Fact or Fiction? The Top 15 Osteoarthritis Myths
Myth #1: Osteoarthritis is Just a Condition of Old Age
Osteoarthritis (OA) is a painful condition that becomes more common with age and is due in part to the gradual wear and tear of cartilage (bone cushion) in the joints. However, injuries, obesity, family history and weak muscles also play a part in OA development, and symptoms can occur at a younger age. For example, in younger people who have had a sports-related or vehicle accident, cartilage can wear away and cause joint disorders.
OA most commonly occurs in the hands, knees, hips and spine with symptoms of pain, joint stiffness, and possibly swelling due to fluid accumulation.
Myth #2: Osteoarthritis and Rheumatoid Arthritis Are the Same
Although they are both forms of arthritis, osteoarthritis (OA) and rheumatoid arthritis (RA) are very different conditions with different treatments. For some people, but not all, OA is also accompanied by inflammation (swelling). In contrast, RA is an autoimmune inflammatory disease of the joints where healthy tissues are attacked and inflammation can be debilitating.
These diseases do have some similarities - both can occur in the hands, feet or wrist; no cures exist; and treatments for both can lead to substantial relief.
Myth #3: Diagnosis of Osteoarthritis Does Not Require Laboratory Tests
Your provider will diagnose osteoarthritis (OA) using a combination of family and medical history, symptoms, physical exam, and laboratory tests. Your doctor may use these tests to confirm the diagnosis of OA:
- Joint Aspiration: Under local anesthesia, joint fluid is withdrawn to look for evidence of joint deterioration/crystals.
- X-ray: The physical effects of OA, like bone/cartilage changes, can be shown with imaging techniques.
- MRI: MRIs provide a two-dimensional view that offers better images of soft tissues, such as cartilage.
Myth #4: Stiffness with Osteoarthritis Lasts the Entire Day
Pain and stiffness are the most common symptoms of osteoarthritis (OA). "Morning stiffness" is the pain and stiffness you may feel when you first wake up in the morning. Stiffness typically lasts for only a few minutes and subsides in 30 minutes or less. It is improved by movement and activity that loosens the joint.
As the day goes on, however, the pain may get worse. An exception is inflammatory OA of the hand which may have all-day stiffness early in the disease. Morning stiffness helps to differentiate osteoarthritis from rheumatoid arthritis. With rheumatoid arthritis, joint stiffness may not improve for several hours or it may last throughout the entire day.
Myth #5: Patients With Osteoarthritis Should Avoid Exercise
Evidence-based guidelines strongly recommend that all patients with osteoarthritis be enrolled in an exercise program. Physical activity increases blood flow, and joints and muscles are supplied with more oxygen. Swimming (aquatic) exercises or weight-based and strengthening exercises can be selected; the choice depends upon the patients preference and their ability. For patients who have little aerobic capacity, swimming is a good initial choice. A 2016 study even suggested Tai Chi might be one conservative option for knee pain.
Weight loss should be a goal to lessen joint stress for overweight patients. Exercise programs should only be started after physician consultation and possible supervision by a physical therapist.
Myth #6: Osteoarthritis Is Treated Only with Pain Medications
First-line treatment of osteoarthritis does not always involve drug therapy.
- Rest: Activity is important for OA to prevent joint stiffness, but in times of flare-ups a day of rest can improve symptoms.
- Weight Loss: Weight loss can lower the risk of pain in weight-bearing joints.
- Exercise: Exercise helps to strengthen muscles, improve flexibility, and lessen pain.
- Orthoses: Devices to help to align joints - orthotic shoe inserts, splints, and braces.
- Heat and Cold: Can help to relieve pain, stiffness and muscle spasms.
Myth #7: Acetaminophen Won't Work for Osteoarthritis
Acetaminophen (Tylenol, Panadol, Anacin Aspirin Free) is a popular pain reliever but it does not have anti-inflammatory actions to decrease swelling. However, contrary to popular belief, not all OA has an inflammatory component. Patients with non-inflammatory OA can often use a combination of rest and exercise, heat and cold, and acetaminophen for effective pain relief. However, a 2016 study in the Lancet did not find that acetaminophen was effective for hip or knee osteoarthritis, but this is controversial.
