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UC Davis Health System

UC Davis Health System

Strategies for managing degenerative joint disease

African-American couple walking in park
Regular exercise is important to keep joints flexible and improve muscle strength, reducing the burden on affected joints. Initial work with a physical therapist can reveal specific exercises that build strength and increase your joints’ range of motion.

Posted April 14, 2010

By Ron Sprinkle, M.D. 

You may first notice stiffness in your spine, hips or knees that is worse in the morning and improves as the day goes on. Or you may feel soreness in the small joints of your fingers or the base of your thumb when you use your hands.

If you are middle-aged or older, chances are high that you are developing symptoms of osteoarthritis, a common degenerative joint disease that afflicts virtually everyone, at least to some degree, after the age of 60.

Osteoarthritis results from a reduction in cartilage, the connective tissue between bones within a joint. Healthy cartilage acts as a pad to prevent bones from rubbing against one another. But cartilage, which can not regenerate, may be broken after an injury and gradually wears down with use. The resulting rubbing together of bones causes pain, as well as bony growths, cysts and other abnormalities to develop, often resulting in decreased mobility of the joint.

Correct diagnosis important

Dr. Sprinkle is a family practitioner with UC Davis Medical Group at 2660 W. Covell Blvd. in Davis.

Establishing a diagnosis of osteoarthritis is important to distinguish it from other disease processes or other forms of arthritis, which have different treatments. Doctors can usually diagnose osteoarthritis based on a physical exam and a patient’s symptoms and history.

Although it is rarely necessary for diagnosis, X-rays or magnetic resonance imaging (MRI) can show the loss of cartilage and other joint abnormalities. For osteoarthritis in the knee, sometimes arthroscopy, involving the insertion of a small tube with a lens and fiber optic equipment, is used to better understand the condition and possibly treat it during the procedure by removing damaged cartilage.

Managing pain

It is advisable to consult a physician before regularly using even over-the-counter medications because of possible interactions with other drugs and potential side-effects from their long-term use.

Treatment of osteoarthritis focuses on pain management and maintenance of joint mobility. There is a variety of pain medications available, including aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen.

It is advisable to consult a physician before regularly using even over-the-counter medications because of possible interactions with other drugs and potential side-effects from their long-term use. Aspirin, for example, may dangerously amplify the effects of blood-thinning agents commonly taken by elderly people for heart conditions.

The long-term use of  NSAIDs may also cause serious side-effects, including ulcers and other gastric disturbances. Many NSAID-users regularly take antacids to relieve the discomfort and in the belief that it confers protection against damage. A recent study indicates, however, that use of antacids actually increases the likelihood of developing ulcers, as they mask symptoms, causing patients to delay seeking treatment until the condition becomes serious. 

Non-pharmacological agents can also help control pain. Heat, applied with wet or dry towels can decrease morning stiffness and increase mobility. This can be alternated with ice applications to reduce inflammation.

Crucial to keep moving

Regular exercise is important to keep joints flexible and improve muscle strength, reducing the burden on affected joints. Initially, you may wish to work with a physical therapist to learn specific exercises to build strength and increase your joints’ range of motion.

Daily aerobic activity, such as swimming, bicycling or walking, is excellent for endurance and to improve physical fitness and general well-being. It also promotes weight control, which can prevent osteoarthritis from developing in knee joints.

For severe osteoarthritis, when movement is severely limited or pain interferes with sleep, surgery is sometimes an effective option. Joints can sometimes be fused to eliminate painful movement and complete joints, such as the hip, can sometimes be replaced with mechanical devices.

Question alternative treatments

The Arthritis Foundation offers a magazine, information and programs for those who suffer from osteoarthritis and other joint diseases, including rheumatoid arthritis, fibromyalgia and gout. Call (800) 283-7800 or visit the foundation's Web site

Many people with serious, chronic diseases turn to fad treatments that they have read about in advertisements or hear about from other sufferers. Copper bracelets, mineral springs and snake venom have all been popularly attributed to relieving osteoarthritis.

The latest alternative treatment is a combination of glucosamine and chondroitin, two natural components of cartilage, which are sold in health food stores. This “medical miracle” has been promoted in a best-selling book to relieve the pain of osteoarthritis and even as a possible cure.

The problem with alternative treatments is the lack of large population studies to show efficacy and safety, which physicians usually require before advocating new treatment. Before embarking on an alternative treatment, I recommend that you consult with a physician whom you trust to advise you on whether and how to proceed.