Osteoarthritis

The process starts with cartilage becoming thin and uneven and then over time, perhaps wearing out completely. At the same time, the joint capsule becomes thicker and more synovial (lubricating) fluid is manufactured which makes the joint swell. In addition to cartilage degeneration, bony spurs grow causing inflammation in the surrounding tissues.

Osteoarthritis can involve all joints of the body, but is most commonly found in the fingers, knees, hips and spine.

What are the symptoms of osteoarthritis?

- Joint stiffness and pain. This improves with activity, but is often worse again after a period of rest.
- Backache.
- Reduced range of movement in affected joints.
- Possible swelling of affected joints.
- Possible grating of the joint on movement.
- It is not usually associated with redness or heat of the affected joint.

Who is most at risk?

Osteoarthritis is not hereditary, but the following factors are associated with an increased risk of developing the condition:

- obesity. Being overweight for several years can put strain on the joints.
- stress on joints caused by one's occupation.
- stress on joints caused by activity or ageing.
- injury to the joint lining, caused by a past fracture.

How is osteoarthritis diagnosed?

- Medical history and examination by a doctor.
- An X-ray examination will be able to reveal whether a patient has osteoarthritis. Often there will be no correlation between the amount of pain and the severity of the arthritis as shown by the X-ray. It is the pain and the problems with movement that are decisive in making the diagnosis.
- Laboratory blood tests may be performed to rule out any inflammatory forms of arthritis.

How is osteoarthritis treated?

- Pain can be relieved by applying heat to stiff and painful joints for 20 minutes up to three times a day. Various deep-heat lotions, heating pads, infrared lamps, hot baths, etc can be used.
- Swimming in a heated pool can help.
- Severe osteoarthritis of the neck spine can be eased by wearing a soft collar.
- Massaging the muscles around the joints.
- Sleeping on a firm orthopaedic mattress to ease the pain in the spine.
- Mild to moderate disease can usually be managed successfully with simple over-the-counter painkillers, such as paracetamol, aspirin or ibuprofen (a non-steroidal anti-inflammatory drug).
- A GP may prescribe a different non-steroidal anti-inflammatory drugs (NSAIDs) if this is appropriate for you, or a stronger codeine-based painkiller.
- •There is now increasing evidence that the natural treatment glucosamine is very effective at relieving some of the symptoms of osteoarthritis, especially in the knee joints. This should be taken in the form of glucosamine sulphate at a dose of 1500mg/day. It is now also available on a doctors prescription, and for some patients can replace anti-inflammatory drugs with very few side effects.
- Should the patient's condition deteriorate to the point where their mobility is severely affected, they may be advised by their GP to consider the possibility of surgery to replace a knee or hip joint.
- Following surgery, the patient will stay in hospital for about two weeks and a period of physiotherapy and rehabilitation is necessary to recover muscle strength.
- Modern artificial joints are expected to function for up to 20 years.

Future prospects

In spite of great progress with artificial joints, there are unfortunately still many people who have to live with their osteoarthritis and the daily pain it can cause. Patients may still have to see the doctor from time to time to have their condition reassessed and a treatment plan discussed. The GP can give advice to help patients understand the disorder and cope with it more successfully.

How can osteoarthritis be prevented?

It is not usually possible to prevent the condition occurring completely. Maintaining a normal weight for height and body structure, keeping physically active, and avoiding excessive stress on the joints as you get older, can reduce the severity and effects of osteoarthritis.

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