50–60 | year = 2001 | pmid = 11464731 | doi = 10.1016/S1098-3597(01)90069-9 }}</ref> The rate of osteoarthritis in the United States is forecast to be 78 million (26%) adults by 2040.<ref name=cdc2016/>
In the United States, there were approximately 964,000 hospitalizations for osteoarthritis in 2011, a rate of 31 stays per 10,000 population.<ref>Pfuntner A., Wier L.M., Stocks C. Most Frequent Conditions in U.S. Hospitals, 2011. HCUP Statistical Brief #162. September 2013. Agency for Healthcare Research and Quality, Rockville, Maryland.{{cite web |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.jsp |title=Most Frequent Conditions in U.S. Hospitals, 2011 #162 |access-date=9 February 2016 |url-status=live |archive-url=https://web.archive.org/web/20160304032807/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.jsp |archive-date=4 March 2016 }}</ref> With an aggregate cost of $14.8 billion ($15,400 per stay), it was the second-most expensive condition seen in US hospital stays in 2011. By payer, it was the second-most costly condition billed to Medicare and private insurance.<ref>{{cite web |vauthors=Torio CM, Andrews RM |title=National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011 |publisher=Agency for Healthcare Research and Quality |location=Rockville, Maryland |date=August 2013 |url=http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp |url-status=live |archive-url=https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp |archive-date=14 March 2017 }}</ref><ref>{{cite book | vauthors = Pfuntner A, Wier LM, Steiner C | chapter = Costs for Hospital Stays in the United States, 2011: Statistical Brief #168 | title = Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. | location = Rockville (MD) | publisher = Agency for Healthcare Research and Quality (US) 2006 February | date = December 2013 | pmid = 24455786 }}</ref>
=== Europe === In Europe, the number of individuals affected by osteoarthritis has increased from 27.9 million in 1990 to 50.8 million in 2019. Hand osteoarthritis was the second most prevalent type, affecting an estimated 12.5 million people. In 2019, knee osteoarthritis was the 18th most common cause of years lived with disability (YLDs) in Europe, accounting for 1.28% of all YLDs. This has increased from 1.12% in 1990.<ref>{{cite web |date=8 November 2017 |title=PEMFs and knee osteoarthritis – almagia |url=https://almagia.com/pemfs-and-knee-osteoarthritis/,%20https://almagia.com/pemfs-and-knee-osteoarthritis/ |access-date=18 August 2023 |language=en-US }}{{dead link|date=November 2025}}</ref>
=== India === In India, the number of individuals affected by osteoarthritis has increased from 23.46 million in 1990 to 62.35 million in 2019. Knee osteoarthritis was the most prevalent type of osteoarthritis, followed by hand osteoarthritis. In 2019, osteoarthritis was the 20th most common cause of years lived with disability (YLDs) in India, accounting for 1.48% of all YLDs, which increased from 1.25% and 23rd most common cause in 1990.<ref>{{cite journal | vauthors = Singh A, Das S, Chopra A, Danda D, Paul BJ, March L, Mathew AJ, Shenoy P, Gotay C, Palmer AJ, Antony B | title = Burden of osteoarthritis in India and its states, 1990–2019: findings from the Global Burden of disease study 2019 | journal = Osteoarthritis and Cartilage | volume = 30 | issue = 8 | pages = 1070–1078 | date = August 2022 | pmid = 35598766 | doi = 10.1016/j.joca.2022.05.004 | doi-access = free }}</ref>
==History==
===Etymology=== Osteoarthritis is derived from the prefix ''osteo-'' (from {{langx|grc|ὀστέον|ostéon|bone}}) combined with ''arthritis'' (from {{lang|grc|ἀρθρῖτῐς}}, {{transliteration|grc|arthrîtis}}, {{Literal translation|'of or in the joint'|lk=no}}), which is itself derived from ''arthr-'' (from {{lang|grc|ἄρθρον}}, {{transliteration|grc|árthron}}, {{Literal translation|'joint, limb'|lk=no}}) and ''-itis'' (from {{lang|grc|-ῖτις}}, {{transliteration|grc|-îtis}}, {{Literal translation|'pertaining to'|lk=no}}), the latter suffix having come to be associated with inflammation.<ref>{{cite book | vauthors = Devaraj TL |title= Nature Cure for Common Diseases |year=2011 |publisher= Arya Publication |location= New Delhi |isbn= 978-81-89093-74-7 |page=368 |chapter= Chapter 41: Nature cure yoga for osteoarthritis |chapter-url= https://books.google.com/books?id=PdwRBAAAQBAJ&pg=PA368}}</ref> The ''-itis'' of osteoarthritis could be considered misleading as inflammation is not a conspicuous feature. Some clinicians refer to this condition as ''osteoarthrosis'' to signify the lack of inflammatory response,<ref>{{cite journal | vauthors = Tanchev P |date= 17 April 2017 |title= Osteoarthritis or Osteoarthrosis: Commentary on Misuse of Terms |journal= Reconstructive Review |volume=7 |issue=1 |page= 178 |issn= 2331-2270 |doi=10.15438/rr.7.1.178|doi-access= free }}</ref> the suffix ''-osis'' (from {{lang|grc|-ωσις}}, {{transliteration|grc|-ōsis}}, {{Literal translation|'(abnormal) state, condition, or action'|lk=no}}) simply referring to the pathosis itself.
