Osteoarthritis

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Osteoarthritis

A complete guide for patients...

Osteoarthritis is a disease that affects your joints. The surfaces within your joints which include cartilage becomes damaged so the joint doesn’t move as smoothly as it should and the bone surface rubs against bone giving rise to pain. In Osteoarthritis, the synovial fluid in the joint responsible for lubrication and nourishment of the joints is also reduced.

 

The condition is sometimes called arthritis or Osteoarthritis. Older terms are degenerative joint disease or wear and tear.

What is Osteoarthritis?

Osteoarthritis is a condition that affects the joints, causing pain and stiffness. It’s by far the most common form of joint disease. Who gets Osteoarthritis? Almost anyone can get Osteoarthritis but, it’s most likely if:

 

  • You’re in your late 40s or older
  • You’re a woman
  • Your parents have had osteoarthritis
  • You’re overweight
  • You’ve had a previous joint injury
  • You have a physically demanding job where you make repetitive movements
  • Your joints have been damaged by another disease, for example gout or rheumatoid arthritis.

What causes Osteoarthritis?

There are many factors that can increase your risk of osteoarthritis, and it’s often a combination of these that leads to the condition.

 

Age - It usually starts after the age of 40 but can start earlier in some depending on genetic factors and the use of joints including traumas. It is a slowly progressive condition.

 

Gender - It tends to affect more women than men.

 

Weight - Obesity is a risk factor for developing osteoarthritis especially of knees early.

 

Joint injuries - any trauma can accelerate the process of osteoarthritis in that joint. If some people are born with anatomical variation of joints especially hip – It can lead to early osteoarthritis.

What are the symptoms of Osteoarthritis?

Symptoms of osteoarthritis can include:

 

  • Pain
  • Stiffness
  • A grating or grinding sensation (crepitus) when the joint moves
  • Swelling (either hard or soft)
  • Not being able to use the affected joint normally, which can make it difficult to do certain activities (for example – climbing stairs, getting up from squatting position, reduced grip and pain especially around the base of the thumb).

 

Which joints are affected?

Weight bearing joints are most frequently affected. Joints include:

 

  • The knee
  • The hip
  • The hand
  • The back and neck
  • The foot

What are the possible complications?

The patient delays in seeking advice or seeing specialist regarding OA pain as it is regarded as normal part of ageing.

 

However, although OA is slowly progressive joint disease- if preventative measures are not taken initially and treatment is not taken then the disease can cause functional limitations and stiffness of joints leading to significant impact in quality of life. The joints also can become weak as in osteoporotic and result in early fractures.

How is osteoarthritis diagnosed?

There are many different types of arthritis and some need very different treatments. Osteoarthritis is usually diagnosed based on your symptoms and the physical signs that your doctor finds when examining your joints.

 

There is no blood test for osteoarthritis, although your doctor may suggest you have them to help rule out other types of arthritis.Blood test may include uric acid levels as gout can be associated with osteoarthritis.

 

X-rays are the most useful test to confirm osteoarthritis. The different areas to X-ray include where symptoms are maximum for e.g. - both knees standing, both hips, pelvis, ankles with feet, lumbar spine and cervical spine, both hands and wrists including wrists.

 

Magnetic resonance imaging(MRI) scan of the joint can be helpful.This will show the soft tissues (for example cartilage, tendons, muscles) and changes in the bone that can’t be seen on a standard x-ray.

What treatments are there for osteoarthritis?

Ideally prevention is better and should start early in life .The joints should be looked after with regular exercise and weight control. Once symptoms develop - seek opinion from Rheumatologist or Orthopaedic doctor for diagnosis and treatment. The pain management also includes physiotherapy. This includes:

 

Pain relief - Topical pain relief include anti-inflammatory gels, oral pain killers. Your doctor will suggest suitable pain killers depending on your age and other medical conditions. Do not take long term pain killers by self over the counter as it can impact your kidneys and stomach leading to ulcerations causing vomiting of blood.

 

The pain killers can be paracetamol, anti -inflammatory or opiates depending on severity of condition and other medical circumstances.
Some patients may be recommended injection into the joint itself to relieve symptoms temporarily which can vary from few months to year
This could be steroids or hyaluronic acid  Some patients use glucosamine which is not immediate pain relief but can help over the course of time.

 

Surgery - If the symptoms are progressive and impacting quality of life, an orthopaedic surgeon can be consulted for consideration of various surgical procedures which can help reduce symptoms and restore function.

What can I do to help myself?

Exercise- It’s very important to keep your joints moving. You’ll need to find the right balance between rest and exercise –most people with osteoarthritis find that too much activity increases their pain while too little makes their joints stiffen up. Little and often is usually the best approach to exercise if you have osteoarthritis.

 

Types of exercises include - muscle strengthening exercises and aerobic exercises, swimming and cycling are recommended.

 

Weight management - Research shows that being overweight or obese not only increases your risk of developing osteoarthritis but also makes it more likely that your arthritis will get worse over time. Losing even a small amount of weight can make a big difference to the strain on weight-bearing joints. No special diet has been shown to help with osteoarthritis, but if you need to lose some weight we would recommend a balanced, reduced-calorie diet combined with regular exercise.

Self-management tips

  • Patients can benefit in the short term with massages and heat therapy.
  • Using walking stick to maintain balance and prevent falls as it reduces weight impact on the joints.
  • Joint braces and supports for comfort.
  • Patients should take precautions regarding falls as the balance is poor and muscles are weak – some suggestions include use of commodes rather than squatting.
  • Wearing appropriate footwear- including low heel and wide fitting footwear.