Fact or Fiction? The Top 15 Osteoarthritis Myths
Myth #1: Osteoarthritis is Just a Condition of Old Age
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
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
- Joint Aspiration: Under local anesthesia, joint fluid is withdrawn to look for evidence of joint deterioration/crystals.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
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
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
- 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 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
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.
Myth #9: Glucosamine-Chondroitin Is Proven Effective
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 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.
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
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
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)
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