Osteoarthritis is joint wear that almost everyone gets with age. How bad it looks on an X-ray tells you very little about how much it will hurt.
What is osteoarthritis?
Cartilage thins, the gap in the joint narrows and bone spurs form. Inflammation inside the joint drives much of the pain.
How bad the scan looks and how bad the pain feels match up poorly. People with dramatic X-rays get around well. People with mild changes suffer.
What are the symptoms of osteoarthritis?
- Pain when you use the joint that eases with rest, at least early on.
- Morning stiffness lasting under 30 minutes.
- Grinding or catching in the joint.
- Swelling after activity.
What is the best treatment for osteoarthritis?
- Image-guided joint injection — corticosteroid or hyaluronic acid.
- Physical therapy, one of the most effective treatments there is for joint arthritis.
- Metabolic treatment, because inflammation and load both matter.
- Genicular nerve blocks and ablation for knee arthritis where injections stop working.
To be assessed, call us or request an appointment.
What usually gets missed
The most harmful myth is that it is simple mechanical wear and that activity speeds it up. Osteoarthritis is an active process. It involves inflammation and bone remodeling (bone reshaping itself). The right amount of load protects the joint. It does not harm it.
Patients told to rest a painful joint reliably get worse, because the muscle that supports it wastes away and each bit of cartilage carries more load.
Does osteoarthritis get worse over time?
Change on X-ray is slow and matches symptoms poorly. Many people hold steady for years.
Exercise therapy and weight control work about as well as many drugs and procedures. Where injections and therapy stop being enough, nerve-targeted options like genicular ablation treat the pain without touching the joint.
When this becomes urgent
A hot, swollen, acutely painful joint with fever is a septic (infected) joint and an emergency. Sudden severe joint pain where you cannot bear weight after a minor injury needs imaging to rule out a fracture, most of all when bone density is low.
Orthobiologic treatment options
Some osteoarthritis has outgrown pills and steroid shots but is not ready for a joint replacement. For that, orthobiologics are the middle step. These are treatments made from your own tissue: platelet-rich plasma (PRP), bone marrow concentrate, and microfragmented fat. They go inside the joint, into a worn tendon, or into the bone just under damaged cartilage. Results depend on the platelet dose delivered and on the rehab built around it. That is why one shot with nothing around it is not the plan.
Some joints have their own page here: thumb arthritis, ankle arthritis and knee pain. Procedures are done awake with local numbing medicine at our regenerative clinic, 4477 Woodson Rd in St. Louis. Orthobiologic care is not covered by insurance, and HSA and FSA funds can generally be used.
For every condition we treat with orthobiologics, see our PRP injections in St. Louis page.
What causes osteoarthritis pain?
Osteoarthritis is an active process, not passive wear. Cartilage loses its matrix (its inner framework). The bone under it reshapes and thickens. The synovium (the joint lining) becomes inflamed. That inflammation drives a large share of the pain. This is why symptoms swing week to week while the changes in the joint build over years. It is also why anti-inflammatory approaches help even though the joint surface has not changed.
What it gets confused with
The most harmful myth is that it is mechanical wear that activity speeds up. Loading the joint within what it can handle protects it. It keeps the cartilage fed. It keeps the muscle that takes load off the joint. Patients told to rest reliably decline, because muscle wastes away and each bit of cartilage left carries more load.
What the first appointment covers
Expect a longer talk than you may be used to. We ask what the pain does across a full day, what sets it off and what calms it. We ask what past treatment did and how long it lasted. Partial and short-lived results tell us a great deal. The exam then tests the possible sources your story points to. We tell you what we think is causing the pain and how sure we are.
Common questions
Is it worth exercising with arthritis?
Yes, strongly. Muscle around a joint is the best support it has. Sitting still speeds up both pain and decline.
Knee Pain covers exercise therapy for an arthritic knee.
Does exercise wear the joint out faster?
No. The right amount of load protects the joint. Sitting still is what speeds up the loss of function. During a flare, ease off impact. Do not quit it.
My X-ray looks terrible. Does that predict how bad it will get?
Poorly. How bad the X-ray looks and how bad the symptoms feel match up weakly. Many people hold steady for years.
This is set out in Knee Pain.
What helps with osteoarthritis pain?
Several things working together. Physical therapy is one of the most effective treatments for joint arthritis. Loading the joint within what it can handle protects it. Rest lets the muscle around it waste away. Image-guided injections of corticosteroid or hyaluronic acid calm the joint. Metabolic treatment takes on inflammation and load. And for knee arthritis, genicular nerve blocks and ablation treat the pain when injections stop working.
Does the pain of osteoarthritis ever go away?
It comes and goes more than most people expect. Inflammation inside the joint drives much of the pain. So symptoms swing from week to week, even though the changes in the joint move over years. Many people hold steady for years. Pain can ease while the joint surface stays the same. That is why anti-inflammatory treatment, therapy and nerve-targeted options still help.
What causes an osteoarthritis flare?
Inflammation. Osteoarthritis is an active process, not passive wear. The lining of the joint becomes inflamed, and that inflammation drives a large share of the pain. It is why a joint can swell after activity. It is why symptoms rise and fall week to week while the X-ray barely changes. During a flare, ease off impact, but do not stop moving.
Sources
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 2020. PubMed 31908149
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 2019. PubMed 31278997
- Gibbs AJ et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis and cartilage, 2023. PubMed 37394226
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, N.J.), 2020. PubMed 31908163
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