==Other animals==
Osteoarthritis has been reported in several species of animals all over the world, including marine animals and even some fossils; including but not limited to: cats, many rodents, cattle, deer, rabbits, sheep, camels, elephants, buffalo, hyena, lions, mules, pigs, tigers, kangaroos, dolphins, dugong, and horses.<ref name="Nganvongpanit Soponteerakul Kaewkumpai Punyapornwithaya 2017 pp. 140–155">{{cite journal | vauthors = Nganvongpanit K, Soponteerakul R, Kaewkumpai P, Punyapornwithaya V, Buddhachat K, Nomsiri R, Kaewmong P, Kittiwatanawong K, Chawangwongsanukun R, Angkawanish T, Thitaram C, Mahakkanukrauh P | title = Osteoarthritis in two marine mammals and 22 land mammals: learning from skeletal remains | journal = Journal of Anatomy | volume = 231 | issue = 1 | pages = 140–155 | date = July 2017 | pmid = 28542897 | pmc = 5472524 | doi = 10.1111/joa.12620 | publisher = Wiley }}</ref>
Osteoarthritis has been reported in fossils of the large carnivorous dinosaur ''Allosaurus fragilis''.<ref name="molnar-pathology">{{cite book | vauthors = Molnar RE |year=2001 |chapter=Theropod Paleopathology: A Literature Survey |title=Mesozoic Vertebrate Life | veditors = Tanke DH, Carpenter K, Skrepnick MW |publisher=Indiana University Press |pages=[https://archive.org/details/mesozoicvertebra0000unse/page/337 337–363] |chapter-url=https://books.google.com/books?id=mgc6CS4EUPsC&pg=PA337 |isbn=978-0-253-33907-2 |url=https://archive.org/details/mesozoicvertebra0000unse/page/337 }}</ref>
==Research== ===Therapies=== {{see also|Disease-modifying osteoarthritis drug}}
Pharmaceutical agents that will alter the natural history of disease progression by arresting joint structural change and ameliorating symptoms are termed as disease modifying therapy.<ref name="Disease-modifying drugs in osteoart"/> Therapies under investigation include the following: * Strontium ranelate – may decrease degeneration in osteoarthritis and improve outcomes<ref>{{cite book | vauthors = Civjan N | title=Chemical Biology: Approaches to Drug Discovery and Development to Targeting Disease|year=2012|publisher=John Wiley & Sons | isbn = 978-1-118-43767-4 | page = 313 | url = https://books.google.com/books?id=ezXLFlwfJycC&pg=PA313 | url-status = live | archive-url = https://web.archive.org/web/20131231173832/http://books.google.com/books?id=ezXLFlwfJycC&pg=PA313 | archive-date = 31 December 2013 }}</ref><ref name="pmid19087296">{{cite journal | vauthors = Bruyère O, Burlet N, Delmas PD, Rizzoli R, Cooper C, Reginster JY | title = Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system | journal = BMC Musculoskeletal Disorders | volume = 9 | article-number = 165 | date = December 2008 | pmid = 19087296 | pmc = 2627841 | doi = 10.1186/1471-2474-9-165 | doi-access = free }}</ref> * Gene therapy – Gene transfer strategies aim to target the disease process rather than the symptoms.<ref>{{cite journal | vauthors = Guincamp C, Pap T, Schedel J, Pap G, Moller-Ladner U, Gay RE, Gay S | title = Gene therapy in osteoarthritis | journal = Joint Bone Spine | volume = 67 | issue = 6 | pages = 570–571 | year = 2000 | pmid = 11195326 | doi = 10.1016/s1297-319x(00)00215-3 }}</ref> Cell-mediated gene therapy is also being studied.