Osteoarthritis
Introduction
There is no cure for osteoarthritis, but the symptoms can be eased by using a number of different treatments. Mild symptoms can often be managed through exercise, or by wearing suitable footwear. However, in more advanced cases of osteoarthritis, other treatments may be necessary, such as analgesics (painkillers), physiotherapy, or surgery.
What is osteoarthritis?
Osteoarthritis is a condition that affects the joints. It is the most common type of arthritis in the UK, with an estimated 8.5 million people affected by the condition.Osteoarthritis is sometimes referred to as 'wear and tear' arthritis.
There are three characteristics of osteoarthritis:
- causes damage to cartilage - the strong, smooth surface that lines the bones and allows joints to move easily and without friction,
- results in bony growths developing around the edge of the joints, and
- causes mild inflammation of the tissues around the joints (synovitis).
Osteoarthritis mostly occurs in the knees, hips, and small joints of the hands. However, almost any joint can be affected.
Who develops osteoarthritis?
Osteoarthritis usually develops in people who are over 50 years of age, and it is more common in women than in men. It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not true.
Younger people can also be affected by osteoarthritis; in some cases, as a result of an injury, or another medical joint condition.
Managing osteoarthritis
Osteoarthritis is often thought of as a critical and disabling condition, but this is not usually the case. The symptoms vary greatly from person to person, and between different affected joints.
There can also be variation between the amount of damage to the joints, and the severity of the symptoms. For example, a joint may be severely damaged without causing symptoms, or your symptoms may be severe without affecting the movement of your joint.
^^ Back to top
Symptoms
The main symptoms of osteoarthritis are:
- pain,
- stiffness (which is worst when you wake up in the morning but improves within about 30 minutes when you start to move), and
- difficulty moving your affected joints.
However, in some cases of osteoarthritis, you may not have any symptoms at all. Usually, you will only experience symptoms in one joint, or a few joints, at any one time. You may also find that your symptoms develop slowly.
Other symptoms of osteoarthritis may include:
- joint tenderness,
- increased pain and stiffness when you have not moved your joints for a while,
- joints appearing slightly larger, or more 'knobbly' than usual,
- a grating, or crackling sound, or sensation, in your joints,
- limited range of movement in your joints,
- weakness and muscle wasting (loss of muscle bulk), and
- warm joints.
Which joints are affected by osteoarthritis?
You are most likely to develop osteoarthritis in the joints of your:
Symptoms of osteoarthritis in the knees
If you have osteoarthritis in your knees, it is likely that both of your knees will be affected, unless it has occurred as the result of an injury, or another condition.
Your knees may be most painful when you walk, particularly when walking uphill, or going up stairs. Sometimes, your knees may 'give way' beneath you, or lock into position, so that you cannot straighten your legs. You may also hear a soft, grating sound when you move the affected joint.
Symptoms of osteoarthritis in the hips
Osteoarthritis in your hips often causes difficulty moving your hip joints. You may find it difficult to put your shoes and socks on, or to get in and out of a car.
If you have osteoarthritis in your hips, you may have pain in your hips. However, it is quite common to have pain in your knee and not in your hip. Rarely, you may have pain in other areas, such as the thighs, buttocks, knees, and ankles. In most cases, pain will be at its worst when you walk, although it can also affect you when you are resting.
Symptoms of osteoarthritis in the hands
There are three main areas of your hand that are often affected by osteoarthritis - the base of your thumb, the joints closest to your fingertips, and the middle joints of your fingers.
Your fingers may become stiff, painful, and swollen and you may develop bumps on your finger joints. However, over time, the pain in your fingers may decrease and eventually disappear altogether, although the bumps and swelling may remain.
You may find that your fingers bend sideways slightly at your affected joints, or that you develop painful cysts (fluid-filled lumps) on the backs of your fingers.
In some cases, you may also develop a bump at the base of your thumb where it joins your wrist. This can be painful and you may find it difficult to perform some manual tasks, such as writing, opening jars, or turning keys.
^^ Back to top
Causes
Osteoarthritis occurs when there is damage to the protective surface (cartilage) that allows your joints to move smoothly. The cartilage becomes worn and uneven which causes your bones to get thicker and broader.
The main cause of osteoarthritis is a mismatch between damage that is caused to your cartilage and the repair process. If you develop osteoarthritis, the damaged cartilage cannot repair itself in the normal way.
