Osteoarthritis

What is Osteoarthritis?

Osteoarthritis is the most common form of arthritis in the world, and it can range from an incidental finding on an X-ray to a seriously disabling condition.^[1] It is a varied condition that is becoming more common mainly because people are living longer and body weight is rising.^[2]

Common symptoms

Osteoarthritis typically causes joint pain that gets worse with use and eases with rest. Morning stiffness is usually brief and there are no whole-body symptoms such as fever.^[3]

• Stiffness after sitting or waking, which settles with movement
• Swelling or tenderness around the joint
• Less range of motion, with a grinding or cracking feeling
• Visible change in the shape of the joint in advanced disease

The knees, hips, hands, spine and the base of the big toe are the joints most often affected.^[1]

Causes and risk factors

Osteoarthritis is no longer thought of as simple wear and tear. Age, obesity, past joint injury and mechanical loading all contribute, and they appear to act partly by changing the lining of the joint.^[4] Overweight and obesity are the most important risk factors you can change.^[3] Family history and being female after about age 50 also raise the risk.^[1]

How it is diagnosed and treated conventionally

Diagnosis rests mainly on your history and a physical exam. X-rays can show a narrowed joint space and bone spurs, and blood tests are used mainly to rule out other types of arthritis.^[1]

A review of clinical guidelines found that the higher-quality ones consistently recommend education, exercise and weight management, with oral anti-inflammatory medicines considered for hip and knee pain and corticosteroid injections for the knee. Advice on adjunctive treatments such as acupuncture was less consistent between guidelines.^[5] Current treatments relieve pain and improve function but do not reverse the joint changes. Surgery is considered when other approaches fail to control pain.^[3]

Why Osteoarthritis calls for a whole-person approach

Osteoarthritis is not only a problem of cartilage. Inflammation, body weight, muscle strength and the way the nervous system handles pain all affect how much a joint hurts, which is why two people with similar X-rays can feel very different.^[2]

Care that looks at these factors together is a reasonable addition to treatment aimed at the joint. The factors below are the ones researchers have studied most.

Inflammation in the joint

Inflammation of the joint lining is present in osteoarthritis and has been linked to pain and to worsening of the joint over time.^[4] This is one reason anti-inflammatory medicines are commonly used.

Body weight and mechanical load

Extra weight is the most important modifiable risk factor for knee osteoarthritis.^[3] A recent Lancet review notes that managing obesity and staying active remain important, while also saying that newer evidence has questioned how well exercise programs and a focus on weight loss work.^[2]

Pain processing in the nervous system

Different pain mechanisms exist in osteoarthritis, and pain does not always match what imaging shows.^[2] Pain signals can be amplified by the spinal cord and brain, a process called central sensitization, which is one of the targets of pain-focused therapies.^[6]

Movement, strength and daily habits

Exercise and education are the treatments most consistently recommended by high-quality guidelines.^[5] Any complementary care is best seen as a support for staying active, not a substitute for it.

Acupuncture for Osteoarthritis

What the research shows

Acupuncture may reduce knee pain and improve function, but the research is mixed and often of low certainty. Most of the evidence is for knee osteoarthritis.

A 2024 review of 80 trials with 9,933 people found that acupuncture may reduce pain more than sham acupuncture, anti-inflammatory drugs and usual care, though the certainty of the evidence was very low. Electroacupuncture, in which a small current is passed through the needles, appeared to work better than manual acupuncture in the exploratory analysis.^[7] A review of 10 trials with 3,221 people found that benefits compared with sham or usual care may last for roughly 3 to 6 months after treatment ends. When acupuncture was added to exercise-based physical therapy, it was no better than exercise alone.^[8]

Sham-controlled trials give mixed results. In a trial of 480 people given treatment three times a week for 8 weeks, 60.3% of those who received electroacupuncture had a clinically meaningful improvement, versus 47.3% with sham. Manual acupuncture did not beat sham at 8 weeks.^[9] A trial of 86 people found no difference between superficial needling and non-penetrating sham acupuncture.^[10]

The Cochrane review of peripheral joint osteoarthritis found small benefits over sham that did not reach its thresholds for clinical relevance and were probably partly due to placebo effects. Larger benefits against waiting-list groups may reflect expectation.^[11] For hip osteoarthritis, a Cochrane review of 6 small trials concluded acupuncture probably has little or no effect on pain compared with sham.^[12] Overall, results vary from person to person, and the benefit over sham treatment is small.

