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An Overview of Osteoarthritis and Its Management

What is it?

Osteoarthritis (OA) is a condition whereby there is an inflammation of the joint caused by a degeneration of the cartilage that lines the joint. As the cartilage degenerates there can also be changes in the bony surfaces of the joint which can lead to pain and joint dysfunction (see symptoms for more details).

Otherwise known as the “wear and tear arthritis” OA is thought to affect an estimated 8.5 million people in the UK. Most commonly, osteoarthritis develops over the age of 50 and is more common in women. Osteoarthritis is more common if there has been some kind of injury to one of the joints.

What causes it?

There are two main types of Osteoarthritis

a) Primary and b) Secondary.

Primary osteoarthritis is related to age and repetitive and/or high stress on a normal joint. Primary osteoarthritis often affects multiple members of the same family and many researchers believe that some families have a genetic susceptibility to cartilage damage.

Secondary osteoarthritis is related to a previous joint dysfunction that could be caused by a number of factors including:

* Trauma
* Congenital disorders (ie) Congenital hip subluxation
* Diabetes
* Perth’s disease
* Obesity
* Pregnancy

What are the symptoms?

Osteoarthritis symptoms will vary from person to person. However, the following symptoms have been commonly reported:

* Swelling and inflammation in one or more joints
* Stiffness around the joints
* Morning stiffness in the joint
* Pain worsening in wet weather
* Increased pain after long periods of weight bearing exercises
* Constant or recurring pain in a joint

What therapies may help?

Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) involves placing small pads onto the surface of the skin that pass a very small current to the area. TENS is thought to work by sending sensory signals up to the brain, which can reduce the number of pain signals that are also travelling up to the brain. TENS is safe and comfortable to use and can provide pain relief in some patients with Osteoarthritis.

Exercise Therapy
There has been a great deal of interest in the use of exercise in the management of hip and knee osteoarthritis. Several large scale studies have shown that strengthening of the muscles around the knee improves lower limb strength, reduces pain and increases function compared with people who did not complete an exercise programme. It is important to remember that too much exercise may lead to some inflammation in the affected joints and so it may be useful to seek advice from a qualified medical practitioner before starting a programme. If tolerated, aerobic exercises such as swimming and walking have been found to be helpful to reduce the knee pain associated with osteoarthritis. Proper use of a walking stick may also help in reducing load on the painful joints.

Thermal Therapy
Thermal therapy simply involves applying gentle heat to the painful area. It is not clear how heat therapy works but some people believe that it may reduce muscle spasm and promote relaxation. Heat therapy can range from having a warm bath or shower and hydrotherapy (exercising in warm water) to applying hot packs to the area.

Lifestyle Factors
Obesity can lead to increased pressure being placed on joints and so it is not surprising that weight loss has been associated with reduced risk of developing symptomatic knee OA.

What Drugs and Surgery may help?

Non Steroidal Anti Inflammatory Drugs (NSAIDs)
Non steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Diclofenac have been used to treat mild to moderate Osteoarthritis pain. NSAIDs work by blocking some of the chemicals in the body that play a role in the inflammatory process which causes pain and swelling. It is important to know that some NSAIDs take 1-2 weeks before the full effects can be felt, whilst other NSAIDs work within a few hours. It is important, therefore, to check with your pharmacist how long you should expect to wait to feel the pain relieving effects of the NSAIDs you are planning to take. One of the possible side effects of long term use of NSAIDs is gastrointestinal irritation.

Corticosteroid Injections
During more advanced OA, corticosteroid joint injections have been reported to be helpful in reducing pain and increasing function. Corticosteroids are thought to work by interfering with production of chemicals that trigger inflammation. Intra-articular means that the steroids are injected directly into the affected joint/s. A number of different steroid preparations are available for intra-articular injection in Osteoarthritis including Methylprednisolone and Triamcinolone. Clinical evidence suggests that benefits can last approximately 24 weeks, although this varies a great deal from person to person.

Hyaluronic Acid Injections
Hyaluronic acid is found in the fluid within many joints and is thought to play an important role in joint function. The concentration of intra-articular endogenous Hyaluronic acid is decreased during osteoarthritis and so Hyaluronic acid has been injected to help increase levels within the affected joints. A number of research studies have shown that intra-articular injections of Hyaluronic acid are both safe and can decrease the symptoms of osteoarthritis.

Glucosamine is a compound found naturally in the body which is thought to play a role in the formation and repair of cartilage. There is some evidence which suggests that Glucosamine may reduce Osteoarthritis symptoms and possibly even slow disease progression. Since glucosamine is classed as a food supplement you can buy it at health food shops and pharmacies.

For most people the symptoms of Osteoarthritis are not severe enough to require surgical intervention. However, for severe cases arthroscopic washout, knee replacements and hip replacements have all been used successfully.

An Arthroscopic lavage (rinsing of the interior of a joint), is generally combined with a debridement whereby some of the degenerated tissue in the affected joint is removed using a combination of a washing inside the joint and cutting out the damaged tissue. The operation involves keyhole surgery which means that it is performed using very small joint excisions.

Joint replacement
As the title suggests a joint replacement involves removing part of the damaged joint and replacing it with an artificial joint. The 2 most common joint replacements associated with arthritis are the knee replacement and hip replacement. A joint replacement does not last forever but most will last over 10 years depending on how active you are.

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