Your joints may become knobbly where your bones begin to protrude, forming bony lumps, which are called osteophytes. As your bones thicken and broaden, your joints will become stiff, painful, and be difficult to move. There may also be a build up of fluid in your joints which causes them to swell up.
Contributory factors
The reason why the breakdown in the repair process that leads to osteoarthritis occurs is unknown. However, it is thought that there are probably several factors that contribute to the development of osteoarthritis. These factors are outlined below.
Wear and tear
Your joints are always exposed to a small amount of damage through your daily activities and, in most cases, are able to repair themselves. However, osteoarthritis may occur because your body's natural repair process cannot always make up for the wear and tear of everyday life.
This may help to explain why osteoarthritis is common in people who are over 50 years of age, and also why the condition becomes more common as you get older.
It is not known exactly what triggers osteoarthritis in older people. However, it is likely be due to particular effects of increasing age, such as less blood flow to your joints, your muscles becoming weaker, and a slower repair processes in your body.
Joint injury or disease
Osteoarthritis can develop in a joint that has been previously damaged by an injury, or operation. Overusing your joint when it is has not had enough time to heal after an injury, or operation, can also contribute to osteoarthritis in later life.
Sometimes, osteoarthritis can occur in joints that have been severely damaged by a previous, or existing, condition, such as rheumatoid arthritis. Rheumatoid arthritis is a form of arthritis that is caused by your body's own immune system.
Osteoarthritis that develops as a result of damage, or another condition, is known as
secondary osteoarthritis. It is possible for secondary osteoarthritis to develop many years after the initial damage to your joint.
Family history
In some cases, osteoarthritis may be passed on from one member of a family to another. It is estimated that 40-60% of cases of hand, knee, and hip osteoarthritis may have a genetic link, although the genes that carry the condition are not yet known.
Being obese
Research into the causes of osteoarthritis has shown that being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips. As a result, osteoarthritis can often be worse in those who are obese.
^^ Back to top
Diagnosis
You should see your GP if you think that you may have osteoarthritis. There is no definitive test that can be used to diagnose the condition, so your GP will ask you about your symptoms and carry out an examination of your joints and muscles.
Your GP may suspect that you have osteoarthritis if you:
- are over 45 years of age,
- have persistent joint pain, which gets worse the more you use your joints, and
- have stiffness in your joints in the morning that lasts no longer than half an hour.
If your symptoms are slightly different from those listed above, your GP may think that you have another form of arthritis. For example, if you have joint stiffness in the morning that lasts for longer than an hour, you may have rheumatoid arthritis, which is caused by your body's immune system.
X-ray
In order to confirm which type of arthritis you have you may need to have an X-ray of your affected joints. An X-ray uses high energy radiation to produce an image of the inside of your body. It can also show how advanced your condition is.
An X-ray can also show any loss, or break down, of cartilage, as well as any damage to your bones, or osteophytes (bony lumps caused by osteoarthritis). However, an X-ray may not be able to show early osteoarthritis.
If your GP thinks that your symptoms are due to a different form of arthritis, such as rheumatoid arthritis, you may also need to have a blood test.
^^ Back to top
Treatment
Osteoarthritis cannot be cured, but treatment for the condition can ease your symptoms and prevent them from affecting your every day life.
However, if your osteoarthritis is mild, or moderate, you may not need to have any treatment. Your GP will be able to provide you with advice about managing your symptoms by making changes to your lifestyle, which may be enough to keep the condition under control.
See the 'self help' section for more information about things that you can do to help manage your osteoarthritis.
Medical treatments for osteoarthritis
There are several medicines, treatments, and pieces of equipment that can make living with osteoarthritis easier. Some of these are available from your GP, such as analgesics (painkillers), medicines that are injected into your joints, and thermotherapy (warm and cold packs).
However, if your osteoarthritis is causing you severe pain and discomfort, or affecting your mobility, your GP may refer you for specialist treatment from a physiotherapist, or an occupational therapist. In severe cases, surgery may be required.
The various medicines, treatments, and equipment that you need to have for osteoarthritis are outlined below.
Analgesics (painkillers)
The type of analgesic (painkiller) that your GP may recommend for you will depend on the severity of your pain, and any other conditions or health problems that you may have.
