Osteoarthritis (OA) is a degenerative joint disease that affects the cartilage and bones of joints. It is very common for osteoarthritis to develop in multiple joints rather than just one joint.
What is osteoarthritis?
Osteoarthritis occurs when the cartilage that cushions the ends of bones in joints gradually wears away over time. This leads to pain, swelling, and problems moving the joint. Osteoarthritis can affect any joint, but it most commonly affects joints in the hands, knees, hips, and spine.
Some key facts about osteoarthritis:
- OA is the most common form of arthritis.
- It usually develops slowly over years.
- The main symptoms are joint pain and stiffness.
- There is no cure, but treatment can help manage symptoms.
- It becomes more common with older age.
What causes osteoarthritis?
The exact cause of osteoarthritis is unknown, but certain factors increase the risk of developing it:
- Age – The risk increases as you get older because cartilage wears down over time.
- Obesity – Excess weight puts more pressure on joints.
- Joint injury – Damage from sports, work injuries, or accidents increases risk.
- Genetics – Some genetic abnormalities can affect joint cartilage.
- Joint stress – Jobs or activities that put repetitive stress on joints.
Is osteoarthritis usually in multiple joints?
Yes, it is very common for osteoarthritis to develop in multiple joints throughout the body rather than just one joint. Some key points:
- Hand osteoarthritis often affects multiple joints in both hands.
- Knee OA often leads to OA in the other knee and hips.
- Having OA in one joint makes you more likely to develop it in other joints.
- The more joints affected, the more severe and widespread the OA.
A large European study found that among people with hand osteoarthritis:
- 15% had OA in just one joint
- 35% had OA in two joints
- 50% had OA in three or more joints
So having osteoarthritis in multiple joints is actually more common than having it in just one joint.
What are the most commonly affected joints?
While osteoarthritis can occur in any joint, the most commonly affected joints are:
- Hands – base of thumb and fingers (DIP, PIP, MP joints)
- Knees – particularly the inner/medial aspect
- Hips
- Spine – middle to lower back and neck
- Feet – big toe and midfoot
Other joints that can be affected include the shoulders, elbows and ankles. When osteoarthritis occurs in multiple joints, it typically involves some combination of the above locations.
Are certain types of OA more likely to be widespread?
Yes, there are certain forms of osteoarthritis that are more likely to affect multiple joints:
- Erosive hand OA – An aggressive, inflammatory type of hand OA that tends to affect multiple joints.
- Generalized OA – Defined as involvement of at least three joint areas (hand, spine, knee, etc.).
- Polyarticular OA – OA in five or more joints.
- Nodal OA – Characterized by swelling of finger joints. Tends to affect multiple joints.
People with these general, widespread patterns of OA tend to have more severe symptoms and joint damage.
Does osteoarthritis progress between joints?
Research shows that osteoarthritis does seem to spread from one joint to another in many cases. Some potential reasons for this include:
- Having OA in one joint may increase strain or instability in other nearby joints.
- Systemic factors like inflammation may contribute to OA worsening throughout the body.
- Some cases may be due to an underlying predisposition to developing widespread OA.
For example, people with knee osteoarthritis are at increased risk of going on to develop OA in their opposite knee or hips. The progression of OA between joints likely involves a combination of mechanical and systemic factors.
What are the symptoms of multi-joint osteoarthritis?
The main symptoms of osteoarthritis typically include:
- Joint pain that worsens with use
- Stiffness after periods of inactivity
- Swelling around affected joints
- Reduced range of motion and flexibility
- Tenderness when pressing on joints
- Joint instability or buckling
- Bony nodules around joints
- Creaking/cracking sounds during movement
In multi-joint OA, these symptoms occur in two or more joints. The pain, stiffness and problems using the affected joints can have major impacts on everyday activities.
How is widespread osteoarthritis diagnosed?
Doctors diagnose widespread OA based on:
- Medical history – asking about joint pain and function.
- Physical examination of all joints – checking for swelling, tenderness, range of motion.
- Imaging tests – X-rays, ultrasounds, MRI scans to assess joint damage.
- Blood tests – To rule out other types of arthritis.
They will assess which joints are affected and the severity of symptoms and joint damage. Classification criteria are used to determine if it meets definitions of generalized, erosive or polyarticular OA.
What are the treatment options?
Treatment options for widespread osteoarthritis aim to relieve joint pain and improve function. They include:
- Medications – Acetaminophen, NSAIDs, corticosteroid joint injections.
- Weight loss – To reduce pressure on joints.
- Physical therapy – Stretching, strengthening exercises.
- Assistive devices – Canes, splints, knee braces.
- Surgery – Joint replacement surgery for severely damaged joints.
Treatment needs to be tailored based on which joints are affected and the severity in each joint. A combination of medical and lifestyle approaches is often needed to manage widespread OA.
What is the outlook for multi-joint osteoarthritis?
The outlook for people with widespread osteoarthritis depends on several factors:
- How many joints are affected – The more joints involved, the worse the symptoms and disability tend to be.
- Which joints are affected – Weightbearing joints like hips and knees cause more functional impairment.
- Age of onset – Developing OA at a younger age typically indicates more aggressive disease.
- Response to treatment – Some people respond better to treatment to control symptoms.
While there is no cure for osteoarthritis, the progression can be slowed with proper treatment. Joint replacement surgery can help restore function in severely damaged joints.
| Joint(s) Affected | Symptoms | Treatment Options |
|---|---|---|
| Hands | Pain and stiffness in fingers/base of thumb. Difficulty gripping objects. | Finger splints, acetaminophen, NSAIDs, cortisone injections. |
| Knees | Knee pain walking/climbing stairs. Swelling, buckling. Difficulty standing from sitting. | Weight loss, assistive devices (cane, braces), physical therapy, NSAIDs, injections, knee replacement surgery. |
| Hips | Stiffness, pain getting in/out of cars and turning in bed. Limping. | Activity modification, gait aid, physical therapy, anti-inflammatories, hip replacement surgery. |
| Spine | Lower back stiffness and pain. Reduced mobility bending/twisting. Pain can radiate. | Heat/ice, exercise, posture correction, analgesics, steroid epidural injections, surgery for severe cases. |
| Feet | Big toe pain and reduced motion. Bony foot/toe enlargement. Ingrown toenails. | Shoe inserts, toe spacers, analgesics, surgery for severe bunions/deformities. |
This table summarizes the typical symptoms in the most commonly affected osteoarthritic joints and some treatment options for each.
Conclusion
In summary, it is very common for osteoarthritis to occur in multiple joints rather than isolated to a single joint. The hands, knees, hips and spine are most often affected. Certain forms like generalized and polyarticular OA by definition involve widespread joint damage. Treatment requires managing symptoms in all affected joints with medications, therapy, lifestyle changes and sometimes surgery.