Out of the 8 million people in the UK who suffer from arthritis, osteoarthritis is the most common
This degenerative joint disease affects the cartilage - the slippery tissue that covers the ends of bones in joints. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. Osteoarthritis causes the surface layer of cartilage to break down and wear away. This allows bones under the cartilage to rub together, causing pain, bone swelling and loss of joint motion.
Over time, the joint may lose its normal shape. Also, bone spurs (small growths called osteophytes) may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, causing more pain and damage.
Osteoarthritis only affects joints. Rheumatoid arthritis - the second most common arthritis - affects other body parts besides joints. It also begins earlier than osteoarthritis, causes inflammation and can make the sufferer feel sick, tired and sometimes feverish.
Are you at risk?
Although some younger people get osteoarthritis from a joint injury, it most often occurs in people over 45. Since the number of older people is increasing, so is the incidence rate. Before the age of 45, more men have the condition, often the result of a sports or work injury, while after 45 osteoarthritis is more common in women.
Researchers don't yet know what causes it, but they suspect a combination of factors in the body and environment. Diet, weight and stresses on the joints from certain jobs, hobbies or other activities affect the disease and how a person reacts to it.
Researchers suspect that inheritance plays a role in 25-30 per cent of osteoarthritis cases. A gene defect affecting collagen (an important part of cartilage) appears to be a key trigger in patients with an inherited kind of osteoarthritis that starts at an early age.
The mutation weakens collagen protein, which may break or tear more easily under stress. Scientists are also looking for other genetic mutations that may be involved in osteoarthritis. In the future, a test to determine who carries the genetic defect or defects could help people to reduce their risk of developing it.
Wat are the symptoms?
The warning symptoms include steady or intermittent pain that usually worsens with activity in a joint, stiffness after getting out of bed, joint swelling or tenderness in one or more joints and a 'crunching' feeling or sound of bone rubbing on bone.
Osteoarthritis develops slowly. Early in the disease, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint, but most often occurs at the ends of the fingers, thumbs, neck, lower back, knees and hips.
Hands
Osteoarthritis of the fingers is the one type of the disease that seems to be hereditary. More women than men have it, and risk increases after menopause. Small, bony knobs appear on the end joints of the fingers, called Heberden's nodes. Similar knobs called Bouchard's nodes can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and may ache or feel stiff and numb, and the base of the thumb joint is also commonly affected. Medications, splints or heat treatment can help this kind of osteoarthritis.
Knees
The knees are the body's primary weight-bearing joints and for this reason are among the joints most commonly affected by osteoarthritis. An afflicted knee may be stiff, swollen and painful, making it hard to walk, climb, get in and out of chairs and use the bath. If not treated, osteoarthritis in the knee can lead more rapidly to disability, but even with treatment it might still progress. Medications, losing weight, exercise and walking aids can reduce pain and disability; in severe cases, knee replacement surgery may be helpful.
Hips
Osteoarthritis in the hip can cause pain, stiffness and severe disability. The sufferer may feel the pain in their hips or in their groin, inner thigh or knees. Walking aids including canes or walkers can reduce hip stress, but osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care a challenge. Walking aids, medication and exercise can help relieve pain and improve motion. A doctor may recommend hip replacement if the pain is severe and not helped by other methods.
Spine
Stiffness and pain in the neck or in the lower back can result from osteoarthritis of the spine. Weakness or numbness of the arms or legs also can result. Some people feel better when they sleep on a firm mattress or sit using back support pillows. Others find help from heat treatment or an exercise programme to strengthen the back and abdominal muscles. In severe cases, a doctor may suggest surgery to reduce pain and help restore function.
Feet
Usually the base of the big toe is affected with gradual stiffening of the joint until it no longer moves at all (hallux rigidus) or it becomes bent (hallux valgus).
How is it diagnosed?
No single test can diagnose osteoarthritis. Most doctors use a combination of the following methods to diagnose the disease and rule out other conditions:
A doctor will enquire about symptoms and when and how the condition started. Be sure to provide a good description of pain, such as what makes it worse or better, stiffness, joint function and how these symptoms change over time. You should also share information on other medical conditions and any medicines you are taking.
A doctor will check your general health, reflexes and muscle strength and examine the joints that bother you. He or she will observe your ability to walk, bend and carry out activities of daily living.
X-rays show how much joint damage has been done; they can show such things as cartilage loss, bone damage and bone spurs. But there is often a big difference between the severity of osteoarthritis that the X-ray shows and the degree of pain and disability the patient has. Additionally, X-rays may not show early osteoarthritis damage (before much cartilage loss has taken place). Arthroscopy is used for diagnosis as well as treatment of some types of joint injury. The arthroscope (a small, flexible tube that transmits the image of the inside of a joint to a video monitor) is inserted through a small incision near the affected joint under local anaesthetic.
