Osteoarthritis

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis affecting 10% of the population. Osteoarthritis affects both men and women with women having a higher rate of osteoarthritis. Osteoarthritis rates increase sharply after the age of 50.

The whole joint and the tissue around it can be affected by osteoarthritis, including the muscle around joints, tendons, joint capsule, and the cartilage inside. In the end stage of osteoarthritis, the cartilage that cover the bone inside the joint wear off leading to bone grinding on bone. This creates a painful sensation when weight is put on them, such as while walking, standing up, and climbing stairs.

As the condition progresses, pain and swelling of the affected joints become more frequent and even persistent. The joints may become crooked looking.

Almost any joint can be affected. However, osteoarthritis commonly develops in the knees, hips, spine, and hands.

What are the symptoms of osteoarthritis?

The first symptom of osteoarthritis is a pain around the affected joint(s) after a period of prolonged or strenuous use, such as after a long walk or exercise. The pain increases with continued use of the joint, but usually subsides after sufficient rest. At the beginning, the pain often comes and goes, and may become persistent pain over time.

Mild stiffness usually sets in when the joints have been rested (“gelling”). Therefore, if you have been sitting still for some time, your hips and knees may feel stiff upon standing again. Some patients may have a warm feeling in the joint and even see the joint swelling. Worsening of pain and stiffness with weather changes is a common complaint. Over time, the affected joint(s) may look crooked. If knees are the affected joints, they may become bow-looking.

How is osteoarthritis prevented?

The most important thing that reduces the risk of developing osteoarthritis is maintaining a healthy weight, engaging in moderate exercise and eating a healthy diet. Prevention of injuries to joints minimises risk of osteoarthritis.

What causes osteoarthritis?

The primary cause of osteoarthritis is increasing body weight and increasing age. Apart from ageing, overweight and obesity are the main causes of osteoarthritis. The load to the knee joints, for example, is as much as four times of one’s body weight for every step walked. 

What are the risk factors for osteoarthritis?

Weakness of muscles around the joint, previous injuries to the joint and heavy manual occupational overuse are also a common risk factors.

Osteoarthritis can arise as a side effect of other problems that put abnormal stress on the joints, such as abnormally shaped hips and knees (added stress is placed on these joints when a person moves), a previous fracture or injury involving the joint.

Other form of arthritis like rheumatoid arthritis or psoriatic arthritis can cause damage to joints. However, these arthritides are relatively uncommon in the general population.

How is osteoarthritis diagnosed?

If a patient exhibits symptoms of osteoarthritis, the doctor can confirm the diagnosis via a typical symptom profile and physical examination. X-rays can sometimes assist doctors in making a diagnosis.

Very occasionally, additional tests and procedures may be needed, mainly to exclude other possibilities of joint problems:

• Joint aspiration - may be carried out to obtain a sample of the fluid in the joint, mainly excluding diagnosis of gout or cancerous conditions in the joint.
• Magnetic resonance imaging (MRI) - may be used to get a better picture of the condition of the different structures inside the joint.

How is osteoarthritis treated? 

There is currently no cure for osteoarthritis. Hence, sustained and increasing research is necessary. Treatment of osteoarthritis focuses on alleviating its symptoms, regaining lost muscle strength and surgery.

• Physiotherapy
  

  Exercise is needed to build up the strength in the surrounding muscles so that they can hold up the joint better, lessening the stress and strain that is exerted on it. It is a wrong concept that exercise worsens osteoarthritis, because it may only happen in physical activities of very strenuous intensity, such as athletics. On the contrary, a sedentary lifestyle weakens the muscles around the joints making the joints more vulnerable. Physiotherapists are the best exercise coaches, who assess the condition of the muscle and joints and teach / prescribe the appropriate exercise regimen to patients (as if doctors prescribe the appropriate medicine). Exercise is the most effective strategy to relieve pain for patients who have osteoarthritis. Apart from having a good coach, the keys to success are discipline and perseverance.
  
  Exercises such as swimming are the most gentle and recommended for most forms of arthritis. Land-based exercises like cycling, brisk walking and slow jogging are also helpful. Exercises that focus on strengthening of muscle around the joints are advised. Please consult your physiotherapist for the exercise regimen that suits you most.
  



• Medication
  

  Sometimes, medicine is useful to relieve joint pain, especially during bad days. Creams, balms, ointments and plasters are very safe and helpful options. Paracetamol (Panadol) can be prescribed for low level pain, while stronger drugs like non-steroidal anti-Inflammatory drugs (NSAIDs) and COX-2 inhibitors may be necessary for more severe pain. Supplements like glucosamine and chondroitin may relieve pain for some patients, but do not protect one from the wearing of cartilages. Speak to your doctor first before you try these medicines.



• Injection of medicine into the joints
  

  Lubricant injections into the joints can relieve in the short terms for some patients. The effect of lubricant injections usually does not last more than five months. It is more useful for younger patients who need temporary relief of pain in order to achieve an increased exercise demand in short term. Steroid injection into the joint can also relieve pain, but the effect is usually shorter-lasting. Repeated steroid injection into joints or repeated removal of fluid from joints is not recommended as a choice of treatment. Every injection into joints carries a small risk of joint infection.



• Surgery

  For a minority of patients, surgery may be required to remove bone fragments, realign the joints, or even replace the joint with an artificial part. Joint replacement surgery should be considered when the pain is severe, for those who need long term use of pain killers, and when the joint pain is affecting his / her mobility. Not everybody needs a joint replacement surgery. Speak to your doctor on the risks and benefits, and to decide on the most appropriate timing for joint replacement surgery.
  

References

1. Osteoarthritis (OA). Versus Arthritis. (n.d.). https://versusarthritis.org/about-arthritis/conditions/osteoarthritis/
2. Centers for Disease Control and Prevention. (n.d.). Osteoarthritis. Centers for Disease Control and Prevention. https://www.cdc.gov/arthritis/osteoarthritis/index.html
3. Osteoarthritis: Symptoms, diagnosis, and treatment: Arthritis foundation. Osteoarthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation. (n.d.). https://www.arthritis.org/diseases/osteoarthritis
4. 2020 OARSI World Congress on osteoarthritis. (2020). Osteoarthritis and Cartilage, 28. https://doi.org/10.1016/j.joca.2020.02.002