Joint aches and pains are a cardinal sign of arthritis, one of the most common, chronic health problems associated with aging. So, if your joints don’t ache or feel stiff, does it mean you’re arthritis free? Certainly, having achy joints is a red flag that you could have arthritis or some other orthopedic issue, but is the absence of joint pain a reliable sign that you DON’T have arthritis?
What is Arthritis?
There are various types of arthritis, but the one we most often refer to when we speak of chronically achy joints is osteoarthritis, the most common form. Osteoarthritis can affect a number of joints including those in the hips, knees, hands, and feet. Osteoarthritis is a degenerative form of arthritis, although recent research suggests there may be an inflammatory component as well. It’s a health problem strongly linked with aging.
The incidence of osteoarthritis rises sharply after the age of 50 and it’s almost twice as common in women as in men. The way it appears, and its course varies widely between individuals. And yes, you can have osteoarthritis and be symptom-free. In fact, one study found that 20% of women and 10% of men have symptomatic osteoarthritis, but a whopping 27 % to 80% of a similar population has evidence of osteoarthritis on X-ray.
The classic signs and symptoms of osteoarthritis are joint pain and stiffness, but these symptoms manifest to varying degrees and, in some cases, a person can have evidence of osteoarthritis on X-ray and be free of symptoms. If you have to have it, that’s the best kind to have! If you have arthritis, you might feel stiff when you first wake up in the morning or after you sit for a long period of time. You don’t always have the joint aches, particularly in the early stages. One study found that discomfort walking upstairs, pain when squatting, and a grating sound with knee movements are among the most common symptoms of early osteoarthritis.
Osteoarthritis of the knees is one of the most common forms. Research shows that up to 60% of people with osteoarthritis of the knees don’t have joint pain or stiffness at all. However, on x-ray, these folks would have narrowing of the joint spaces in their knees, a classic sign of knee arthritis. Sometimes, small cysts and bone spurs form in the joint too. In some cases, the diagnosis of osteoarthritis happens incidentally when you get an x-ray for another reason, such as a knee injury.
The symptoms of knee arthritis often don’t correlate with what the x-ray shows. For example, you can have a relatively unremarkable knee x-ray and still experience joint discomfort and vice versa. Your x-ray can look bad and your symptoms may still be mild. Osteoarthritis is tricky!
Sometimes, osteoarthritis manifests with seemingly unrelated signs that subtly suggest a joint or joints is unhealthy. For example, a study published in Gait and Posture in 2017 found that people who go on to develop osteoarthritis of the hips may have subtle abnormalities when the walk. These changes go unnoticed early on. Some of these signs include a slightly asymmetrical gait, problems with tandem walking, walking in a straight line with the toe of one foot touching the heel of the other, and subtle difficulties with turning their body when they change directions.
Why do some people have symptoms when they have osteoarthritis on X-ray while others do not? A study that focused on knee osteoarthritis looked at this issue. This study found that certain risk factors increase the odds of having arthritic symptoms, like joint pain and stiffness. These factors include:
· Being female
· Being over the age of 50
· Having a body mass index greater than 25
· Being knock-kneed (where the knees angle inward and touch when you straighten your legs)
You can’t control all of these factors. In fact, you can only control one – your body mass index. That’s why the number one thing overweight people can do to ease joint pain and stiffness is to lose weight. Therefore, one of the best ways to lower the risk of developing symptomatic osteoarthritis is to stay a healthy body weight throughout life. Studies show that fat cells release chemicals called adipokines that promote low-grade joint inflammation. Losing excess fat tissue reduces the release of adipokines and the joint inflammation. Plus, being overweight places more force and stress on the joints.
Research shows even modest weight loss can have benefits for osteoarthritis. For example, shedding just 10 pounds removes 40 pounds of pressure on the knee joints. Over time, this can have a significant impact on joint health. Losing weight also improves the symptoms of osteoarthritis. In a study published in the Journal of The American Medical Association found that losing only 10% of body weight was enough to reduce joint pain and improve joint function.
Exercise is important too! Contrary to popular belief, exercise doesn’t worsen arthritis. Moving your joints helps keep the joint lubricated and enhances nutrient delivery. Plus, it strengthens the muscles that protect the joints. People with osteoarthritis who don’t exercise develop muscle weakness, become deconditioned and lose range-of-motion of the joint.
What kind of exercise is best? A large trial called the Fitness Arthritis and Seniors Trial (FAST) looked at this issue. Older adults were assigned to one of three groups: resistance training only, aerobic exercise only, or a control group who did no exercise. The results? Both forms of exercise led to similar improvements in functioning and a decrease in joint symptoms. So, movement, both aerobic and resistance exercise, is important for joint health and for easing the symptoms of arthritis as well. Check with your physician if you have significant joint symptoms before doing high-impact exercise.
The Bottom Line
Yes, you can have osteoarthritis without any joint symptoms at all, but there are things you can do to lower your risk of developing symptomatic osteoarthritis. Maintain a healthy weight and make sure you’re resistance training and doing aerobic exercise to help your joints stay lubricated.
· Osteoarthritis Cartilage. 2013;21(9):1145.
· Gait & Posture. Volume 54, May 2017, Pages 248-254.
· JAMA. 2013;310(12):1263-1273. doi:10.1001/jama.2013.277669
· Risk Factors of Symptomatic and Asymptomatic Osteoarthritis of the Knee. Joewono Soeroso, Leonila F Dans, Maria Lourdes Amarillo, Gina Santoso.
· Arthritis Foundation. “Benefits of Weight Loss”
· Johns Hopkins Arthritis Center. “Role of Exercise in Arthritis Management”