Fact or Fiction? The Top 15 Osteoarthritis Myths
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 15, 2021.
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. It's common to think osteoarthritis - often just called arthritis - is an inevitable part of growing older.
However, injuries, obesity, family history and weak muscles also play a part in OA development, and symptoms can occur at a younger age, too.
For example, in younger people who have had a sports-related or vehicle accident, cartilage can wear away and cause joint disorders more quickly than normal. This can lead to symptoms such as pain and inflammation at a younger age.
OA most commonly occurs in the:
Symptoms of pain, joint stiffness, and swelling due to fluid accumulation can occur.
Myth #2: Osteoarthritis and Rheumatoid Arthritis Are the Same
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 cure exists
- treatments for both can lead to substantial relief.
Myth #3: Diagnosis of Osteoarthritis Does Not Require Special 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- Joint Aspiration: Under local anesthesia, joint fluid is withdrawn to look for evidence of joint deterioration and crystals.
- X-ray: The physical effects of OA, like bone or cartilage changes, can be shown with imaging techniques.
- MRI: MRI (magnetic resonance imaging) provides 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 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
Wrong! 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 recent 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 (OA) may 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.
- Orthotics: Devices to help to align joints - orthotic shoe inserts, splints, and braces.
- Heat and Cold/Ice: Can help to relieve pain, swelling, stiffness and muscle spasms.
Myth #7: Acetaminophen Won't Work for Osteoarthritis
- However, contrary to popular belief, not all arthritis has an inflammatory component.
- Patients with non-inflammatory osteoarthritis (OA) can often use a combination of rest and exercise, heat and cold, and acetaminophen for effective pain relief. Effects are most likely individual.
- An acetaminophen trial may be worthwhile if NSAIDs like ibuprofen are not tolerated or can't be used due to side effects.
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) or naproxen (Aleve) can worsen these issues. Older patients and those with heart risks may be at greater risk, too.
Do not exceed recommended doses for acetaminophen or drink excessive alcohol as it can cause dangerous 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 the recommended daily maximum dose (maximum 3,000 to 4,000 miiligrams per day in adults and children 12 years of age or older).
- In addition, if you are using the maximum dose of acetaminophen, be sure to avoid other products that also contain acetaminophen, such as over-the-counter cold remedies, combination pain pills such as acetaminohen and hydrocodone (Lortab, Vicodin), and many other products. Always double check the ingredients or ask your pharmacist if you aren't sure.
- More than 3 alcoholic drinks consumed per day while using this product can lead to severe liver damage.
Myth #9: Chondroitin and Glucosamine Cures Arthritis
Glucosamine and chondroitin (Osteo-Bi-Flex and others) are dietary supplements promoted for pain relief in arthritis. There is no cure for arthritis.
- Chondroitin sulfate in combination with glucosamine has been studied for osteoarthritis treatment; however, data on its effectiveness is conflicting and weak. Most clinical studies show that these treatments are no more effective than a placebo (an inactive pill).
- The American College of Rheumatology (ACR) guidelines do not support glucosamine, or glucosamine + chondroitin supplement use in osteoarthritis (OA) of the knee or hip, but it is conditionally recommended for OA of the hand. A single trial showed pain relief of chondroitin sulfate, without evidence of harm, in hand OA.
- Side effects, such as upset stomach, heartburn and drowsiness are mild. The chances of any side effect with these alternative agents is low.
- Stop this treatment after six months if there is no pain relief; supplements can be expensive.
Myth #10: Hot Chili Pepper Cream is a Hoax
Capsaicin is what makes a chili pepper hot. It's 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 (OA) when compared to a placebo. The American College of Rheumatology (ACR) guidelines do not recommend the use of capsaicin for hand OA but conditionally agree it could used for knee OA. Effects can vary from patient to patient.
- Capsaicin works by blocking a substance in the nerves 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. Remember, the active ingredient comes from chili peppers.
- Topical agents may be worth a trial in older patients (> 75 years) who cannot use oral NSAIDs.
Myth #11: Joint Injections Can Be Used as Often as Needed
Intra-articular (in the joint space) injections for osteoarthritis (OA) pain may be used if trials of topical agents (Aspercreme, Voltaren Gel) and oral analgesics (Tylenol, Motrin, Aleve, Ultram, others) do not provide adequate relief. The 2019 ACR guidelines recommend that steroid injections may be used conditionally for hand OA and are strongly recommeded for use in the knees and hips.
There are two types of intra-articular injections that can be used for knee osteoarthritis - glucocorticoids ("steroids") and hyaluronate (brand name examples: Euflexxa, Hyalgan, Orthovisc, Synvisc-One.
Hyaluronate injection is a viscosupplementation agent that replaces the natural fluids in joints to allow easier movement. Hyaluronate injections can be repeated in 6 months if the response is good.
- Based on the latest 2019 ACR guidelines, intra-articular glucocorticoid injections are conditionally recommended over other forms of intraarticular injections, including hyaluronic acid preparations.
- It is stated that head-to-head comparisons are few, but the evidence for efficacy of glucocorticoid injections is of considerably higher quality than that for other agents.
However, warnings have surfaced about use of "steroid" shots in the knee. One study suggests there may be no advantage to these shots and they may even cause harm.
- A randomized, double blind, placebo-controlled study in JAMA found that steroid injections do not help alleviate knee pain and may worsen progression of osteoarthritis.
- Over a 2-year period using intra-articular injections of triamcinolone (given every 3 months), and compared with intra-articular saline, there was significantly greater cartilage loss in the knee and no significant difference in knee pain.
- Cartilage loss theoretically may worsen knee pain over the long term.
Myth #12: NSAIDs are Always Recommended
ACR strongly recommends use of oral NSAIDs for patients with knee, hip, and/or hand OA. They state that oral NSAIDs are recommended over all other available oral medications.
However, not all patients are candidates for NSAIDs. 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.
- 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).
- It may be recommended that these drugs be combined with a proton pump inhibitor (PPI) like esomeprazole (Nexium) to help protect the stomach.
- These treatments should be used with close monitoring in the elderly, and should be avoided if risk factors for bleeding, kidney damage or heart effects are present.
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. Voltaren Arthritis Pain gel became available over-the-counter (OTC) in Feb. 2020.
Myth #13: Cymbalta is Not as Effective as NSAIDs
In the 2019 guidelines The American College of Rheumatology conditionally recommends use of duloxetine for knee, hip and hand osteoarthritis.
- 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). It may be useful for patients with OA in multiple joints. However, the American College of Rheumatology makes no recommendation about the use of duloxetine for the treatment of OA of the knee or hip.
- 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 - including nausea, fatigue and constipation. Some people also experience withdrawal symptoms during discontinuation.
Myth #14: Most People with Osteoarthritis Will Require Surgery
Osteoarthritis (OA) is the most common form of arthritis and affects more than 30 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).
The 2019 American College of Rheumatology guidelines conditionally recommends acupuncture for patients with knee, hip and hand OA.
- 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. 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.
- Many controlled studies in acupuncture have not found benefits for osteoarthritis (OA), but trial design is difficult and may not represent the true results. Studies that have used a "sham" intervetion have found results are similar between sham and true acupuncture groups, suggesting a placebo effect.
- Some clinicians feel that if safe, sterile acupuncture can be accessed, that a trial may be worthwhile, especially if the patient is out of therapeutic options and is open to accupuncture.
Finished: Fact or Fiction? The Top 15 Osteoarthritis Myths
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- 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. Vol. 72, No. 2, February 2020, pp 149–162 DOI 10.1002/acr.24131
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