Paracetamol
If you have pain that is caused by osteoarthritis, to begin with your GP may suggest taking paracetamol, which is available over-the-counter (OTC) in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable.
However, when taking paracetamol, you should always make sure that you follow the dosage that your GP recommends, and that you do not exceed the maximum dose that is stated on the pack.
Non-steroidal anti-inflammatories (NSAIDs)
If paracetamol proves ineffective in controlling the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, aspirin, or diclofenac.
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available over-the-counter (OTC) without a prescription. They can be particularly effective if you have osteoarthritis in your knees, or hands, and as well as helping to ease pain, they can also help to reduce any swelling that you have in your joints.
Sometimes, NSAIDs may not be suitable for you if you have certain conditions, such as asthma, or a peptic ulcer. If you are unsure about whether NSAIDs are suitable for you, you should speak to your GP. They will be able to discuss any potential risks or benefits of taking NSAIDs with you. Children who are under 16 years of age should not take aspirin.
If your GP recommends, or prescribes, an NSAID to be taken by mouth, they will usually also prescribe a medicine known as a proton pump inhibitor (PPI) for you to take alongside it. This is because taking an NSAID can break down the lining in your stomach that protects against stomach acid. However, PPIs reduce the amount of acid by blocking the tiny ducts (or pumps) in your stomach that produce it, reducing the risk of damage to your stomach lining.
Opioids
Opioids, such as codeine, are another type of analgesic that may help to ease your pain if paracetamol does not work. Opioids can help to relieve severe pain, but they can also cause side effects, such as drowsiness, nausea, and constipation.
If you need to take an opioid regularly, your GP may prescribe a laxative for you to take alongside it.
Capsaicin cream
If you have osteoarthritis in your hands, or knees, and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.
Capsaicin cream works by blocking the nerves that send pain messages, although you may have to use it for a while before it has an effect. You should experience some pain relief within the first two weeks of using the cream, but it may take up to a month before the treatment is fully effective.
You should apply a pea-sized amount of capsaicin cream to your affected joints four times a day, but not more than every four hours. Do not use capsaicin cream on skin that is broken, or inflamed, and always wash your hands after applying it.
You should also be careful not to get any capsaicin cream on delicate places, such as your eyes, mouth, nose, and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. However, avoid using too much cream, or having a hot bath, or shower, before, or after, applying it because it may can make the burning sensation worse.
Intra-articular injections
If your osteoarthritis is severe, treatment using analgesics (painkillers) may not be enough to control your pain. If this is the case, you may be able to have a type of treatment where medicine is injected into the parts of your body that are affected by osteoarthritis. This type of treatment is known as intra-articular because it is injected inside your affected joints.
If you need to have intra-articular injections, it is likely that you will have injections of corticosteroid, which is a medicine that reduces swelling and pain. However, the National Institute for Health and Clinical Excellence (NICE) do not recommend intra-articular injections of hyaluronic acid for osteoarthritis.
As too many intra-articular injections can damage your joints, you will have to wait at least three months between treatments, and each joint should not be treated more than three times a year.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is a treatment method which uses a machine that may help ease the pain that is caused by your osteoarthritis. It works by numbing the nerve endings in your spinal cord which control pain, so that you can no longer feel it.
Treatment with TENS is usually arranged by a physiotherapist. Small electrical pads (electrodes) are applied to the skin over your affected joint, which deliver small pulses of electricity from the TENS machine. Your physiotherapist can advise on the strength of the pulses, and how long your treatment lasts.
Thermotherapy
Thermotherapy is a form of treatment that can be used for osteoarthritis. It uses warm and cold temperatures to help ease the pain and stiffness in your joints. A hot water bottle filled with either hot or cold water, and applied to the affected area, can be very effective in helping to reduce pain. Special hot and cold packs that can either be cooled in the freezer, or heated in a microwave oven, are also available, and work in a similar way.
Manual therapy
Not using your joints can cause your muscles to waste, and may worsen stiffness that is caused by osteoarthritis. Manual therapy is a treatment method that is provided by a physiotherapist and uses stretching techniques to keep your joints supple and flexible.
