Osteoarthritis

Osteoarthritis is the most common form of arthritis in Canada. It affects the whole joint: the cartilage that cushions the ends of the bones, the bone underneath, and the muscles and ligaments that support it. Over time the joint can become painful and stiff, and everyday things like stairs, walking or gripping a jar can get harder.

What osteoarthritis is, and what it is not

Osteoarthritis is often described as wear and tear, but that is only part of the picture. Cartilage does thin with use, and the bone underneath and the soft tissues around the joint change as well. Past injuries, how much load a joint carries, muscle strength and family history all play a part, which is why two people the same age can have very different joints.

It is also not only a condition of later life. Arthritis Society Canada reports that more than half of Canadians living with osteoarthritis are younger than 65. The knees, hips, hands, feet and spine are affected most often, and it is common to have symptoms in more than one joint.

Signs and symptoms

• Pain in a joint that gets worse with use and eases with rest
• Stiffness after sitting still or first thing in the morning, usually easing within about 30 minutes
• Swelling, or a feeling of warmth, around the joint
• A grating, clicking or crunching feeling when the joint moves
• Less movement than before, or new trouble with stairs, walking or gripping
• Tiredness, and sleep broken by joint pain

Symptoms vary from person to person and often change from day to day. Many people have long stretches where a joint feels manageable, then a flare that settles again.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since osteoarthritis becomes much more common after age 50
• Being female, which is linked to higher rates in Canada
• A family history of osteoarthritis
• A past joint injury, such as a torn knee ligament or cartilage

Others can often be worked on, usually with support from a health care team:

• Carrying extra body weight, which adds load to the knees and hips
• Work or sport involving repeated kneeling, squatting, lifting or joint impact
• Low muscle strength and long periods of inactivity around an affected joint

How osteoarthritis is diagnosed in Canada

Osteoarthritis is usually identified by a family doctor or nurse practitioner, based on how you describe the pain, how long it has lasted, and a physical examination of the joint. X-rays may be ordered to look at the joint and to help rule out other causes, and blood tests may be used to check for inflammatory types of arthritis. Some people are referred on to a rheumatologist, an orthopaedic surgeon or a physiotherapist for further assessment.

Treatment and day-to-day management

Clinical research for Osteoarthritis is enrolling. See the current studies ↓

There is no treatment yet that repairs a joint already damaged by osteoarthritis. Care in Canada focuses on easing pain, keeping the joint moving and protecting your independence. Depending on your situation and what matters to you, a health care team may discuss:

• Exercise therapy and physiotherapy, including structured programs such as GLA:D Canada that are offered in many provinces for hip and knee osteoarthritis
• Weight management and self-management education through primary care, dietitians and community programs
• Pain medicines chosen with a clinician, including acetaminophen, topical and oral anti-inflammatory medicines, and in some situations duloxetine
• Occupational therapy, braces, canes and other aids, and psychological approaches such as cognitive behavioural therapy for pain
• Procedures and surgery, from corticosteroid injections into a joint through to hip or knee replacement for advanced disease, which Canada tracks through the Canadian Joint Replacement Registry

What suits one person will not suit another. These are decisions for you and your own clinician, and this page is not a recommendation about any of them.

When to talk to a doctor

• If a joint suddenly becomes very painful, hot, red or swollen and you feel feverish or unwell, seek medical care the same day. Go to an emergency department or call 911 if you feel very unwell, because a joint infection needs urgent treatment.
• If you cannot put weight on a joint, or a joint locks or gives way after a fall, have it assessed promptly.
• If joint pain comes with unexplained weight loss, night pain that wakes you, or new numbness, tingling or weakness in an arm or leg, book an appointment with your health care provider.

Why clinical research matters for osteoarthritis

Nothing available today has been shown to stop or reverse the joint damage of osteoarthritis, so most care is aimed at symptoms rather than the disease itself. That gap is what osteoarthritis research is trying to close. Studies are currently evaluating candidate disease-modifying drugs aimed at cartilage and bone, antibodies and other agents that target pain-signalling pathways such as nerve growth factor, injectable and cell-based approaches, and non-opioid pain medicines. Others compare ways of delivering exercise and self-management support, including digital and remote programs, and look at how to help people whose pain persists after joint replacement.

Clinical studies are how any of these are tested. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can tell in advance whether a study will help you personally.

Learn more from Canadian sources

• Arthritis Society Canada: osteoarthritis
• Public Health Agency of Canada: osteoarthritis in Canada
• Canadian Institute for Health Information: hip and knee replacements in Canada
• Pain BC: support programs and pain support line