Arthritis means inflammation of the joints. Osteoarthritis (OA) is the most common type of arthritis Worldwide. Osteoarthritis affects the joint cartilage and the bone tissue next to the cartilage.
According to WHO, there were around 86.7 million individuals (20 years and older) with incident knee OA in 2020 worldwide.
Table of Contents
What causes osteoarthritis?
All normal joints and joint tissues are constantly undergoing some form of repair. This is because of the wear and tear that is placed on them through our daily activities. However, in some people, it seems that this repair process becomes faulty in some way. This occurs perhaps because of severe wear and tear to the joints or a problem with the repair process, and osteoarthritis develops.
In joints with osteoarthritis, the joint cartilage becomes damaged and worn. The bone tissue next to the cartilage can also be affected and bony growths can develop around the joint edges. These growths are called osteophytes and may be seen on X-rays. The joints and the tissues around the joints can also become inflamed. This inflammation is called synovitis.
Factors that may play a role in the development of osteoarthritis:
Age
Osteoarthritis becomes more common with increasing age. It may be that the state of the blood supply to the joint and the state of the natural repair mechanisms become less efficient in some people as they age. Primary OA develops in previously healthy joints. Most cases develop in people aged over 50 years. By the age of 65 years, at least half of people end up developing osteoarthritis in some joint(s) – mainly knee and hip joints
Genetics
There may be some inherited tendency for osteoarthritis to develop in some people.
Obesity
Knee and hip osteoarthritis are more likely to develop or be more severe, in people with obesity. This is because there is an increased stress on the joints and a potential for more joint damage.
Gender
Women are more likely than men to develop osteoarthritis.
Previous joint injury, damage or deformity, occupational overuse
For example, this may include previous joint infection, previous break (fracture) in the bone around a joint, or previous ligament injury that caused joint instability. This is known as Secondary OA which develops in joints already affected by previous injury, damage or deformity. This can occur in younger people.
Osteoarthritis symptoms
Joint pain, stiffness, and limitation
These are typical symptoms of osteoarthritis. Osteoarthritis pain typically comes on during activities that use the joint; for example, walking or running. The joints feel painful and stiff, which tends to be worse first thing in the morning. It then tends to loosen up after half an hour or so.
Swelling and inflammation
This can sometimes occur in the joints affected by osteoarthritis. However, it is not very common for them to be swollen, red or warm. Tell your doctor if a joint suddenly swells up or becomes red or hot. This is a symptom of osteoarthritis that more commonly occurs with other types of arthritis.
Flare-ups
People with osteoarthritis often experience ‘flares’ of symptoms – where pain, stiffness and sometimes joint swelling become worse for several days. This usually settles within a week or two. During a flare, people with osteoarthritis may need to take more pain relief than usual.
A joint affected by osteoarthritis tends to look a little larger than normal. This is due to overgrowth of the bone next to damaged cartilage.
No symptoms
No symptoms may occur. Quite a number of people have X-ray changes that indicate some degree of osteoarthritis but have no, or only very mild, symptoms. The opposite can also be true. That is, you may have quite severe symptoms that affect your quality of life but with only minor changes seen on the X-ray.
Secondary symptoms
Some people with OA may develop other problems because of their symptoms. For example, pain can affect sleep for some people. Mobility problems may affect your ability to work and carry out family duties. Some people may get down or even depressed because of their pain and other symptoms.
Which joints are affected most by osteoarthritis?
Any joint can be affected by osteoarthritis (OA) but joints in the hips, knees, fingers, thumbs and lower spine are most commonly affected. The shoulders, elbows, wrists, ankles, and toe joints are less commonly affected by osteoarthritis.
How is osteoarthritis diagnosed?
Your doctor can often osteoarthritis based on your age, your typical symptoms and examination of your affected joints. Tests such as X-rays or blood tests are usually not needed. However, sometimes your doctor may suggest X-rays or other tests if they are uncertain about the diagnosis and want to exclude other problems.
