Osteoarthritis (OA) is a condition of the joints between the bones and can be described as wear and tear of the joints. OA happens with ageing and also after trauma and it is the fifth leading cause of disability in Singapore for adults in the community and 80 per cent of people with OA have difficulties with movement. (Guccione et al, 1994).
Osteoarthritis can cause the cartilage in the joint to lose its elasticity and become stiff. As a result, it becomes more susceptible to damage. When the cartilage eventually wears away, its ability to act as a shock absorber will be dramatically reduced. Many individuals over 60 years of age have osteoarthritis to a certain degree but in most cases, the severity can vary. People in their 20s and 30s can also develop the condition although it is often attributed to other underlying reasons like overuse and repetitive joint stress.
OA can affect any joints but it most commonly affects the weight-bearing joints, especially the knees. Normally cartilage covers the bone ends. The cartilage is a smooth and slippery medium which normally glides and cushions the bone ends from rubbing. If the cartilage starts to degenerate then the bone ends start to rub causing pain and stiffness.
Osteoarthritis symptoms often manifest gradually but may worsen over time.
Common symptoms of osteoarthritis include:
- Tenderness – The joint might feel tender when light pressure is applied.
- Pain – The joint may hurt after or during movement.
- Flexibility loss – Full range of motion might become limited.
- Stiffness – Joint stiffness may manifest after a period of inactivity or when a patient wakes up in the morning.
- Bone spurs – Extra bone bits which can seem like hard lumps may form around the joint affected.
- Grating sensation – A grating sensation might be felt or heard when the joint is used.
Several factors that increase one’s risk of developing osteoarthritis have been identified. Some of these factors include:
- Obesity – Excess body weight has been known to contribute to the condition in several ways. For starters, extra weight can put added stress and strain on weight-bearing joints like the knees and hips. In addition, fat tissues can produce proteins that may result in harmful inflammation both in and around the joints.
- Age – The risk of developing the condition often increases with age.
- Sex – There are more cases of osteoarthritis in women compared to men.
- Occupation – If one’s job involves tasks that can put repetitive stress on any joint, it might eventually result in osteoarthritis.
- Genetics – Some individuals inherit the tendency to develop the condition.
- Joint injuries – Injuries resulting from accidents or playing sports may sometimes result in osteoarthritis.
During the physical examination, the doctor will often check for swelling, redness, tenderness, and range of motion of the affected joint. Imaging and lab tests might also be recommended when necessary.
- Joint fluid analysis – Analyzing the joint fluid can often help the doctor accurately assess the condition. A needle is used to draw fluid from the affected joint. Testing and examining the fluid can help identify if the pain and the inflammation are due to an infection or gout.
- Magnetic resonance imaging (MRI) – Using a strong magnetic field and radio waves, an MRI can produce a detailed image of the soft tissues and the bone, including the cartilage. While an MRI is not often ordered to diagnose osteoarthritis, it is sometimes utilized to gain more insight, especially in complex cases.
- X-rays – X-ray is often used to check for cartilage loss as well as bone spurs.
OA is presented differently in each person and will require an individualised treatment plan. Treatment approaches can include medications, physical therapy, weight loss, exercise, injections, and surgery, among others. Surgery is often the recourse when the condition does not respond to other treatments.
The type of treatment for osteoarthritis is dependent on various factors including occupation and activities, medical history, age, overall health, and the location and severity of the condition.
The following are some of the common treatment options that a doctor may prescribe.
Drugs and Supplements
- Painkillers, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Hyaluronic acid injections into the joint
- Chondroitin and glucosamine
- Heat/ice to help with pain management.
- Soft tissue releases (strong massage) to soothe pain and shorten recovery time.
- Exercises that strengthen muscles to help cushion joints.
- Joint mobilizations to help glide the joint for pain relief and increased range of movement.
- Lifestyle, biomechanics and posture changes. This may help offload the painful structures.
- Hemiarthroplasty/half joint replacement, the convex (ball) portion
- Arthroplasty (joint replacement)
- Arthrodesis (joint fusion)
- Lubrication injections – Hyaluronic acid injections may help alleviate pain by providing knee cushioning. Hyaluronic acid is identical to a component typically found in the joint fluid.
- Cortisone injections – Injecting corticosteroid medications in the joint is often done to help relieve pain. However, cortisone injections are often limited to three or four times each year as it might result in more joint damage over time.
Various alternative and complementary treatments have been proven to help with osteoarthritis symptoms. Promising treatment approaches include:
- Avocado-soybean unsaponifiables – This nutritional mixture of soybean oils and avocado is widely used in Europe to treat hip and knee osteoarthritis. The mixture is considered anti-inflammatory and some studies indicate it can help slow down joint damage.
- Acupuncture – Some studies claim acupuncture can improve function and relieve pain in people suffering from knee osteoarthritis. This procedure involves inserting hair-thin needles in the skin at specific spots in the body.
Assistive or supportive devices can greatly help in decreasing pressure on the joints in patients with osteoarthritis. Knee supports are also beneficial as it helps ease pain and stabilize the tendons and ligaments. Canes and crutches are also helpful in taking the pressure off certain joints.
Apart from pain relief, assistive devices can also prevent falls and improve function. A physical therapist or a healthcare professional would be able to recommend the best devices for you.