Signs and Symptoms of Osteoarthritis

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Osteoarthritis is the most common form of arthritis. Signs and symptoms of osteoarthritis include joint pain and stiffness, limited range of motion, and joint enlargement or swelling. Cartilage loss is common in osteoarthritis, and symptom onset usually accompanies the gradual loss of cartilage in an affected joint.

Frequent Symptoms

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

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

Common symptoms of both types of osteoarthritis include:

  • Joint pain or tenderness
  • Stiffness or limited range of motion
  • Joint inflammation or enlargement
  • Crepitus (cracking, grinding, or popping)
  • Joint instability
  • Joint deformity or malalignment

It is interesting to note that people with osteoarthritis can have joint damage that is evident on a conventional 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.

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 that 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 and typically lasts 30 minutes or less (less than is characteristic of rheumatoid arthritis). Joint stiffness associated with osteoarthritis also tends to recur throughout the day, especially following periods of inactivity (what's known 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 (crepitus). 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. Medial compartment knee osteoarthritis is also 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 weight-bearing joint will buckle or give out. It can also cause a joint to lock, which also affects 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.

Rare Symptoms

Depending on which joints are affected, you may have other symptoms that don't typically come to mind when you think "arthritis." These symptoms often occur when osteoarthritis is affecting the neck or spine.

Uncommon symptoms of osteoarthritis include:

  • Numbness and tingling of the arms or legs
  • Weakness of the arms or legs
  • Headache that is centralized on the back of the head
  • Pain that radiates from your shoulder blade down your arm

There are many other health problems that can cause these symptoms, though, so you should always bring them to your doctor's attention so that you can get a correct diagnosis.

Complications

Osteoarthritis is a progressive disease, so joint damage can worsen over time. As osteoarthritis progresses, so does pain, stiffness, and limited mobility. You may find it harder to do things like button your shirt, drive, or get in and out of bed.

If osteoarthritis limits your movement significantly, the sedentary lifestyle can lead to weight gain. Not only does being overweight worsen osteoarthritis, it can also lead to diabetes, high blood pressure, and heart disease long term. Gentle exercise is ideal to combat this.

Another problem that develops as osteoarthritis progresses is an increased risk of falling. Joint instability, muscle weakness, and limited mobility decrease balance and makes it harder to catch yourself. If you do fall, you're at an increased risk of injury like broken bones.

Your doctor can help create an appropriate treatment plan for your osteoarthritis which, in turn, can help lessen the chances of these complications.

When to See a Doctor

Some people chalk joint pain and stiffness up to normal aging, so they don't discuss symptoms with their doctor. Regardless of its cause, it is worth getting a formal diagnosis of osteoarthritis, as it can be managed, reducing your pain. While there is no cure, early treatment can help slow the progression of this disease.

No matter what your age, if you have these symptoms you should be seen by a doctor:

  • Joint pain that lasts for more than several days
  • Pain or stiffness that comes and goes over the course of several weeks
  • Joint pain that isn't relieved by over-the-counter (OTC) pain medication or that returns after such a drug
  • Pain, stiffness, inflammation, or creaking that you aren't sure of the cause of or that is concerning to you

If you have already been diagnosed with osteoarthritis, let your doctor know if your osteoarthritis is getting worse. In particular, be on the lookout for:

  • Increased pain or grinding
  • Signs of bone spurs (bumps on the joint)
  • A joint that looks out of alignment
  • Joint locking

Call Your Doctor Immediately

If you have signs of acute joint inflammation (redness, pain, heat, and swelling) or you have severe joint pain, see your doctor right away.

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Article Sources

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Additional Reading

  • 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.