Osteoarthritis: symptoms, treatment and relief

It is usually not difficult to tell if a patient has osteoarthritis. It's more difficult to tell if the disease is causing the patient's symptoms. Osteoarthritis is so common, especially in older people, that it may mask other conditions responsible for symptoms, ruling out other disorders and identifying conditions that may make the symptoms worse.

Not everyone with osteoarthritis feels pain. In fact, only a third of people with evidence of osteoarthritis on their X-rays report pain or other symptoms.

How is it treated?
Most successful treatment programmes involve a combination of therapies tailored to needs, lifestyle and health. Osteoarthritis treatment has three general goals:

• Control pain through drugs and other measures
• Improve joint care through rest and exercise
• Maintain an acceptable body weight and achieve a healthy lifestyle

In addition to the guidance of your GP, you may need care from a physiotherapist and a rheumatologist (a doctor who specialises in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and bones).

Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans involve exercise, rest and joint care, pain relief, weight control, medications, surgery and non-traditional treatment approaches.

If you are diagnosed with osteoarthritis, you may be prescribed a variety of medicines to eliminate or reduce pain and to improve functioning. Doctors consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and a drug's potential side effects. You must use medicines carefully and tell a doctor about any changes that occur. The following types of medicines are commonly used in treating osteoarthritis:

• Acetaminophen (paracetamol). This drug is a non-anti-inflammatory pain reliever that does not irritate the stomach and is less likely than NSAIDs (see below) to cause long-term side effects. Research has shown that in many patients with osteoarthritis, acetaminophen relieves pain as effectively as NSAIDs.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some over the counter (for example, aspirin and ibuprofen), while others need a prescription. These drugs all work in a similar way: they fight inflammation or swelling and relieve pain. However, each NSAID is a different chemical, and has slightly different effects in the body.

NSAIDs can cause stomach irritation or affect kidney function. The longer you use them, the more likely you are to have side effects, and the more serious those effects can be. Many other drugs cannot be taken with NSAIDs. They are associated with serious gastrointestinal problems, including ulcers, bleeding and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding.

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