<ref>{{cite journal | vauthors = Lee KH, Song SU, Hwang TS, Yi Y, Oh IS, Lee JY, Choi KB, Choi MS, Kim SJ | title = Regeneration of hyaline cartilage by cell-mediated gene therapy using transforming growth factor beta 1-producing fibroblasts | journal = Human Gene Therapy | volume = 12 | issue = 14 | pages = 1805–1813 | date = September 2001 | pmid = 11560773 | doi = 10.1089/104303401750476294 | s2cid = 24727257 }}</ref><ref>{{cite journal | vauthors = Noh MJ, Lee KH | title = Orthopedic cellular therapy: An overview with focus on clinical trials | journal = World Journal of Orthopedics | volume = 6 | issue = 10 | pages = 754–761 | date = November 2015 | pmid = 26601056 | pmc = 4644862 | doi = 10.5312/wjo.v6.i10.754 | doi-access = free }}</ref> One version was approved in South Korea for the treatment of moderate knee osteoarthritis; however, this was cancelled after it was discovered that the approval application and list of ingredients were misleading.<ref>{{cite web |title=Seoul revokes license for gene therapy drug Invossa |date=28 May 2019 |work=Yonhap News Agency |url=https://en.yna.co.kr/view/AEN20190528004400320}}</ref><ref name=Herald/> The drug was administered intra-articularly.<ref name="Herald">{{cite news|url=http://www.koreaherald.com/view.php?ud=20170712000766|title=Korea OKs first cell gene therapy 'Invossa'|work=The Korea Herald|date=12 July 2017|access-date=23 November 2017 }}</ref> *The anti-IL-1β monoclonal antibody canakinumab showed a reduced incidence of knee and hip replacements in those with osteoarthritis in a long term trial. IL-1β is a cytokine involved in joint destruction in osteoarthritis.<ref name="Katz 2021" />
===Cause=== As well as attempting to find disease-modifying agents for osteoarthritis, there is emerging evidence that a system-based approach is necessary to find the causes of osteoarthritis.<ref>{{cite journal | vauthors = Chu CR, Andriacchi TP | title = Dance between biology, mechanics, and structure: A systems-based approach to developing osteoarthritis prevention strategies | journal = Journal of Orthopaedic Research | volume = 33 | issue = 7 | pages = 939–947 | date = July 2015 | pmid = 25639920 | pmc = 5823013 | doi = 10.1002/jor.22817 }}</ref> A study conducted by scientists at the University of Twente found that osmolarity induced intracellular molecular crowding might drive the disease pathology.<ref>{{cite journal | vauthors = Govindaraj K, Meteling M, van Rooij J, Becker M, Wijnen AJ, Ramos YF, van Meurs J, Post JN, Leijten J | title = Osmolarity-Induced Altered Intracellular Molecular Crowding Drives Osteoarthritis Pathology | journal = Advanced Science | volume = 11 | date = July 2024 | issue = 11 | article-number = e2306722 | pmid = 38213111 | doi = 10.1002/advs.202306722 | pmc = 10953583 | bibcode = 2024AdvSc..1106722G }}</ref>
===Diagnostic biomarkers=== Guidelines outlining requirements for inclusion of soluble biomarkers in osteoarthritis clinical trials were published in 2015,<ref name=PMID25952342>{{cite journal | vauthors = Kraus VB, Blanco FJ, Englund M, Henrotin Y, Lohmander LS, Losina E, Önnerfjord P, Persiani S | title = OARSI Clinical Trials Recommendations: Soluble biomarker assessments in clinical trials in osteoarthritis | journal = Osteoarthritis and Cartilage | volume = 23 | issue = 5 | pages = 686–697 | date = May 2015 | pmid = 25952342 | pmc = 4430113 | doi = 10.1016/j.joca.2015.03.002 }}</ref> but there are no validated biomarkers used clinically to detect osteoarthritis, as of 2021.