Can osteoarthritis contribute to pain and loss of function?

From the Guidelines

Yes, osteoarthritis definitely contributes to pain and loss of function. Osteoarthritis is the most common form of arthritis, characterized by the breakdown of joint cartilage and underlying bone. This degenerative process typically causes pain that worsens with activity and improves with rest. As the condition progresses, patients often experience reduced range of motion, joint stiffness (particularly in the morning or after periods of inactivity), and decreased ability to perform daily activities. The pain occurs because as cartilage wears away, bones begin to rub against each other, causing inflammation, swelling, and pain. Additionally, bone spurs may form around the affected joint, further limiting movement and causing pain. The functional limitations can affect various aspects of life, from basic activities like walking, climbing stairs, or gripping objects to more complex tasks depending on which joints are affected.

According to the most recent evidence, osteoarthritis affects an estimated 302 million people worldwide 1 and is a leading cause of disability among older adults. The condition is characterized by pathology involving the whole joint, including cartilage degradation, bone remodeling, osteophyte formation, and synovial inflammation, leading to pain, stiffness, swelling, and loss of normal joint function 1.

Management of osteoarthritis typically involves a combination of:

• Pain medications (like acetaminophen, NSAIDs such as ibuprofen or naproxen)
• Physical therapy to maintain joint function
• Weight management to reduce stress on weight-bearing joints
• In severe cases, surgical interventions such as joint replacement. The use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen has been widely adopted in the treatment of knee osteoarthritis, with evidence supporting their effectiveness in improving pain and function 1.

It's also important to note that sustained weight loss has been shown to benefit pain and, to a lesser extent, function in overweight and obese patients with knee osteoarthritis 1. Intra-articular injections, such as corticosteroid, hyaluronic acid, and platelet-rich plasma, are also widely used, although the evidence for their effectiveness varies 1.

Overall, osteoarthritis is a significant contributor to pain and loss of function, and management should be tailored to the individual patient's needs, taking into account the latest evidence and guidelines, such as those from the American Academy of Orthopaedic Surgeons 1 and the European League Against Rheumatism (EULAR) 1.

From the Research

Osteoarthritis and Its Impact on Pain and Function

• Osteoarthritis (OA) is a common cause of pain, loss of function, and disability in adults, with the prevalence expected to increase substantially in the future 2.
• The disease can lead to significant functional limitations, poor sleep, fatigue, depressed mood, and loss of independence due to joint pain 2.
• OA-related pain is a complex condition with a pathophysiology that includes neuropathic peripheral and central abnormalities, as well as local inflammation involving all joint structures 3.

Contribution to Pain

• Most patients with osteoarthritis seek medical attention because of pain, and the safest initial approach is to use a simple oral analgesic such as acetaminophen 4.
• Therapeutic ultrasound has been found to be effective in reducing pain in patients with knee OA, although the positive effect may not be persistent in the long term 5.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids can be used to treat osteoarthritis pain, but their effectiveness and safety vary depending on the preparation and dose 6.

Contribution to Loss of Function

• Osteoarthritis can lead to loss of function, particularly in advanced disease, and patients may eventually require surgery to restore function 4.
• Therapeutic interventions such as exercise and physical therapy can help improve physical function in patients with OA 5, 2.
• The effectiveness of treatments for OA-related loss of function can be influenced by various factors, including the individual patient's psychological and genetic factors 3.

Management and Treatment

• A comprehensive approach to managing OA should include non-pharmacologic measures such as patient education, weight loss, and exercise, as well as pharmacologic treatments like NSAIDs and opioids 4, 6.
• Topical diclofenac may be a safer and effective treatment option for knee OA, especially for patients with comorbidities or those who require long-term treatment 6.
• Further research is needed to develop more effective and safe treatments for OA, particularly for patients with other chronic conditions 2, 3.