Osteoarthritis treatment
There is no cure for osteoarthritis but there are a number of things that can be done to ease symptoms and reduce pain. For anyone with osteoarthritis, the aims of treatment should be:
- To reduce any pain and stiffness.
- To maintain or improve the mobility of your affected joint or joints.
- To limit any joint damage.
- To minimize any disability that may result from your OA.
- To minimize any side effects from medicines used as treatment.
Exercise
If possible, exercise regularly. This helps to strengthen the muscles around the joints affected by osteoarthritis, to keep you fit and to maintain a good range of joint movement. Exercise can reduce joint pain, swelling, and stiffness from osteoarthritis. Swimming is ideal for most joints; other good low-impact exercises include walking, cycling, rowing, and using elliptical trainers. However, any exercise is better than none. Many people can manage a regular walk.
Weight control
If you are overweight, try to lose some weight, as the extra burden placed on your back, hips and knees can increase your risk of osteoarthritis or make symptoms of osteoarthritis worse. Even a modest weight loss can make quite a difference.
Shoe insoles and other devices
Some research trials have shown that the following may help to ease symptoms from osteoarthritis of the knee in some cases:
- Wearing a knee brace.
- Using shoe insoles.
Walking aids
If you have osteoarthritis of your hip or knee, when walking try using a walking stick. Hold it in the hand on the opposite side of the body to the affected joint. This takes some pressure off the affected joint and helps to ease symptoms in some cases.
Physiotherapy
Advice or treatment from a physiotherapist is helpful for osteoarthritis –
For advice on which exercises to do to strengthen the muscles above the knee (quadriceps muscles) if you have osteoarthritis of the knee. Strengthening the quadriceps muscles has been shown to improve symptoms caused by OA of the knee.
- For advice on shoes, insoles, knee braces, taping to the knee, and how to use walking aids properly (to make sure you have one of the correct height).
Other therapies
Some people have found that transcutaneous electrical nerve stimulator (TENS) machines help to ease pain from osteoarthritis. A TENS machine delivers small electrical pulses to the body via electrodes placed on the skin.
Some people have some pain relief from using hot or cold packs on the affected joint(s). This is also called thermotherapy. You can use a hot water bottle filled with either hot or cold water and apply it to the affected area. Or, special hot and cold packs that can either be cooled in the freezer, or heated in a microwave, are also available.
Osteoarthritis Management Options- Medicines
Each treatment option for Osteoarthritis has various benefits, risks and consequences.
Medicines used to treat osteoarthritis
Simple painkillers like Paracetamol (Panadol)
Paracetamol is commonly used to treat osteoarthritis (OA). However, recent research suggests that paracetamol is probably not very effective at treating pain from osteoarthritis. Paracetamol – if taken at the recommended dose – is a safe medicine with few side effects.
Anti-inflammatory painkillers like NSAIDs
Topical preparation of an anti-inflammatory painkiller (cream or gel-like Fruben, brufen, voltarol) that you rub on to the skin over osteoarthritis-affected joints are helpful. This can be instead of, or in addition to, paracetamol tablets. This may be particularly helpful if you have knee or hand osteoarthritis.
Anti-inflammatory painkillers that are taken by mouth are not used as often as paracetamol. This is because there is a risk of serious side effects, particularly in older people who take them regularly. However, one of these medicines is an option if paracetamol or topical anti-inflammatories do not help.
Anti-inflammatory oral painkillers should be used for short spells, perhaps for a week or two when symptoms flare up. There are many different brands of anti-inflammatory painkillers. If one does not suit, another may be fine. Commonly used anti-inflammatory medicines are Ibuprofen (brufen), Naproxen (Naprosyn, Flexin), and Diclofenac (Voltarol, Dicloran), Celecoxib (Celebrex, Celox, Gencelox ), Piroxicam ( Roxicam, Pcam, Riacin).