Acetaminophen may be the first treatment of choice for OA patients who have a history of stomach ulcers or kidney problems; NSAIDs such as ibuprofen (Motrin, Advil) can worsen these issues. Do not exceed recommended doses for acetaminophen as it can cause liver toxicity.
Myth #8: Acetaminophen Has No Side Effects
Acetaminophen (Tylenol, Extra-Strength Tylenol, generics) is usually a safe choice, but it's not without risks itself. Acetaminophen can be toxic to the liver when used excessively. It is important to read the labels on any bottle of acetaminophen to be sure you do not exceed recommended daily dose.
In addition, if you are using the maximum dose of acetaminophen, be sure to avoid other products that also contain acetaminophen, such as OTC cold remedies, combination pain pills such as acetaminohen/hydrocodone (Lortab, Vicodin), and many other products. Always double check the ingredients or ask your pharmacist if you aren't sure.
Myth #9: Glucosamine-Chondroitin Is Proven Effective
Glucosamine and chondroitin (Osteo-Bi-Flex and others) are dietary supplements promoted for pain relief in arthritis. Chondroitin sulfate in combination with glucosamine has been studied for OA treatment; however, data on its effectiveness is conflicting and weak. Most clinical studies show that these treatments are no more effective than a placebo (sugar pill); although a 2015 study presented at The American College of Rheumatology Annual Meeting in San Francisco did show some slowing of the progression of osteoarthritis in patients who took high-grade chondroitin supplements for two years.
The American College of Rheumatology guidelines do not support glucosamine-chondroitin use in osteoarthritis; however, some physicians may agree that a trial could be started; side effects, such as upset stomach, heartburn and drowsiness are mild. Stop this treatment after six months if there is no relief.
Myth #10: Cream Made From Hot Chili Peppers is a Hoax
Capsaicin is what makes a chili pepper hot. It is also the active ingredient found in some OTC creams for arthritis symptoms. In clinical trials, capsiacin has been shown to be effective for patients with symptoms of osteoarthritis when compared to a placebo.
Capsaicin works by blocking a substance in the nerve that can lead to pain. Side effects such as burning, stinging, and redness may occur on the skin. It may take up to 2 weeks for the cream to have a full effect on your pain. Common OTC brand names of capsaicin cream include Zostrix, Capzasin-HP, and others.
Be sure to wear gloves when you apply capsaicin and keep it away from your eyes, mouth, and other mucous membranes.
Myth #11: Joint Injections Can Be Given as Often as Needed
Glucocorticoids like triamcinolone are commonly used to reduce inflammation and pain when injected into arthritic knees, but can't be used frequently. A 2015 study found that steroid injections can help alleviate knee pain but do nothing to slow progression of osteoarthritis. Hyaluronate injection is a viscosupplement that replaces the natural fluids in joints to allow easier movement. Hyaluronate injections can be repeated in 6 months if the response is good. Intra-articular injections for osteoarthritis pain may be used if trials of topical (Aspercreme, Voltaren Gel) and oral analgesics (Tylenol, Panadol, Motrin, Aleve, Ultram, others) do not provide adequate relief.
Myth #12: Older Patients Should Not Use Any Type of NSAID
The use of NSAIDs such as ibuprofen may be harmful in older patients due to the risk for stomach bleeding, kidney damage or heart side effects. However, topical treatments such as OTC trolamine salicylate (Aspercreme, Sportscreme) and prescription diclofenac sodium gel (Voltaren Gel) can help relieve painful symptoms in the hands or knee.
Under the care of a physician, older patients without risk factors may be able to use oral nonselective NSAIDs such as naproxen, or a COX-2 selective inhibitor such as celecoxib (Celebrex) combined with a proton pump inhibitor (PPI) like esomeprazole (Nexium) to help protect the stomach.
