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Osteoarthritis Symptoms and Diagnosis

Osteoarthritis Symptoms and Diagnosis

What are early signs and symptoms of osteoarthritis?


Skelton showing joints affected by osteoarthritisOsteoarthritis (OA) usually progresses slowly over a period of months or years. Early on, osteoarthritis symptoms tend to come and go. Over time, as damage accumulates, symptoms can become more constant, occurring at rest and disturbing sleep. The good news is that symptoms can improve with treatment, even if the disease process itself is unchanged. Symptoms may be experienced in the joint or outside of the joint as well.

The joints most commonly affected by osteoarthritis are the knees, hips, big toes, hands and spine. OA affects everyone differently, but common symptoms include joint pain, aching, morning stiffness lasting less than 30 minutes, reduced range of movement in the affected joint(s) and possibly swelling. The symptoms may come and go, but the intensity of pain can increase over time given that OA is a progressive disease.

Common osteoarthritis joint symptoms include:

  • Joint pain

    Your joint may hurt during heavy use, and improve with rest. As the disease progresses, the pain may be triggered by increasingly ordinary activities and may become unpredictable, occurring at rest and during sleep. The pain you feel may not necessarily match the degree of arthritis seen on an x-ray. Pain is a complicated process affected by what is happening inside your joint as well as factors outside of your joint, such as surrounding muscle strength, genetics, physical activity, sleep and mood.

  • Joint stiffness

    The joint may be stiff after not moving it for a while, such as when you wake in the morning or sit for a long time. This stiffness usually lasts 30 minutes or less. If you find it lasting significantly longer, check with your doctor.

  • Joint swelling

    You may notice an increase in the size of affected joints. This can be from an increase in fluid in the joint (inflammation), or from a bony outgrowth (often found in affected finger joints and big toes).

  • Joint crepitus

    You may feel a grinding sensation or notice a creaking sound when the joint moves.

  • Joint instability

    Joints like the knee or hip may feel like they are giving way or buckling.

  • Joint dysfunction

    The joint does not function as well as it should. This can be due to pain or reduced movement of the affected joints:

    • Hands – you may have difficulty with fine motor activities, such as doing up buttons, writing with a pen, or gripping door handles.
    • Hips – you may have difficulty with daily activities like walking, getting in or out of a car, or putting on your shoes.
    • Knees – you may have difficulty with activities like walking, getting up from a chair, squatting, kneeling or climbing stairs.
Woman with osteoarthritis knee pain

Osteoarthritis symptoms outside the joint may include:

  • Sleep disruption

    OA symptoms may disrupt your sleep, which in turn can make your symptoms feel worse, and reduce your capacity to cope.

  • Altered mood

    OA symptoms can have a negative effect on your mood. Mental health issues like depression and anxiety are significantly more common in people living with chronic pain, and can in turn worsen pain and negatively impact your overall health.

  • Fatigue

    It is common for people with severe pain from OA to experience high levels of fatigue (extreme tiredness, exhaustion).

  • Impaired quality of life

    OA symptoms can make it harder for you to keep up with the activities and relationships that make your life enjoyable, affecting your overall quality of life and your ability to do things you want to do.

  • Pain sensitization

    Some individuals with OA experience more severe symptoms from a process called pain sensitization, which comes from abnormal pain processing by the central nervous system. It’s as if the ‘volume knob’ on your pain system has been left turned up like a radio stuck on ’loud.’ As a result, you may feel exaggerated pain in response to a painful trigger, pain in response to a non-painful trigger e.g. light touch, or ongoing pain in the absence of any trigger.
    Your feelings of pain may extend beyond the boundaries of the joint and become widespread (such as up and down your affected leg). You may also experience nerve symptoms such as tingling and shock-like sensations. See your doctor to check if these symptoms are from your arthritis, or from another cause. It’s really important to understand that you can ‘turn the volume down’ as you progress through self- management strategies such as regular exercise, optimal sleep and stress-reduction techniques, but it often takes effort and time. Medications that target the central nervous system may also be beneficial. Your healthcare provider can help to guide you in this process.

Fatigued person with osteoarthritis

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How is osteoarthritis diagnosed?


Diagnosing osteoarthritis with a x-rayThere is no single test for OA. The diagnosis can be made based on your symptoms and physical examination findings. If you are over the age of 40 and have symptoms typical of OA, your doctor will probably not do an x-ray. It is helpful to know that symptoms of osteoarthritis do not always match what is found on x-rays. For example, in early OA, your x-rays may not reflect the symptoms you are experiencing, and later in the disease process, the damage shown on an x-ray may appear more severe than the symptoms you feel.

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What are the risk factors for osteoarthritis?


Risk factors that may increase your chances of developing OA include the following:

  • Age

    The risk of OA increases with age. However, OA is not an inevitable part of aging. Many people age without having OA symptoms.

  • Sex

    Women are more likely to develop OA than men.

  • Family history

    Genetics can contribute to the development of OA, but just because your family member has OA does not mean you will get it.

  • Excess weight

    Carrying extra weight increases your chance of getting OA in several ways. Excess weight puts more stress on weight-bearing joints such as your feet, knees, hips and spine, and increases your risk of injury as well as the rate of degeneration. In addition, fat tissue can release substances in your body that can increase joint inflammation.

  • Joint injury

    OA can occur in joints that have been “damaged” by a previous injury, such as from a sport or accident.

  • Occupations

    People who repeatedly stress a particular joint may also be at greater risk of developing OA. Examples include elite athletes, dancers, heavy machinery operators and construction workers.

  • Joint misalignment / deformity

    Some people who are born with or develop malformed joints are at greater risk of OA.

  • Muscle weakness

    Weakness of supporting structures around the joint such as muscles and ligaments can increase the risk of OA.

  • Sedentary lifestyle

    A sedentary lifestyle increases your risk of OA.

Woman with osteoarthritis

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What is the osteoarthritis patient journey?


Diagnosing osteoarthritis with doctorA patient journey is the sequence of events that an osteoarthritis patient experiences, from the first signs of symptoms to diagnosis and later to treatment and management. Not all steps will apply to everyone, but this can help you learn more about what you might expect and how to effectively manage your osteoarthritis.

 

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How common is osteoarthritis?


Osteoarthritis is the most common form of arthritis. More than 4 million Canadians have osteoarthritis (OA), more than all other types of arthritis combined. About 1 in 7 Canadian adults live with the impact of this progressive, painful disease.

These findings shine a light on the unrecognized burden of OA at all ages, including young adulthood. These insights and others were derived from a special report entitled The Burden of Osteoarthritis in Canada (2021) by the Arthritis Community Research and Evaluation Unit (ACREU) commissioned by the Arthritis Society. Learn more on our Arthritis Facts and Figures page.
 

 

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This osteoarthritis resource was reviewed in February 2021 with expert advice from:

Dr. Sarah E. Ward, MD, FRCSC
Orthopaedic Surgeon, Division of Orthopaedic Surgery
St. Michael’s Hospital
Assistant Professor, Department of Surgery
University of Toronto

Members of the Canadian Arthritis Patient Alliance Steering Committee, including:

  • Linda Wilhelm
  • Janet Gunderson
  • Therese Lane
  • Louise Crane

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This resource was made possible through unrestricted educational grants from:

Arthritis alliance of Canada
Pfizer