Osteoarthritis (OA) is the most common form of arthritis.
It is estimated that over 305,000 adults are living with OA in New Zealand.
Osteoarthritis has been called “wear and tear”, a ‘heart attack’ of the joint or “degenerative” arthritis.
The pain caused by osteoarthritis has been described as having grinding and shattering jagged pieces of glass between your joints.
People who have experienced injuries – such as sports injuries – are likely to develop OA.
It is classified as non-inflammatory arthritis, however recent research has shown that as the disease progresses there can be inflammation.
About 80 per cent of people with OA experience a restriction in their movement, and 25 per cent are unable to perform normal acts during daily life.
What causes osteoarthritis?
It occurs as a result of mechanical breakdown in the structures affecting the joints.
In healthy joints, cartilage – a shiny gristly material –acts as a shock absorber and provides a smooth surface between the bones to allow easy movement. When a joint develops osteoarthritis the cartilage thins and becomes rough. In some cases the cartilage breaks down, leaving the bones unprotected.
As a result the joint loses its ability to move smoothly. The bones lose shape and thicken at the end, producing bony spurs. Pieces of cartilage may break off and float around in the joint. This can disturb other soft tissue in the joint, causing pain and swelling.
- Factors contributing to OA
- Obesity
- Increasing age
- Being female
- Heredity (some forms of OA)
- Joint injury (sports, professional injuries)
- Other types of joint disease (e.g. rheumatoid arthritis)
How is osteoarthritis diagnosed?
Osteoarthritis progresses slowly and develops over many years. In most cases there are only small changes that affect parts of the joint. However sometimes osteoarthritis can be more severe and extensive.
Osteoarthritis is usually diagnosed by symptoms, physical examination and x-ray. However, some people may experience pain without major changes on their x-rays. Therefore it is important for you to be able to describe the pain in detail including where the pain occurs and when. When your joints are examined, your doctor will be able to feel the bony swelling and creaking of the joint and see any restricted movement.
What parts of the body affected?
Osteoarthritis occurs most often in the large weight bearing joints – the knees, hips and spine. It often occurs in the hands, but rarely in the feet or ankles apart from the big toe. Except as a result of injury or stress, osteoarthritis seldom affects the wrist, elbow, shoulder or jaw.
Management of osteoarthritis
Although there is no cure for osteoarthritis, there are many ways in which you can relieve your symptoms and reduce the likelihood of things progressing. Your health team is there to guide you, but it is important that you get to know about osteoarthritis and its treatment so that you can take the lead in looking after yourself and your osteoarthritis.
Medication: Painkillers are often recommended by your doctor or pharmacist. However they do not treat the arthritis itself.
- Paracetamol is the simplest and safest painkiller and is usually recommended as the medication to try first. Never take more than the recommended or prescribed dose.
If you require something stronger than Paracetamol your doctor or specialist may prescribe the following:
- Stronger painkillers such as Paracetamol together with a codeine-like drug and Tramadol, are sometimes prescribed for persistent pain.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Naproxen, or Celebrex can reduce pain and inflammation but may also cause side effects if used for long periods of time. Creams and gels containing NSAIDs can be also used.
- Steroid injections into the joint – this is usually reserved for extremely painful osteoarthritis. It is important for you to discuss the benefits and potential side effects of steroids and other medications with your doctor or specialist.
Exercise: A properly designed exercise programme by your physiotherapist will not only reduce pain but also increase your flexibility and overall fitness. In many communities there are excellent programmes for people with arthritis including:
- Tai Chi
- Walking
- Swimming
- Gentle exercise classes
- Hydrotherapy (gentle exercise in a heated pool).
Doing stretching, strengthening and aerobic exercises is essential to:
- Maintain and restore normal joint movement
- Reduce pain and stiffness
- Improve muscle strength
- Protect your joints
- Weight management
- Increase energy and sense of well-being.
Studies show that regular and appropriate physical activity help improve pain tolerance, mood and quality of life for people with arthritis. Working with a qualified physiotherapist is an excellent way to get easy-to-understand advice on how to manage an arthritis flare-up, when to exercise and also very importantly, when not to exercise.
Heat and cold: Heat promotes blood circulation and may reduce pain and stiffness in an arthritic area. Having a hot shower in the morning may help you get ready for the day ahead. Do not apply heat to an inflamed joint. If your joints are inflamed, the application of a cold pack can help reduce pain by constricting the blood flow in that area.
Joint protection: You can modify your home or workplace to avoid unnecessary activities that put strain on your joints. Correct use of aids, splints, braces and assistive devices can help; referral to an occupational therapist may be required. Using a walking stick correctly can reduce the weight and stress on a painful hip or knee. A physiotherapist or GP can advise on the correct length of the stick and how to use it properly.
Surgery: If damage to a joint is extensive, surgery to replace or repair the joint may be used. Artificial joints can last 10-20 years before they need to be replaced. This is why joint replacement surgery is delayed until it is clearly necessary.
Complementary therapies: Complementary therapies such as acupuncture, osteopathy and massage have become more popular and widely available over the last few years. About 60% of those who have arthritis have used, or are using, some form of complementary medicine. There is some scientific evidence to suggest that taking fish oil, Capsaicin gel, Chondroitin, and/or green-lipped mussel extract can decrease pain and inflammation in osteoarthritis.
Support groups: Taking part in social events and meeting people with similar conditions may help to deal with day-to-day activities and provide emotional support.