A doctor may order blood tests to rule out other possible causes of your arthritis. Another common test includes 'joint aspiration,' during which fluid is drawn from the joint for examination.
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.
Doctors may prescribe several other medicines for osteoarthritis. They include:
- Topical pain-relieving creams, rubs and sprays (for example, capsaicin cream) applied directly to the skin
- Mild narcotic painkillers, which while very effective are addictive and rarely used
- Corticosteroids, powerful anti-inflammatory hormones made naturally in the body or reproduced synthetically, are typically injected into affected joints to relieve pain temporarily; this is a short-term measure, and not recommended more than two or three times a year
- Hyaluronic acid derivatives relieve pain and are most effective for patients who have mild to moderate knee osteoarthritis. Two drugs, Hyaluronan (Hyalgan) and Synvisc (Hylan) are injected directly into the joint to replace natural hyaluronic acid, a normal component of joint fluid and cartilage that helps joints move freely and breaks down in patients with osteoarthritis.
Most medicines used to treat osteoarthritis have side effects, so it is important to learn about the drugs you are taking. Even non-prescription drugs should be checked. Several groups of patients are at high risk for side effects. Those patients are people with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke and those who consume alcohol.
Surgical measures
Surgeons may replace affected joints with artificial joints called prostheses, which can last 10-15 years or more. These joints can be made from metal alloys, high-density plastic and ceramic material, and can be joined to bone surfaces by special cements. About 10 per cent may need revision. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level and other medical conditions.
The decision to use surgery depends on several factors - level of disability, intensity of pain, interference with lifestyle, age and occupation. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.
Alternative therapies
Glucosamine, a glucose-based chemical produced in naturally healthy joints, is fast gaining ground as one of the most popular alternative treatments for osteoarthritis. Not least because it doesn't have the side affects associated with NSAIDs. The use of glucosamine to treat arthritis was discovered when it was used by vets along with a related joint chemical chondroitin to successfully treat racehorses with tendon strain.
One of the greatest breakthroughs of recent times has been research from Cardiff University which shows the Omega-3 fatty acids in cod liver oil stop or reverse the damage done by enzymes that break down cartilage in the joints.
Other more established remedies include acupuncture (the use of fine needles inserted at specific points on the skin), which preliminary research indicates may be a useful component in some osteoarthritis treatment plans.
Other alternatives include wearing copper bracelets, drinking herbal teas and taking mud baths. However, there is little to no scientific evidence that these alternatives are effective, although some people find them helpful. These treatments are not harmful, but do not try to supplant medical care with them. If you have symptoms, go to a doctor for diagnosis and consultation if treatment is required. When it comes to osteoarthritis, early and aggressive treatment will improve outcome.
If you are overweight, weight loss can reduce stress on weight-bearing joints, limit further injury and results in less pain and better function. A dietician can help you develop healthy eating habits, and a doctor can advise you on exercise, which is one of the best treatments for osteoarthritis whether or not a patient is overweight.
Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise you can do will depend on which joints are involved, how stable the joints are and whether a joint replacement has already been done.
Exercise can produce generalised improvement as well as specific effects. When it comes to osteoarthritis of the knee, the level of muscle strength in the thigh muscle (quadriceps) is very important. Strengthening this muscle can relieve symptoms and prevent more damage. Walking can result in better functioning and increased walking distance.
Some people with osteoarthritis find that relaxation techniques and stress reduction help. Some use canes and splints to protect joints and take pressure off them. Splints or braces provide extra support for a weakened joint and keep the joint in proper position during sleep or activity. Splints must be used for limited periods because joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help you get a properly fitting splint.
Transcutaneous electrical nerve stimulation (TENS) may also provide some pain relief. TENS machines may be available through a physiotherapy department. You can wear them during the day and turn them on and off as needed for pain control.
Prevention
While many osteoarthritis risk factors - being female, advanced age and having a genetic predisposition - cannot be changed, you can work on several other risk factors to lower your risk of developing the condition:
- Obesity: losing extra weight and exercising can help people with osteoarthritis, and most importantly it may reduce the risk of developing osteoarthritis of the knee in younger people
- 'On-the-job' injuries: taking precautions to avoid repetitive joint use and resulting joint injury in the occupational setting can help prevent osteoarthritis
- Sports injuries: using recommended prevention strategies (warm-ups, strengthening exercises and appropriate equipment) helps to avoid joint injuries and damage to ligaments and cartilage, all of which can increase the risk of osteoarthritis
Also, in studies of older women, scientists found a lower risk of osteoarthritis in women who had used oral oestrogens for hormone replacement therapy. The researchers suspect that low oestrogen levels could increase risk for the disease. Further studies are needed to answer this question.
Find out all about glucosamine
Helpful organisations
Arthritis Care
18 Stephenson Way
London NW1 2HD
Tel: 020 7380 6500
www.arthritiscare.org.uk