Assistive devices
If your osteoarthritis causes mobility problems, or performing everyday tasks is difficult, there are a number of devices available which may be able to help. Your GP may refer you to a physiotherapist or an occupational therapist, for specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees, or feet, your physiotherapist, or occupational therapist, may suggest special footwear, or insoles, for your shoes. Footwear with shock-absorbing soles can help to relieve some of the pressure on the joints of your legs as you walk, and special insoles may help to spread your weight more evenly. Leg braces and supports also work in the same way.
If you have osteoarthritis in your hip, or knee, which affects your mobility, you may need to use a walking aid, such as a stick, or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.
A splint (a piece of rigid material that is used to provide support to a joint, or bone) can also be useful if you need to rest a painful joint. Your physiotherapist will be able to provide you with a splint and give you advice about how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks far more manageable. Your occupational therapist will be able to provide you with help and advice about using these devices in your home, or workplace.
Surgery
Surgery for osteoarthritis is only needed in a small number of cases. It can sometimes be helpful for osteoarthritis that affects your hips, knees, or joints, particularly those at the base of your thumb. Your GP may suggest surgery for your condition if other treatments have been ineffective, or if one of your joints is severely damaged.
If you need to have surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon before your symptoms become severe enough to cause permanent damage, or very severe pain.
There are a number of different types of surgery for osteoarthritis. You may have surgery to smooth the surfaces of your joints, or restore cartilage (an arthroscopy), or you may have surgery to replace your whole joint, or to fuse it into position.
Arthroplasty
Joint replacement therapy, also known as an arthroplasty, is most commonly carried out to replace hip and knee joints.
In an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint that is made of special plastics and metal (prosthesis). An artificial joint can last for up to 20 years. However, it may eventually need to be replaced.
Arthrodesis
If joint replacement is not suitable for you, your surgeon may suggest an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.
Having surgery for osteoarthritis can greatly improve your symptoms, mobility, and quality of life, and can also help to prevent further damage to your joints. However, surgery cannot guarantee to get rid of your symptoms altogether, and you may still experience pain and stiffness as a result of your condition.
Osteotomy
If you have osteoarthritis in your knees, but you are too young for knee replacement surgery (arthroplasty), you may be able to have an operation called an osteotomy. This type of surgery involves your surgeon adding, or removing, a small section of bone either above, or below, your knee joint.
This helps to re-align your knee so that your weight is no longer focused on the damaged part of your knee. An osteotomy can greatly relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
^^ Back to top
Self-help
As well as medical treatments for osteoarthritis, there are a number of ways that you can ease the symptoms of your condition yourself. Your GP, or physiotherapist, can give you advice about changes that you can make to your lifestyle in order to manage your osteoarthritis at home.
In some cases, this may be all you need to do to keep your symptoms of osteoarthritis under control.
Exercise
If your osteoarthritis causes you pain and stiffness, you may not think that exercise is for you. However, exercise is very important for treating osteoarthritis. Not only will regular exercise keep you active and mobile, it will help to build up your muscles, which in turn strengthens your joints. Exercise is also good for relieving stress, losing weight, and improving your posture, all of which will ease your symptoms of osteoarthritis.
Your GP, or physiotherapist, should discuss the benefits of regular exercise with you, and will be able to provide you with an exercise plan to follow at home. It is very important that you follow this plan carefully, because the wrong sort of exercise, or carrying out exercises incorrectly, may cause further damage to your joints.
Your exercise plan is likely to include exercises which improve your flexibility, strength, and fitness.
Flexibility exercises focus on your range of movement and involve gently stretching your joints to make them more supple. Strengthening exercises will improve your muscle strength and tone. However, the type of exercises that will be recommended for you will depend on which of your joints are affected by osteoarthritis. Exercises to improve your fitness will raise your heart rate, and improve your stamina, and may include cycling, walking, or swimming.
See the 'selected links' section for more information about exercises that are suitable for osteoarthritis.
Weight loss
Being overweight, or obese, makes your osteoarthritis worse because the extra weight puts even more strain on your joints, particularly those in your lower limbs which bear your weight.
If you are overweight, or obese, you should try to lose weight by exercising regularly, and eating a healthy diet. However, see your GP, or physiotherapist before starting a new exercise programme, or making any changes to your diet. They will be able to devise an exercise plan that is suitable for you, and give you advice about how to lose weight slowly and safely.
Complementary therapies
There are many complementary therapies that are available for easing the symptoms of osteoarthritis, although there is little, or no, medical evidence to say that they are effective.
