Osteoarthritis (OA) involves the inflammation of joints due to degeneration (wear and tear) of the joint. It is one of the most common chronic conditions affecting the joints. OA can affect any joint, but most commonly affects the knees, hips, lower back/neck, and the fingers and toes.
In normal joints, cartilage covers the end of each bone and allows for smooth and unrestricted movement of the two bones, and provides a cushion for your bone. However, cartilage can break down over time, causing pain, stiffness and swelling, affecting the joint’s movement.
OA can affect anyone at any age, but most commonly occurs in elderly above 65 years of age. Risk factors that may contribute to the development of OA include:
- Previous Injuries
- Joint Overuse
- Weak Muscles
Stages Of Osteoarthritis
In the early stages of OA, cartilage will begin to break down, causing pain, stiffness and swelling. These symptoms are mild at this point, but may affect daily activities. Over time, the cartilage, and even bone, continues to break down and can potentially chip off. If this occurs to bone, it can cause growths on the chipped area called spurs.
Spurs are generally asymptomatic, but can cause other conditions. For example, bony spurs in the spine can cause narrowing of the space in between the spinal cord, causing the nerve to become irritated or impinged. This causes pain, weakness and numbness down in the legs and arms. Another example is in the shoulder, where bony spurs can cause impingement of the rotator cuff tendons which move the arm. This can cause rotator cuff syndrome (inflammation of the rotator cuff tendon), and potentially a tear in serious cases!
Eventually, the cartilage completely wears out, meaning that the bones in the joint are rubbing against each other, causing further joint damage and significant, debilitating pain.
X-Rays: Normal vs Osteoarthritic
X-Rays are one of the primary ways used to diagnose OA, giving health practitioners, as well as educated patients, an idea of the health of their relevant joints. When comparing the healthy knee joint to the osteoarthritic knee joint, you can notice that there is much less space between the bones in the knee with OA compared with the healthy knee joint. There are also a lot more jagged edges around the arthritic knee joint. This is due to the development of bone spurs (osteophytes).
Symptoms will vary based on the stage of OA and the joints that are affected. However, some common symptoms across the board include:
- Stiffness that goes away with increased activity/movement: this is generally the worst in the morning
- Crepitus (creaking/crackling) of a joint upon movement
- Intermittent episodes of pain, especially after activity
- Joint swelling, heat, redness
The pain, stiffness and swelling may cause simple activities and tasks to become very difficult. If the joints in the leg are affected with OA, walking, climbing stairs and squatting down to pick up objects becomes painful. If the joints in the arm or hand are affected, reaching and grasping for objects may become painful and difficult, and impossible if the object is too heavy. Simple tasks like folding bedsheets, bathing, opening cans of drink or food, and hanging the clothing (as examples) all become impossible. If left unmanaged, the symptoms can worsen and make tasks even more difficult!
Joint OA can also cause secondary problems not directly related to the joint disease. For example, the pain, swelling and restricted movement can cause patients to reduce their level of activity, indirectly promoting a sedentary lifestyle. This can lead to the development of other chronic health conditions, mainly diabetes, obesity and heart disease.
Right now, the damage to joints affected by OA is irreversible, meaning that management (both self guided and by health practitioners) is key to help reduce any further degeneration, as well as loss of function and pain. If you see a physiotherapist, they will educate you on OA and self-management of OA at home.
There is significant evidence to back up exercise as a method of reducing pain and improving physical function. A physiotherapist will be key to help prescribe exercises that will be most effective and relevant to help achieve your goals. They can also supervise you to ensure you are doing exercises correctly and safely. Exercise will also prevent the development of chronic conditions like diabetes, obesity and heart disease which will appear with maintenance of a sedentary lifestyle.
A study has found that for every kilo of weight lost, there is 2.2 kg less force travelling through the knee joint during regular walking. Less force travelling through the knee will help to reduce further degeneration of cartilage and bone, while helping to ease symptoms associated with OA!
Physiotherapists can also provide manual therapy, massage, as well as electrotherapy or ultrasound in order to ease the pain, improve physical function and range of motion, all of which have moderate to high amounts of reputable evidence to support their use amongst patients.
Medications can also be used for managing symptoms such as pain and stiffness. Some medications that are commonly used include NSAID’s, analgesics, and in more severe cases, corticosteroids. These are prescribed and provided in moderation by your GP.
By Clinton Huynh
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