<ref>{{cite book |url=https://shop.elsevier.com/books/cartilage-tissue-and-knee-joint-biomechanics/nochehdehi/978-0-323-90597-8 |title=Cartilage Tissue and Knee Joint Biomechanics |vauthors=Singh A, Antony B |publisher=Elsevier |year=2023 |isbn=978-0-323-90597-8 |edition=1st |pages=Chapter 10 |language=English |chapter=Magnetic resonance imaging and biochemical markers of cartilage disease}}</ref><ref>{{cite journal | vauthors = Antony B, Singh A | title = Imaging and Biochemical Markers for Osteoarthritis | journal = Diagnostics | volume = 11 | issue = 7 | page = 1205 | date = July 2021 | pmid = 34359288 | pmc = 8305947 | doi = 10.3390/diagnostics11071205 | doi-access = free }}</ref>
A 2015 systematic review of biomarkers for osteoarthritis, looking for molecules that could be used for risk assessments, found 37 different biochemical markers of bone and cartilage turnover in 25 publications.<ref name=PMID25963100>{{cite journal | vauthors = Hosnijeh FS, Runhaar J, van Meurs JB, Bierma-Zeinstra SM | title = Biomarkers for osteoarthritis: Can they be used for risk assessment? A systematic review | journal = Maturitas | volume = 82 | issue = 1 | pages = 36–49 | date = September 2015 | pmid = 25963100 | doi = 10.1016/j.maturitas.2015.04.004 }}</ref> The strongest evidence was for urinary C-terminal telopeptide of type II collagen (uCTX-II) as a prognostic marker for knee osteoarthritis progression, and serum cartilage oligomeric matrix protein (COMP) levels as a prognostic marker for incidence of both knee and hip osteoarthritis. A review of biomarkers in hip osteoarthritis also found associations with uCTX-II.<ref name=PMID25623593>{{cite journal | vauthors = Nepple JJ, Thomason KM, An TW, Harris-Hayes M, Clohisy JC | title = What is the utility of biomarkers for assessing the pathophysiology of hip osteoarthritis? A systematic review | journal = Clinical Orthopaedics and Related Research | volume = 473 | issue = 5 | pages = 1683–1701 | date = May 2015 | pmid = 25623593 | pmc = 4385333 | doi = 10.1007/s11999-015-4148-6 }}</ref> Procollagen type II C-terminal propeptide (PIICP) levels reflect type II collagen synthesis in body and within joint fluid PIICP levels can be used as a prognostic marker for early osteoarthritis.<ref>{{cite journal | vauthors = Nguyen LT, Sharma AR, Chakraborty C, Saibaba B, Ahn ME, Lee SS | title = Review of Prospects of Biological Fluid Biomarkers in Osteoarthritis | journal = International Journal of Molecular Sciences | volume = 18 | issue = 3 | page = 601 | date = March 2017 | pmid = 28287489 | pmc = 5372617 | doi = 10.3390/ijms18030601 | title-link = doi | doi-access = free }}</ref>
== References == {{Reflist}}
== External links == {{commons category|Osteoarthritis}} * {{cite web | url = https://medlineplus.gov/osteoarthritis.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Osteoarthritis }} {{Medical resources | eMedicine_mult = {{eMedicine2|orthoped|427}} {{eMedicine2|pmr|93}} {{eMedicine2|radio|492}} | DiseasesDB = 9313 | ICD10 = {{ICD10|M|15-M19}}, {{ICD10|M|47||m|45}} | ICD9 = {{ICD9|715}} | ICDO = | OMIM = 165720 | MedlinePlus = 000423 | eMedicineSubj = med | eMedicineTopic = 1682 | MeshID = D010003 | SNOMED CT = 227588009 }}
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Category:Osteoarthritis Category:Skeletal disorders Category:Wikipedia medicine articles ready to translate Category:Wikipedia emergency medicine articles ready to translate