What is Degenerative Joint Disease?
Degenerative joint disease (DJD), also known as osteoarthritis or “wear-and-tear” arthritis, is the most common form of arthritis affecting over 32.5 million American adults. It occurs when the protective cartilage that cushions the ends of your bones gradually breaks down over time.
Unlike inflammatory arthritis (such as rheumatoid arthritis), DJD is primarily a mechanical condition caused by the cumulative stress and damage to joints over years of use. While it can’t be reversed, many treatments effectively manage symptoms and slow progression.
How Joints Degenerate Over Time
Healthy joints contain smooth cartilage that allows bones to glide over each other with minimal friction. In degenerative joint disease:
- Cartilage breakdown: The smooth cartilage surface becomes rough and thin
- Bone changes: Underlying bone thickens and develops bone spurs (osteophytes)
- Synovial changes: The joint lining becomes inflamed
- Joint space narrowing: Less cushioning between bones
- Bone-on-bone contact: In advanced stages, bones may rub directly together
Stages of Degenerative Joint Disease
Stage 1: Minor
- Minimal cartilage damage
- Small bone spurs may be present
- Little to no pain
- Often discovered incidentally on X-rays
Stage 2: Mild
- Noticeable bone spurs on imaging
- Cartilage remains at healthy thickness
- Stiffness after prolonged sitting
- Pain after extended activity
Stage 3: Moderate
- Visible cartilage erosion
- Joint space narrowing on X-rays
- Frequent pain during daily activities
- Morning stiffness becoming more pronounced
- Inflammation and joint swelling
Stage 4: Severe
- Significant cartilage loss
- Bone-on-bone contact
- Chronic pain even at rest
- Substantial mobility limitations
- Joint deformity may be visible
Commonly Affected Joints
DJD most frequently affects weight-bearing joints and those used repeatedly:
- Knees - Most common, bearing significant body weight
- Hips - Major weight-bearing joints
- Spine - Especially lower back and neck
- Hands - Finger joints and thumb base
- Shoulders - Especially in those with overhead activities
Risk Factors
Non-Modifiable Factors
- Age: Risk increases significantly after 45
- Gender: Women more commonly affected, especially post-menopause
- Genetics: Family history increases susceptibility
- Previous injuries: Fractures or ligament tears accelerate degeneration
Modifiable Factors
- Obesity: Each pound of weight adds 3-4 pounds of stress on knees
- Occupation: Jobs requiring repetitive joint stress
- Activity level: Both extremes (sedentary or high-impact) increase risk
- Muscle weakness: Poor muscle support increases joint stress
Treatment Options
Conservative Management
Most patients begin with non-surgical approaches:
- Weight management: Losing even 10 pounds significantly reduces joint stress
- Exercise: Low-impact activities strengthen supporting muscles
- Physical therapy: Targeted exercises to improve function
- Activity modification: Avoiding movements that worsen symptoms
- Assistive devices: Canes, braces, or shoe inserts to reduce joint load
Medications
- Acetaminophen: First-line for mild to moderate pain
- NSAIDs: Ibuprofen, naproxen for pain and inflammation
- Topical treatments: Anti-inflammatory creams and gels
- Duloxetine: For chronic pain management in some patients
Injection Therapies
- Corticosteroid injections: Reduce inflammation and provide temporary relief
- Hyaluronic acid injections: Improve joint lubrication and cushioning
- PRP injections: Emerging treatment using your own blood platelets
Surgical Options (When Conservative Treatment Fails)
- Arthroscopy: Minimally invasive joint cleaning (limited evidence for DJD)
- Osteotomy: Bone realignment to shift weight off damaged areas
- Joint replacement: Gold standard for severe, end-stage disease
Living with Degenerative Joint Disease
Daily Management Strategies
- Start each day with gentle stretching
- Alternate periods of activity and rest
- Use heat for stiffness, cold for swelling
- Maintain a healthy weight
- Choose joint-friendly exercises (swimming, cycling, walking)
When to Seek Medical Attention
- Pain that doesn’t improve with rest
- Rapid worsening of symptoms
- Joint deformity or instability
- Inability to perform daily activities
- Pain affecting sleep quality
Questions to Ask Your Healthcare Provider
- What stage is my degenerative joint disease?
- Which joints are most affected?
- What can I do to slow progression?
- Which treatments do you recommend starting with?
- When should I consider injection therapy?
- At what point would surgery become an option?