Arthritis is inflammation in the joints. Osteoarthritis (OA) is the most common form of arthritis affecting more than 8.5 million people in the UK. It affects the joint cartilage and the bone tissue next to the cartilage. Symptoms of osteoarthritis include pain and stiffness.
Daily activities causes wear and tear on the joints which mean joints have to constantly undergo repair. In osteoarthritis the joint cartilage becomes worn and the bone next to the cartilage can also be affected and small bony growths called osteophytes can develop around the joint edges. The tissues in and around the joints can become inflamed and is called synovitis.
There are many factors that can play a role in the development of Osteoarthritis which include:
- Age – OA becomes more common with increasing age as the normal state of the blood supply which helps repair the joints becomes less efficient in some people as they age.
- Genetics – there may be some inherited tendency to develop OA in some people
- Obesity – knee and hip OA are more likely to develop and be more severe in obese people due to the excess load on the joints and the potential for more damage
- Sex – woman are more likely to develop OA than men
- Previous joint injury – for example a previous fracture to the joint or ligament injury which caused some instability and ma have required surgery to assist in stability.
- Occupational overuse – OA may be more common in elite athletes of people those who undertook heavy manual work throughout their lives.
Lifestyle and Arthritis
Diet plays a large part on healthy joints. The effects of poor eating habits are numerous and include:
- Increased risk of heart disease and high blood pressure
- Increased risk of diabetes
- Increased risk of weight gain
- Increased risk of negative attitudes
- Increased risk of caner
- Reduced energy levels
In most cases OA develops in those over 50 years old. By 65 at least half the population have some OA in some joints but 1 in 10 people over 65 years have a major disability due to OA, mainly due to hip and knee OA.
Pain, stiffness and reduced movement of the joint are the typical symptoms associated with OA. Stiffness tends to be worse in the mornings and loosens after an hour or so but can return again if the joint is not moved for short periods during the day. Swelling and inflammation is very common.
Badly affected knee or hip OA can cause significant mobility problems and can be a cause of falls.
A common way of helping to diagnose joint pain is through X-rays but it is important to remember that some people have X-ray changes that indicate some degree of OA but have no, or very mild symptoms. The opposite can also be true, and it is always why treatment is based on symptoms and not the X-ray!
There is no cure for OA but here are a number of things that can be done to help ease the symptoms. The aims of treatment are to:
- Help the individual understand OA and how to manage it.
- Reduce pain and stiffness
- Maintain and improve mobility for the affected joint(s)
- Limit further damage to the joint
- Minimise disability which results from OA
This can be helped with:
- Physiotherapy - Exercise done regularly helps to STRENGTHEN the muscles that support the affected joint, keep you FIT and maintain range of MOVEMENT in the joint. Swimming, cycling, rowing and using a cross trainer are just some ways to achieve this. Specific strengthening exercises can be tailored to your abilities by a physiotherapist.
- Weight loss – 1kg of weight = 4kg of weight on the knees when you are walking. The extra burden placed on joints by being overweight can make symptoms worse. Evan a small amount of weight loss can make a big difference.
- Footwear – supportive, well-fitting footwear is important, and sometimes an ache support can be useful.
- Pacing – over doing activity can increase pain and set you back for weeks. Finding activity patterns that keep you active more days of the week can be helpful and limiting activities to shorter periods such as housework/gardening may enable you to do more on the other days.
- Walking aids – sometimes using a walking stick can help reduce the strain put through a hip or knee joint with OA
Pain relieving medication compliments exercise in the management of OA as it can allow you to do more without the side effects of pain. It is important to get expert advice from a doctor, pharmacist or healthcare professional prior to starting any course of medication. Below is an outline of the type of medication that can be helpful to manage OA.
- Paracetamol – this is commonly used in the management of OA however, used on its own it has been shown to provide little in the way of pain relief for OA.
- Anti-inflammatories – these can be taken as a topical cream or orally, in tablet form and can be used in addition to paracetamol. The topical cream such ibuprofen gel or diclofenac can be particularly helpful for knee OA and compared to anti-inflammatory tablets, the amount of medicine that gets into the bloodstream is much less and have less side-effects.
- Hydrocortisone (steroid) injections can be useful to help with longstanding knee pain to allow some period a short period of pain relief. They work by slowly releasing anti-inflammatory medicine into the joint – this can be helpful for several months but is not a cure for the pain. They are mainly used for knees.
Flares of pain
From time-to-time you may experience a flare of pain in the arthritic joint. Learning how to manage the flares is important and can reduce the amount of time the flare lasts.
- Adjust activity levels
- Keep moving but don’t overdo it
- Increase pain relief
- Apply heat or ice depending on your preference
Versus Arthritis - https://www.versusarthritis.org/
This is an excellent website for additional information regarding the management of hip and knee arthritis. It also provides additional exercises.
ESCAPE Pain - https://escape-pain.org/
Enabling Self-management and Coping with Arthritic Pain and Exercise. It is an evidence based , cost-effective, group based rehabilitation program for people with chronic joint pain. It can also be followed at home.