Osteoarthritis (symptoms, diagnosis, treatment)
Osteoarthritis is the most common form of arthritis. It is estimated that over 300,000 New Zealanders are living with the condition.
It is a chronic (long-term), degenerative disease that causes the breakdown of cartilage in the joints. Symptoms include pain, stiffness and swelling. Treatment options to reduce pain and disability can include lifestyle changes (diet, exercise), therapies, medication and surgery.
Cartilage is a firm rubbery substance that covers the end of bones and acts as a cushion or shock absorber between bone ends. Osteoarthritis causes the progressive breakdown and wearing away of the cartilage, leaving the bone ends unprotected. As this occurs, the joint can become painful, stiff, difficult to move and eventually, swollen.
Osteoarthritis can be classified as primary or secondary.
Primary osteoarthritis has an unknown cause but is generally associated with ageing. It is sometimes referred to as “wear and tear” arthritis.
Secondary osteoarthritis is the destruction of cartilage from a known cause. Conditions that lead to cartilage loss include injury, obesity, gout, infection, congenital abnormalities (abnormalities present at birth) or joint surgery.
Graphic courtesy of A. Bonsall and MedicineNet.com
Osteoarthritis can occur at any time of life but the incidence increases with age. It usually affects people over 40 years of age.
Approximately 50 percent of people over 60 years of age are affected in at least one joint. Virtually all people over the age of 80 years suffer from osteoarthritis to some extent.
Osteoarthritis usualy occurs in the nads and weight-bearing joints such as hips, knees, feet and spine. It does not usually affect the shoulder, wrist, elbow or jaw unless as a result of unusual stress or injury.
Common risk factors for developing osteoarthritis include:
- Being overweight
- Female gender - the condition is more common and more severe in women
- Heredity - the condition, particularly where it affects the hands and fingers, tends to run in families.
Some occupations that involve repetitive heavy activity may damage joints and make them more prone to osteoarthritis later in life.
The most common signs and symptoms of osteoarthritis include:
Pain is the most common symptom of osteoarthritis. It is usually made worse by moving the joint or placing weight on it, and it is usually relieved by rest. As the condition progresses and inflammation develops, pain may become constant.
Stiffness of the affected joint is often noticed first thing in the morning, and after resting.
Swelling, which is sometimes warm to touch, may be noticeable in an arthritic joint.
Deformity can occur with osteoarthritis due to bone growths and cartilage loss. Bone growths in the end joints of the fingers are called Heberden’s nodes. Bouchard’s nodes are bone growths in the middle joints of the fingers. Degeneration of knee cartilage can result in the outward curvature of knees (bow- leggedness).
Crepitus (a crackling sound or grating feeling) may be noticed when an arthritic joint is moved. This is caused by bone rubbing against bone or roughened cartilage.
Osteoarthritis is often able to be diagnosed by its characteristic symptoms of pain, decreased movement and/or deformity. Osteoarthritis maybe confirmed with an x-ray or MRI scan. Common findings include narrowing of the joint space between bones, a loss of cartilage and bone spurs or bone growths.
Blood tests may be used to exclude other possible conditions but they cannot diagnose osteoarthritis.
There is no cure for osteoarthritis but the progression of the disease can be slowed and pain and disability reduced. Treatment will depend on the nature and severity of the condition and treatment will be tailored to the individual. Treatment options include:
Healthy body weight
Maintaining a healthy body weight will reduce stress on the arthritic joints.
Exercise can assist with weight loss, the maintenance of muscle strength and the mobility of arthritic joints. Activity at a level that does not cause pain is not thought to worsen osteoarthritis. Non weight-bearing exercises such as swimming or aqua jogging in a heated pool may be beneficial.
Physiotherapists can advise on appropriate exercises to improve mobility, increase muscle strength and decrease pain with the aim of improving function and maintaining independence. Heat or ultrasound treatment may also be used to relieve pain and relax muscles.
If activities of daily living become difficult, occupational therapists can provide advice on suitable home adaptations and special devices. These may include handrails, tap or bottle turners, large pegs, tongs or other gadgets. Equipment to assist mobility may include a walking stick or walking frame.
Medications can play an important role in the management of pain caused by osteoarthritis. There are different classes of medications that have proven useful. These include simple pain relievers (eg: paracetamol), non-steroidal anti-inflammatories (NSAID's) and corticosteroids (eg: prednisone).
A class of NSAID called Cox II inhibitors (eg: Celebrex) has proven effective in the management of osteoarthritis pain. However some medications in this class have been linked to an increased risk of heart attacks and stroke.
For advice on suitable pain relief medications please consult a medical practitioner who can prescribe and monitor appropriate medication.
Supplements such as glucosamine and chondroitin sulfate have been reported to relieve the pain of osteoarthritis and halt, or even reverse, its progression. While research has not confirmed these claims, many people have reported positive results after taking the supplements. It is advisable to consult a medical practitioner before taking these supplements.
Alternative therapies such as acupuncture and magnetic field therapy have been reported to be effective in relieving symptoms in some people.
The role of diet in the management of osteoarthritis is largely unproven. There are claims that some specific diets (eg: elimination diets) can help to relieve the symptoms of osteoarthritis but research has yet to back up these claims. It is recommended that a healthy balanced diet is followed as this can assist with overall wellbeing and with maintaining a healthy body weight.
Some dietary supplements, such as certain fish oils and Evening Primrose Oil, are thought to have mild anti-inflammatory properties and have been reported to relieve symptoms in some people.
Synovial fluid supplements
When medications, exercise or physiotherapy do not provide adequate relief of symptoms, a synovial fluid supplement may be injected into the joint. Synovial fluid is a clear, sticky, viscous solution that lubricates, protects and supports joints. In osteoarthritis this fluid does not function effectively. Synovial fluid supplements can reduce joint cartilage damage and delay the need for joint replacement surgery. Synvisc is one such supplement and is used to treat some cases of osteoarthritis of the knee.
When osteoarthritis has caused extensive joint damage and produces severe pain, joint replacement surgery may be necessary. The joints most commonly replaced are the hip and knee joints, however partial or complete replacement of the shoulder, elbow, wrist, finger, ankle and toe joints are also possible in some cases. The surgery is performed by an orthopaedic surgeon and can greatly reduce the symptoms of osteoarthritis in the affected joint. This allows greater mobility and an improved quality of life.
For further information and support please contact Arthritis New Zealand:
Arthritis New Zealand
0800 663 463
Arthritis New Zealand (2010) Osteoarthritis. Pamphlet. Arthritis New Zealand. Wellington.
Arthritis New Zealand (2007) Treatments. Arthritis New Zealand, Wellington. http://www.arthritis.org.nz/index.php?section=treat
Meszaros, L (2006) Osteoarthritis. The Gale Encyclopedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills. MI. Thompson Gale.
Ministry of Health (2012) Arthritis. Ministry of Health. Wellington. www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/arthritis
Schiller, A.L. & Teitelbaum, S.L. (1999) Bones and Joints. In E. Rubin & J.L. Farber (eds.) Pathology (3rd ed.) (pp1337-1413) Philadelphia: Lippencott-Raven Publishers
Last Reviewed - 8 March 2013
Go to our Medical Library Index Page to find information on other medical conditions.