What is Osteoarthritis?

Osteoarthritis (OA) is a condition that affects joints in the body. Differing parts of the joint may be damaged. The cartilage may be damaged, bone spurs can grow around the joint (osteophytes) and the lining of the joint can become inflamed (synovitis). OA maybe caused trauma or be related to other causes such as genetics, obesity or ageing. Wear and tear was thought to be related, however studies are showing that there are other more significant reasons for the development of OA. Some roles that requires a lot of kneeling or squatting are at increased risk of developing OA of the knees.

Which joints are the most likely to develop OA?

Any joint in the body could develop OA. The most common sites that cause issues at the knees, hips, large toes and fingers.

How do I know if I have it?

This is different for each person. Some may notice over time that the joint is becoming more painful or swollen, that it becomes stiffer to move in the mornings and gets better over the day. The joint may make cracking noises, the joint may not move as far and sometimes the muscles around the joint can be weak causing instability of the joint.

How does this happen?

There are strong indications that genetics plays a large role in the development of Osteoarthritis. If your parents or grandparents had issues at a younger age, your risk of developing OA is increased compared to a person whose family does not have a history of OA. Being obese further increases the risk of developing OA due to the increased pressure that is experienced by the joint and the increase in inflammatory cells released by the fat tissue. Age is implicated due to the failure of the cartilage to repair and cellular aging. Joint injury is another risk factor most likely related to the changes in biomechanics and the release of further inflammatory cells.

What is the pathophysiology?

Initially there are changes in the cartilage, with a decline in the collagen network at the points of greatest weight bearing. Over time these points are worn away and the cartilage is lost. While this is occurring, the bone under these areas thickens and can develop cysts. Occasionally in very advanced cases the bone can be worn away due to bone on bone movements. Bone spurs can develop where ligament and tendons attach around the joint. The synovium (lining of the joint) becomes inflamed, unfortunately releasing inflammatory cells that can cause further damage to the cartilage. Other structures of the knee are also impacted by these inflammatory cells, cause destruction to menisci, tendons and ligaments of the joint.

How do I fix it?

There is currently no cure for Osteoarthritis. If the condition has progressed far enough joint replacement may be under taken and prior to this, certain injections, hydrocortisone or Hyaluronic acid injection may prolong requiring this surgery but there is no known method or treatment to halt progression of the disease. However, joint replacement or injection is not inevitable. Many people find that the disease does not progress to requiring surgery. There is no method to predict who will and won’t need surgery.

How can I help the pain?

The most important aspect of treating OA is to deal with the pain and continue activity. The main reason for joint replacement is due to significant pain and loss of movement. Non-medications treatment includes:

• Education: Understanding the disease and how you can help manage it is the most important thing that you can do. You will be able to identify charlatans that will try to sell you cures and you will develop the confidence to manage your symptoms
• Activity: it cannot be overstated the importance of continuing to be active, despite the pain you may experience. It will in time assist to reduce the pain, help with your heart and lung health and assist with mental health as well. Developing a plan to slow increase your activity can be developed by yourself, with your GP or physiotherapist.
• Weight Loss: if you are overweight or obsess the loss of weight will assist with the reduction in the pain experience, may slow the progression of the disease and with reduce the impact of other possible diseases such as diabetes or heart disease.
• Tens Machine: this provide and electric current that “distracts” the pain fibres and can provide relief
• Braces: used for a short period can relieve pain – mainly used at night
• Assistive devices: devices that can turn taps, or walking stick are always helpful
There are some medications that may help:
• Paracetamol: regular use of paracetamol may assist you to keep moving longer
• NSAIDs: try topical creams first and then, if appropriate try oral medications. You may need to use other medication at the same to time to reduce the change of gastritis.
• Amitriptyline: can be used to assist with the pain experience and to assist sleep.
• SSRI’s: some of the antidepressants are used to assist with the pain experience. By reducing the level of anxiety and depression associated with pain, you have be more active.
• Capsaicin creams: this is the active ingredient in chili peppers that makes them hot. It can provide some relief to the pain for a short period.