How acupuncture may work

Researchers propose that acupuncture strengthens the body's own pain-inhibiting pathways, calms central sensitization and may lower inflammatory chemicals near the site of pain.^[6] These are proposed explanations, not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles placed around the affected joint and at points elsewhere on the body, usually left in place for about 20 to 40 minutes. Electroacupuncture adds a mild current to some needles. The larger knee trial gave three sessions a week for 8 weeks, but a typical course varies, and we reassess after several visits.^[9]

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). If you have had a joint replacement, tell us which joint and when.

Ayurvedic medicine for Osteoarthritis

The Ayurvedic view

In Ayurveda, osteoarthritis is described as Sandhigata Vata, a disorder in which aggravated Vata, the principle said to govern movement and dryness, settles in the joints, and it is traditionally linked with aging. These are traditional categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to calm Vata, such as warm, regular meals and steady sleep hours
• Warm oil massage (abhyanga) and local steam or heat over the affected joint
• Herbs and formulas used for joint pain, such as Boswellia (shallaki), guggulu-based preparations, and ginger and guduchi combinations, prescribed individually by a practitioner
• Gentle movement or yoga within your physician's guidance

Panchakarma, including medicated enema therapy, is not appropriate during pregnancy, acute illness or frailty, and many people with osteoarthritis are older, so it is used only where medically sensible. Our transdermal medication therapy, in which herbal preparations are applied to the skin over a joint, has not been shown in the studies cited on this page to work.

What the research shows

The evidence for Ayurveda in osteoarthritis is limited. A systematic review of 19 randomized and 14 non-randomized trials covering 2,952 patients found large effects for one compound herbal preparation and an effect comparable to glucosamine for a ginger and guduchi preparation. For Boswellia, guggulu-based preparations, Ayurvedic massage, steam therapy and enema, the review found no evidence of significant effects once the risk of bias was considered. No severe adverse events were seen, but the authors noted several limits in the research.^[14]

A later double-blind trial in India compared a polyherbal Ayurvedic formulation with diclofenac in 80 people for 12 weeks. Both groups improved, and the herbal formula was judged not inferior, but the trial was small, had no placebo group and was done at two hospitals.^[15]

Herbal medicine for Osteoarthritis

Herbs and formulas that have been studied

The herbs with the most research for osteoarthritis are Boswellia serrata (frankincense) extract and turmeric (Curcuma longa) or its component curcumin, both from the Ayurvedic tradition. Chinese herbal formulas are also commonly used for knee pain. We did not find a systematic review of them to cite, so we cannot describe their effect. Herbs are prescribed individually by a qualified practitioner.

What the research shows

The evidence is moderate at best and comes from short trials. A Cochrane review of 49 trials of oral herbal products found high-quality evidence from two small studies (85 people) that an enriched Boswellia extract improved symptoms over placebo during 90 days. The authors found many other plant products only in single studies and called for more research. They reported no serious side effects from the plants studied.^[16]

A meta-analysis of 7 trials with 545 people found that Boswellia extract may reduce pain and stiffness and improve function compared with placebo or standard drugs.^[17] A meta-analysis of 15 trials with 1,621 people found that turmeric extract and curcumin improved pain, stiffness and function compared with placebo, with similar effect to anti-inflammatory drugs and fewer adverse events.^[18] Study sizes were small, and the Cochrane review notes that joint structure was not measured in the Boswellia studies.^[16]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. A systematic review of warfarin interactions found that several herbs and supplements, including ginger, have been linked to bleeding events and a raised risk of bleeding.^[19] If you take blood thinners, anti-inflammatory drugs or any prescribed medicine, a practitioner needs to review any herb first.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes chronic joint pain as obstruction by cold and damp, or deficiency of the Liver and Kidney that nourish tendons and bones. Researchers studying these therapies measure things that loosely parallel this picture: inflammatory signaling in the joint and the way the nervous system amplifies pain.^[6]

Ayurveda's aggravated Vata describes dry, painful, stiff joints in older age. No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for osteoarthritis is complementary. Keep your physician, rheumatologist, orthopedist or physical therapist, and do not stop or change prescribed medicines or injections without your prescriber. We do not diagnose the type or cause of joint pain, so new or unexplained joint symptoms should be medically evaluated.

Please bring your diagnosis, any X-ray or MRI reports, a full list of medicines and supplements, and details of any injections or surgery, planned or past.

When to seek urgent medical care

Some joint symptoms can point to infection, fracture or another serious problem rather than osteoarthritis.

• A hot, red, swollen joint, especially with fever or chills
• A joint that suddenly cannot bear weight, or severe pain after a fall or injury
• Sudden swelling of one joint with severe pain
• Numbness, weakness or loss of bladder or bowel control with back or neck pain
• Unexplained weight loss, or fever with joint pain

If any of these occur, call 911 or go to the nearest emergency department.