Therapies such as acupuncture, aromatherapy, and massage are some of the other commonly used complementary therapies for osteoarthritis. Some people may find that they help, although they can be expensive and time-consuming.
If you have osteoarthritis and you decide to use a form of complementary therapy to treat your condition, make sure that your therapist is fully qualified and an accredited member of the appropriate organisation - for example, the British Acupuncture Council.
Supplements
A number of supplements are available for treating osteoarthritis. Two of the most common supplements for osteoarthritis are chondroitin and glucosamine.
However, there is very little medical evidence to back up the effectiveness of supplements, such as chondroitin and glucosamine. These supplements can also be expensive. The National Institute for Health and Clinical Excellence (NICE) does not recommend the use of chondroitin because it has been found to be ineffective.
Glucosamine
Glucosamine is available in two different preparations, glucosamine hydrochloride, which is licensed, and glucosamine sulphate, which is unlicensed.
Although there is little medical evidence to back up the effectiveness of glucosamine hydrochloride, recent research has shown that taking glucosamine sulphate (which is found in healthy cartilage), or fish oils, may have positive results. However, the NHS cannot recommend, or prescribe, the use of glucosamine sulphate because it does not often prove to cost-effective.
If you want to buy glucosamine sulphate for yourself, it is best to take the 1500mg tablet that is taken once a day, as the 500mg tablets (taken three times a day) seems to be ineffective. However, you should not take glucosamine if you are allergic to shellfish.
Glucosamine sulphate is available from health food shops. However, it is important to remember that it may not be effective for everyone, and you may only get a mild improvement in your pain. You should evaluate the severity of your pain before you start taking glucosamine sulphate, so that you can tell whether or not there is a noticeable improvement.
It is best to take glucosamine sulphate for a trial period at first. If you have not noticed an improvement in your pain, or stiffness, within three months of taking glucosamine sulphate, it is not likely to be effective for you.
Rubefacients
Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. There are several rubefacients which can be used to treat joint pain that is caused by osteoarthritis.
However, research has shown that rubefacients have little, or no, effect in treating osteoarthritis. For this reason, NICE do not recommend their use.
^^ Back to top
Complications
Osteoarthritis can sometimes cause several complications which are outlined below.
Reduced mobility
If you have osteoarthritis, you may sometimes find it difficult to move around. This can increase the risk of accidents and injuries, such as trips and falls.
Disability
Some people may think that osteoarthritis always leads to disability, but this is not the case. In most cases, osteoarthritis is a painful and uncomfortable condition but it does not cause any permanent disability. Many people with osteoarthritis lead completely normal lives.
However, as osteoarthritis varies greatly from person to person, it can sometimes result in disabling damage.
Problems at work
If you have osteoarthritis and you are still working, you may find that your symptoms interfere with your working life, and can sometimes affect your ability to do your job.
This can be very frustrating, and can lead to psychological or emotional problems. Talk to your GP, or occupational therapist, if you are finding it hard to cope.
Septic arthritis
If you have had joint replacement surgery (arthroplasty), it is possible for your replacement joint to become infected. This is a severe complication and requires emergency treatment in hospital.
^^ Back to top
Prevention
It is not possible to prevent osteoarthritis altogether. However, you may be able to minimise your risk of developing osteoarthritis by avoiding factors that can make developing it more likely.
Look after your joints
Try not to put excessive stress on your joints, particularly your hips, knees, and the joints in your hands.
Avoid types of exercise that put strain on your joints and force them to carry all of your weight, such as running and weight training. Instead, opt for exercises like swimming and cycling, where your joints are better supported.
Try to maintain good posture at all times, and avoid staying in the same position for too long. If you work at a desk, make sure that your chair is at the correct height, and take regular breaks to move around.
Keep your muscles strong
Your muscles help to support your joints, so having strong muscles will help your joints to stay strong too. Try to exercise for at least 30 minutes, five times a week to build up your muscle strength.
However, avoid weight-bearing exercises that put excess strain on your joints, such as running and weight training.
Lose weight if you are overweight or obese
Being overweight, or obese, can make your osteoarthritis worse. To find out whether or not you are overweight, or obese, you can use the body mass index (BMI) calculator.
Talk to your GP, and see the 'self help' section for more information about weight loss and osteoarthritis.
^^ Back to top