Osteoarthritis

Osteoarthritis, also known as degenerative arthritis, is a type of arthritis that is most common among adults 50 years of age or older. This happens when joints become painful and swollen due to the breakdown and loss of cartilage, a protein substance that serves as a cushion between bones.

Last Updated: February 21, 2024

Osteoarthritis happens when the cartilage that acts as a cushion between bones gets worn out over time. Eventually, when the cartilage gets completely eroded, bone will rub on bone, causing pain and inflammation of the affected joints. This most commonly affects joints in the hands, knees, hips, and spine. There are various factors which can increase the risk for osteoarthritis: • Aging • Obesity • Repeated injury or surgery to joints • Congenital abnormalities • Certain metabolic diseases, like diabetes mellitus • Hormone disorders

Damage to the cartilage can occur because of (1) mechanical overload associated with certain occupations or with obesity, (2) weak muscles due to lack of exercise, deconditioning, or muscle disease, (3) an imbalance in loading of the joint due to congenital anomalies like knock-knee or bowlegs, (4) instability from torn ligaments or tendons resulting from injuries, or (5) abnormal nerve supply as can be seen in diabetic neuropathy. Recurrent or persistent inflammation of the joint due to gout, rheumatoid arthritis, or infection can also lead to cartilage damage.

OA is more common in older people because with ageing, there is reduced capacity for repair and decrease in the amount and quality of the lubricants in joint (synovial) fluid. However, OA is a disease and is not just an inevitable part of aging. The risk for OA can also be inherited.

Osteoarthritis may produce the following symptoms: • Pain and stiffness in the affected joint/s • Swelling, warmth, and creaking of the affected joint/s • Loss of flexibility

Osteoarthritis can affect almost any joint, but most commonly involves the hands, knees, hips, cervical and lumbar spine. The main symptom of OA is pain that is worse with activity and relieved by rest. Typically, the patient feels short-lived pain and stiffness of the involved joint when moving after a prolonged period of rest. This discomfort disappears as movement is continued but it reappears when activity, like standing or walking, is prolonged. Swelling due to increased joint fluid or enlargement of the bone may occur. Cracking or grating sound or sensation during movement, reduced joint motion, and changes in the shape of the affected joints can also occur.

Osteoarthritis can be diagnosed after interviewing and examining an individual; in more complicated cases, imaging studies like an X-ray and magnetic resonance imaging (MRI) may offer additional information to help manage the individual’s condition.

There is currently no cure to either stop cartilage degeneration or to repair damaged cartilage. However, individuals with the disease can undergo various treatments to help relieve pain and to manage any resulting disability.

Initial treatments are nonsurgical, including:

  • Lifestyle modifications (minimizing high-impact activities and losing weight)
  • Physical therapy
  • Assistive devices, like a cane or braces
  • Pain medications like paracetamol and ibuprofen
  • include acetaminophen (paracetamol) and oral or topical non- steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroid joint injection is used in certain cases can ease short-term pain and swelling.
  • If medications do not relieve pain and improve function, patients with severe OA may need surgery to repair or replace damaged joints.

If a person doesn’t respond to the above treatments, and develops significant disability, he/she may be advised to undergo surgery (like joint replacement) depending on his/her condition.

The following interventions may help prevent osteoarthritis:

  • Weight loss in individuals who are overweight or obese
  • Exercise, especially those that strengthen the quadriceps (to prevent knee osteoarthritis)
  • Avoid haste when moving and keep the environment clutter free to avoid falls and other accidents that can add stress and damage to the joint and surrounding structures.
  • Proper training to avoid injuries when exercising or playing sports
  • Eating certain foods which are rich in Vitamin D (like fatty fish and eggs), and Omega-3 fatty acids (like fish oil and walnuts)
  • Controlling other medical conditions like diabetes mellitus
  • Avoid sitting on a low chair to avoid putting so much stress on the knees when arising.
  • Eat a healthy balanced diet.
  • Lose at least 5% of your weight if overweight or obese because this can reduce pain and slow the worsening of OA.
  • Use assistive devices like canes, grabbers, or walkers to help you do your daily tasks. These can reduce the stress on your joints. Proper use of a cane instantly reduces the weight placed on the painful knee by around 30%.

These measures may also help prevent the development of OA among those at risk for the disease (older age, with family history of OA, congenital deformity, obesity, weak muscles, previous injury or surgery to the joint). We may also consult a musculoskeletal disease specialist to inquire on how best to take care of our joints and reduce the risk of OA.

References: 

https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Fact-Sheet.pdf

https://www.uptodate.com/contents/osteoarthritis-the-basics?topicRef=516&source=see_link

https://www.uptodate.com/contents/osteoarthritis-symptoms-and-diagnosis-beyond-the-basics?topicRef=15444&source=related_link

Last Updated: February 21, 2024