Myth #13: Cymbalta is Not as Effective as NSAIDs
Duloxetine is an inhibitor of neurotransmitters in the brain that may be involved with pain. Researchers have found that duloxetine compares favorably with pain-relieving NSAIDs such as etodolac (Lodine). Duloxetine may be more tolerable for those who cannot use NSAIDs due to stomach bleeding or ulcers. But duloxetine is not without some side effects - they include nausea, fatigue and constipation. Some people also experience withdrawal symptoms on discontinuation.
Myth #14: Most People with Osteoarthritis Will Require Surgery
Osteoarthritis (OA) is the most common form of arthritis and affects 27 million Americans, but surgery is not the typical outcome for most patients. However, if you have severe pain or joint damage, surgery may be needed if other medical treatments have failed or you have significant immobility.
Replacing damaged joints with artificial ones can improve movement, relieve pain and boost independence. Removing bone spurs, and re-aligning joints can also improve OA for many patients. Your physician is the best expert to work with to determine if you need a surgical procedure for OA.
Myth #15: Acupuncture Has No Scientific Basis for Osteoarthritis (OA)
Acupuncture is the ancient practice of inserting thin needles into specific body areas as a component of Traditional Chinese Medicine (TCM). In TCM, health is linked with the flow of qi (energy) along body pathways known as meridians. According to TCM, needle insertion helps to restore the energy balance and promote health.
Many controlled studies in acupuncture have not found benefits for osteoarthritis (OA), but trial design is difficult and may not represent the true results. Research has shown that physiological changes do occur during acupuncture - natural, pain-relieving neurotransmitters like endorphins and enkephalins are released - which may help to explain the positive results seen in some OA patients.
Finished: Fact or Fiction? The Top 15 Osteoarthritis Myths
- Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip and Knee. Arthritis Care Res 2012;64:465-74. DOI 10.1002/acr.21596
- Arthritis Foundation. Disease Center. Osteoarthritis. Accessed June 23, 2016 at http://www.arthritis.org/about-arthritis/types/osteoarthritis/
- Gatti JC. Glucosamine Treatment for Osteoarthritis. Am Fam Physician. (Cochrane for Clinicians) 2006;73:1189-91.
- Press Releases: Chondroitin Outperforms Celecoxib in Knee Osteoarthritis Study. November 09, 2015 American College of Rheumatology http://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/708/Chondroitin-Outperforms-Celecoxib-in-Knee-Osteoarthritis-Study
- Derry S., Moore RA., Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2012;9:CD007400. doi: 10.1002/14651858.CD007400.pub2
- Up to Date. Patient Information: Osteoarthritis treatment (Beyond the Basics). Updated April 16, 2014. Accessed June 23, 2016 at http://www.uptodate.com/contents/osteoarthritis-treatment-beyond-the-basics
- Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: Network meta-analysis. BMJ. 2010;341:c4675
- National Library of Medicine. MedlinePlus. Osteoarthritis. Updated June 7, 2016. Accessed June 23, 2016 at http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
- Abou-Raya S, Abou-Raya M, Helmii M. Duloxetine for the management of pain in older adults with knee osteoarthritis: randomized, placeb-controlled trial. Age Aging. 2012;41:646-52.
- PsychCentral. Research News. 3/29/2013. Antidepressant Cymbalta Helps Alleviate Osteoarthritis Pain. Accessed June 23, 2016 at http://psychcentral.com/news/2012/03/31/antidepressant-cymbalta-helps-alleviate-osteoarthritis-pain/36506.html
- Wang TJ, Belza B, Thompson E, et al. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs. 2007;57:141-52.
- American College of Rheumatology. Press Release. Chondroitin Outperforms Celecoxib in Knee Osteoarthritis Study. November 09, 2015. Accessed 6/25/2016 at http://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/708/Chondroitin-Outperforms-Celecoxib-in-Knee-Osteoarthritis-Study#sthash.HTEPpxh3.dpuf