Osteoarthritis: symptoms, pain relief and a video doctor visit

Osteoarthritis is a joint disease in which the tissues of the joint break down over time. It is the most common form of arthritis, and many people simply call it "arthritis" or "wear and tear" of the joints.

It mostly affects the hands, knees, hips, neck and lower back. The risk rises with age, extra weight, past joint injuries or surgery, jobs with repetitive kneeling, squatting or heavy lifting, and family history. If your knee bothers you most, see also knee pain, where we cover other causes such as a twist or bursitis.

It is not the same as rheumatoid arthritis, an autoimmune disease that usually affects both hands or both wrists at once and causes morning stiffness that lasts more than an hour.

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The most common symptoms are:

• Joint pain when you use the joint or put weight on it
• Stiffness when you get up or after sitting still, lasting under 30 minutes
• Swelling of the joint
• Less movement: stairs or getting up from a chair get harder
• A grinding or scraping noise in the knee when you move it
• In advanced cases, pain at rest or at night

Exercise comes first. NICE recommends therapeutic exercise for everyone with osteoarthritis (strengthening the muscles around the joint plus aerobic activity), and weight loss when needed. Pain may increase a little at first; with consistency, exercise reduces pain and improves movement. Walking, swimming and water exercise are good options.

Medicines, used carefully. NICE recommends a topical anti-inflammatory (a gel or cream applied to the skin) first for knee osteoarthritis, and considering one for other joints. If that is not enough, the doctor may consider an oral anti-inflammatory (an NSAID such as ibuprofen or naproxen) at the lowest dose for the shortest time. NSAIDs can cause stomach ulcers and bleeding, affect the kidneys and raise the risk of heart attack or stroke; check before using them if you have high blood pressure, heart or kidney disease, or past ulcers. That is why a gel is preferred first in older adults.

In dengue season: fever with joint pain can be dengue or chikungunya. Do not take ibuprofen or aspirin until dengue is ruled out; the CDC recommends acetaminophen. Read dengue warning signs.

Osteoarthritis or rheumatoid arthritis? If morning stiffness lasts more than an hour, or the same joints hurt and swell on both sides of your body (both hands, for example), the doctor gives you a lab order for a lab near you (for example rheumatoid factor, anti-CCP, sed rate and C-reactive protein) and, if needed, we refer you to rheumatology. Blood tests do not diagnose osteoarthritis, but they help rule out other causes.

If a single joint suddenly turns hot, red and swollen, it may be gout or an infection; get seen soon. If the pain is in your shoulder, see shoulder pain; if many joints hurt at once, see joint pain.

What is meloxicam used for? Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) taken by mouth and sold by prescription only. Its FDA-approved label says it relieves the pain, swelling and stiffness of osteoarthritis and rheumatoid arthritis, and of juvenile rheumatoid arthritis in young people who meet the label’s criteria. It belongs to the same group as naproxen and ibuprofen, which, unlike meloxicam, are also sold over the counter.

The FDA boxed warning. Like every NSAID, meloxicam carries the FDA’s most serious warning: it can raise the risk of heart attack and stroke, which can be fatal, and of ulcers, bleeding or a hole in the stomach or intestine, sometimes with no warning symptoms. The risk can start early in treatment and rises with long-term use, with age and if you drink alcohol. It is not used around heart bypass (CABG) surgery.

Kidney cautions. NSAIDs can harm the kidneys, especially if you already have kidney disease, heart failure or dehydration, or take diuretics or certain blood pressure medicines. If you have been told your creatinine is high, the doctor takes that into account before deciding.

Pregnancy. In 2020 the FDA recommended avoiding NSAIDs from 20 weeks of pregnancy onward unless your doctor advises it, because they can cause kidney problems in the unborn baby and low amniotic fluid. This does not include low-dose aspirin your doctor has told you to take. If you are or could be pregnant, tell the doctor.

Do not combine NSAIDs. Do not take meloxicam with ibuprofen, naproxen, aspirin or another NSAID: the FDA label does not recommend it. If your doctor told you to take low-dose aspirin for your heart, do not stop it on your own; tell the doctor. Also tell her if you take blood thinners, oral steroids or antidepressants such as SSRIs, because they raise the risk of bleeding. If you have a fever and dengue is possible, take no NSAID until it is ruled out.

The doctor decides. If exercise, a gel and over-the-counter pain relievers are not enough, the doctor reviews your heart, blood pressure, kidneys, stomach and other medicines, and decides whether an NSAID such as meloxicam, naproxen or another option is right for you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.

What you do every day matters as much as medicine:

• Move every day: walk, swim or exercise in water, without forcing the joint.
• Strengthen your leg muscles to protect your knees and hips.
• If you carry extra weight, losing some reduces the load on your knees, hips and feet.
• Use a cane in the hand opposite the sore leg if it helps you walk.
• Heat before exercise to loosen stiffness, and ice wrapped in a towel afterwards if the joint swells.
• Use over-the-counter pain relievers as the label directs; do not take more than 4 grams of acetaminophen a day.

For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.

• A hot, red, very swollen joint with fever (possible joint infection)
• A fall or blow with a deformed joint, or you cannot put weight on the leg
• Vomiting blood or material like coffee grounds, or black stools, while taking anti-inflammatories
• Chest pain, shortness of breath, or sudden weakness or trouble speaking