Side-effects of NSAIDs
- Bleeding from the stomach is the most serious possible side effect. This is more of a risk if you are aged over 65 years, or have had a duodenal or stomach ulcer, or if you are also taking low-dose aspirin.
- Some people with asthma, high blood pressure, kidney failure and heart failure should avoid taking anti-inflammatory painkillers.
- Risk if kidney damage if taken for long duration.
Strong Painkillers – Opioids
In Pakistan, we don’t have much choice in oral opioids. The most common one available is Tramadol (Tramal, Tonoflex). Opioid medicines are sometimes used as a pain reliever for osteoarthritis if paracetamol or topical anti-inflammatory medicines are not sufficient. However, it should be avoided particularly in elderly as risk of side effects like drowsiness, addiction, & constipation.
An injection in joint
A steroid injection directly into a joint may be an option if a joint becomes badly swollen (inflamed) due to osteoarthritis. However, there is evidence that steroid injections may be either completely ineffective or effective for just a relatively short period of time – usually between two and ten weeks.
Herbal creams and gels
There is not a great deal of evidence from studies to show that herbal remedies are effective. However, capsaicin gels and creams have been recommended as being effective for reducing osteoarthritis (OA) pain, especially for knee or hand osteoarthritis.
Food supplements as a treatment of osteoarthritis
Glucosamine and chondroitin supplements have become popular in recent years. Glucosamine and chondroitin are chemicals that are part of the make-up of normal cartilage. The theory is that taking one or both of these supplements may help to improve and repair damaged cartilage.
However, the usefulness of glucosamine and chondroitin is controversial. What seems clear is that glucosamine and chondroitin are no wonder cures. If you do try a food supplement you should assess your level of pain before you start taking it, and then again after three months. If there is no improvement, it would seem reasonable to conclude that it is unlikely to be effective and there is no point in carrying on with it.
Note: you should not take glucosamine if you are allergic to shellfish. Glucosamine may also interact with warfarin.
Surgery for osteoarthritis
Most people with osteoarthritis do not have it badly enough to need surgery. However, OA of a joint may become severe in some cases. Some joints can be replaced with artificial joints. Hip and knee replacement surgery has become a standard treatment for severe osteoarthritis of these joints. Some other joints can also be replaced.
Joint replacement surgery has a high success rate. However, like any operation, joint replacement surgery has risks.
Other treatments that are not recommended
Some treatments have become fashionable or popular for osteoarthritis but are not normally recommended by mainstream doctors. For example:
Hyaluronic acid
Regular injections of hyaluronic acid directly into a joint are a relatively new treatment which has been tried for osteoarthritis. It may produce a small beneficial effect in some people. There is little evidence that it is effective and there may be a risk of problems after the treatment, so it’s not recommended.
Heat rubs (topical rubefacients)
Although widely used, not recommended for use in osteoarthritis. This is because there is little scientific evidence to say that they work.
Arthroscopic lavage and debridement
This is an operation to wash out a joint and trim cartilage from a joint. This should not be offered as part of treatment for osteoarthritis.
Magnetic resonance therapy
This is a new treatment which uses a device with magnets to try to improve pain and healing in the joint. Looking at the evidence there are no major safety concerns but there is insufficient evidence to show that it works.
Geniculate artery embolism
This treatment aims to reduce blood flow to the damaged part of the knee joint, aiming to reduce further damage and pain. There is insufficient evidence to show that it works.
How does osteoarthritis spread/progress?
A common wrong belief is that osteoarthritis is always a progressive and serious disease. The severity of symptoms varies. In many people, osteoarthritis is mild. It does not become worse and does not make you any more disabled than expected for your age. However, in some people, the severity of OA and the disability it causes are out of proportion with their age. One or more joints may become particularly badly affected.
Symptoms often wax and wane. Flare-ups of symptoms for days to weeks are common. Sometimes this is related to things such as the weather. Symptoms often improve in warmer months. A bad spell of symptoms may be followed by a relatively good period.
(Disclaimer: This article is written in simple language for the purpose of educating the general public)
