Osteoarthritis

Osteoarthritis Signs and Symptoms

Osteoarthritis Symptoms

While osteoarthritis is the most common form of arthritis, most people think it is simply a disease associated with growing old. They think it's just something that Grandma and Grandpa have or will have. While it is true that the incidence of osteoarthritis increases with age, anyone can develop the disease. Usually symptoms develop after age 40.

Primary osteoarthritis is the type of osteoarthritis most commonly diagnosed—developing as the result of cartilage loss, joint degeneration, and typically with advancing age, but not associated with any other cause.

Secondary osteoarthritis is associated with another cause, such as joint injury, obesity, or another joint condition.

Before we consider common symptoms associated with osteoarthritis, it is interesting to note that people with osteoarthritis can have joint damage that is evident on plain x-ray while experiencing few symptoms. Conversely, it is possible for someone with osteoarthritis to have pain or other symptoms while not having x-ray evidence of the disease.

Common Symptoms Associated With Osteoarthritis

Symptom onset usually accompanies the gradual loss of cartilage in an affected joint. Osteoarthritis symptoms characteristically include:

Joint pain - Pain is the primary symptom associated with osteoarthritis and it is linked to functional impairment and disability in people with the disease. Usually, osteoarthritis pain develops gradually. With mild to moderate osteoarthritis, pain typically worsens with use of the joint (i.e., with activity) and improves with rest. As the disease progresses, pain is usually more persistent and constant and may not be relieved by rest or conservative treatments for osteoarthritis.

While pain at rest can be a sign of more severe or advanced disease, it can also be a sign of local joint inflammation.

Pain associated with osteoarthritis is not coming from cartilage loss directly. Cartilage is aneural, meaning, it has no nerve tissue. The pain is likely tied to adjacent structures, such as stretching of the joint capsule by bony enlargement, subchondral bone microfractures, synovitis, or other structural changes.

Joint stiffness - Morning stiffness is common with osteoarthritis, but it does not last as long as is characteristic of rheumatoid arthritis. Typically, morning stiffness in people with osteoarthritis lasts 30 minutes or less. Joint stiffness associated with osteoarthritis also tends to recur throughout the day, especially following periods of inactivity. When stiffness occurs after inactivity, it is referred to as gelling. People with osteoarthritis also commonly complain of joint stiffness when there is stormy weather approaching (i.e., changes in barometric pressure).

Joint tenderness - With palpation (touch), it is common for there to be pain or tenderness, especially along the joint margin. Periarticular structures (i.e., structures that surround the joint) may also exhibit tenderness due to bursitis or tendinitis adjacent to the joint.

Limited range-of-motion - Loss of normal range of motion in joints affected by osteoarthritis can develop because of pain, swelling, flexion contractures, and abnormalities associated with cartilage loss, such as malalignment of the joint or mechanical inhibition of the joint related to loose bodies.

Joint swelling - Osteoarthritis can cause a type of swelling referred to as effusion. Joint effusion is an accumulation of excess fluid in the affected joint.

Joint enlargement - Joint enlargement is characteristic of osteoarthritis and may be associated with bony enlargement or joint effusion. Joint enlargement is very common with hand osteoarthritis, particularly the DIP (distal interphalangeal joints) and PIP (proximal interphalangeal joints) of the hand.

The formation of osteophytes (bony outgrowths or bone spurs), which can be felt under the skin in the area of any joint, may also contribute to bony or joint enlargement. Heberden's nodes and Bouchard's nodes are characteristic of osteoarthritis. Effusions associated with osteoarthritis are typically non-inflammatory and not associated with redness or warmth.

Crepitus - Active or passive movement of any joint affected by osteoarthritis may cause crackling or grinding sensations. The sensations may be audible or palpable. The sensation is caused by irregular or rough surfaces of the joint—surfaces that normally would be smooth—or from debris within the joint. 

Joint deformity or malalignment - Severe cartilage loss in the affected joint can result in malalignment or deformity. Malalignment is often evident with knee osteoarthritis. A knee with normal alignment has its load-bearing axis on a line that runs down the middle of the leg. When a knee is malaligned, it can be varus or valgus (bow-legged or knock-kneed, respectively).

Varus malalignment is common with severe knee osteoarthritis, but it also may occur with mild to moderate disease, too. Also, medial compartment knee osteoarthritis is usually associated with varus malalignment, while lateral compartment knee osteoarthritis is typically associated with valgus malalignment.     

Joint instability - Unstable joints can be caused by joint pain, joint stiffness, or joint deformity. The instability may cause you to feel like a weightbearing joint will buckle or give out. It can also cause a joint to lock, especially the knee, which also would affect stability.

Local inflammation - Osteoarthritis is not a systemic inflammatory disease. While there may be soft tissue swelling or effusion, inflammation is localized in osteoarthritis and less impactful compared to inflammatory types of arthritis.

A Word From Verywell

Most commonly, osteoarthritis affects the knees, hands, feet, hips, and spine. The joint may be symptomatic or there may only be x-ray evidence of the disease. Usually, there is both. More than 27 million people in the U.S. have osteoarthritis. About nine million adults in the U.S. are affected by symptomatic knee osteoarthritis, and more than 13 million adults in the U.S. have symptomatic hand osteoarthritis. Without question, it is important to pay attention to early symptoms and consult your doctor for diagnosis and treatment. The goal is to manage pain, minimize functional limitations, and prevent disability. Verywell provides you with the information you need to help minimize the intrusiveness of osteoarthritis and to guide you to wellness. 

Sources:

Clinical Manifestations and Diagnosis of Osteoarthritis. Doherty and Abhishek. UpToDate. Updated August 1, 2016.

Osteoarthritis: Clinical Presentations. Chapter 7. Hooper and Moskowitz. Osteoarthritis Fourth edition. LWW.

Osteoarthritis - Clinical Features. Chapter 11. Paul Dieppe MD. Primer on the Rheumatic Diseases. Arthritis Foundation. Edition 12.

Patient Information: Osteoarthritis Symptoms and Diagnosis (Beyond the Basics). UpToDate. Kenneth C. Kalunian, MD. Updated July 20, 2015.

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