What is osteoarthritis?
A joint is where two bones meet. The ends of the bones are covered by a thin layer of gristle called ‘cartilage’. This cartilage acts as a shock absorber when you put weight on the joint. The smooth, slippery cartilage surface allows the bone ends to move freely. The joint is surrounded by a membrane which produces a small amount of thick fluid. This fluid helps nourish the cartilage and keep it slippery.
Osteoarthritis is a disease which affects joints in the body. Osteoarthritis is a slow process that develops over many years. The cartilage gradually roughens and becomes thin, and the bone underneath thickens. The bone at the edge of the joint grows outwards The joint may produce extra fluid, which then makes the joint swell slightly. The tissue layers outside the joint slowly thicken and contract. Muscles that move the joint may weaken and become thin or wasted.
In severe osteoarthritis, the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch and starts to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges can change the shape of the joint. This forces the bones out of their normal position and causes deformity.
What causes osteoarthritis?
Osteoarthritis usually starts in the late 40s. Some degree of osteoarthritis will develop in everyone in old age and it is estimated that three out of four persons of more than 60 years of age will have definite evidence of osteoarthritis in at least one joint, and one out of ten persons beyond the age of 60 years will have sufficiently advanced disease and have so much trouble that medical advice will be sought. Today, a sizeable number of people in India live with OA. Despite the longevity and frequency of the disease, the cause is still not completely known and there is no cure.
While the exact cause is unknown, there are known to be several possible causes including:
- Previous Injuries
- Heredity/Congenital predisposition
- Repetitive Overuse
- Crystal Deposits
Around the age of forty, the muscles become weaker, we put on weight, and our body’s healing capacity is less. Being overweight also increases the chances of osteoarthritis worsening once it has developed. A major injury or operation on a joint may lead to osteoarthritis at that site in later life. Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis. However, very hard repetitive activity like soccer may injure joints and makes them prone to osteoarthritis. In general, heredity plays a relatively small role compared with obesity, aging and joint injury. There are some myths that osteoarthritis is caused by exercise, by the weather or by a shock. It is not caused by specific items of diet, though it does not help to have poor nutrition, as this is bad for muscles, cartilage, and bone.
Osteoarthritis can affect any joint from foot to the hip joint, and from hand to the shoulder joints. In women, the knees and hands are more commonly affected. Osteoarthritis of the neck and back is called spondylosis. X-rays show that it is very common, but it often causes no trouble, and the x-ray bears little relationship to pain or stiffness in the spine.
Does osteoarthritis vary for different people?
Two people with osteoarthritis of the same joint can have different symptoms. Some people have no problems or just mild trouble. Pain is the main problem for some, while others find it difficult to move and use the joint. Some stay the same for years; others experience a lot of change. Osteoarthritis is so variable it is difficult to generalize. Even in one person, the symptoms may change from time to time. So comparing yourself to someone else with osteoarthritis will not help much.
Symptoms and signs of osteoarthritis
Osteoarthritis tends to creep up on you, gradually increasing over months or years. Stiff and painful joints are the main symptoms. The pain tends to be worse on exercising the joint and at the end of the day. Stiffness after resting usually ‘works off’ in just a minute or two. The joint may not move as freely or as far as normal, and often ‘creaks’ or ‘cracks’ when moved. Occasionally the joint seems to give way because of weak muscles or loss of stability. Muscle exercises can strengthen the muscle and help prevent this.
In a few advanced cases, more severe and constant pain may develop and occur not only after exercise but even at rest or at night. Certain daily tasks and activities may then prove difficult, depending on which joint is affected. For example, osteoarthritis of the knee or hip may cause difficulties going down and upstairs, getting in or out of the car, getting up from sitting, walking far, or putting on shoes and socks. These difficulties can restrict what you can do and limit your independence.
Osteoarthritis does not always get worse. Most people with osteoarthritis do not become severely disabled and carry on a normal life. For many people, osteoarthritis reaches a peak a few years after the symptoms start and then either stays the same or gets a little easier. For others, one or more joints (especially a hip or knee) worsen as the years go by, and it may become painful and disabling. Although there is no cure for osteoarthritis, there are many ways in which you can relieve your symptoms and reduce the likelihood of things progressing.
Two aspects of your daily routine and lifestyle may need to be changed. These can prove more important in the long term in helping your osteoarthritis than any tablet or medication.
Reduce stress on the joints
Reduce the stress on painful osteoarthritic joints by ‘keeping to your ideal weight’. If you are overweight, losing even a few pounds will reduce the stress on your hips, knees, and feet. Combining regular exercise with a diet is often better than dieting alone. ‘Dieting’ means altering your eating habits forever, not just for a few months. Then it is important to ‘pace your activities through the day’. Spread physically hard jobs at intervals through the day, rather than tackling them all at once. You may wear shoes with thick soft soles that act as shock absorbers for your feet, knees, hips, and back. Use a walking stick to reduce the weight and stress on a painful hip or the knee
You can take regular exercise. Strengthening exercises will improve the muscle strength and tone, which will help to stabilize, protect osteoarthritic joints, and reduce the pain. Exercise that increases your pulse rate and makes you breathless (‘aerobic’ exercise) is good for your general health and well-being. Both forms of exercise help people with osteoarthritis, and over several months can relieve pain and improve movement.
Treatment: Tablets & creams
Painkillers often help symptoms and make it easier to get about. They do not affect arthritis itself but take the edge off pain and stiffness. They are best used occasionally for bad spells, or when extra exercise is likely. Mild inflammation in the joint may contribute to the pain and stiffness so you may need anti-inflammatory drugs. NSAID creams and gels can often help, especially for knee and hand osteoarthritis. Compared to NSAID tablets, they are very safe
How can severe osteoarthritis be treated?
A steroid injection may improve pain for several weeks, especially in a knee or thumb with osteoarthritis. This is mainly reserved for very painful osteoarthritis when immediate intervention is not possible. Surgery can succeed in the few cases where severe pain has developed in spite of other treatment. Joint replacement is a very successful operation.
General Advice: Rest Vs Exercise
Joints do not wear out with normal use. However, you must strike a sensible balance between too much activity and too much rest. Most people with osteoarthritis find that while too much exercise worsens their pain, their joints stiffen up if kept still for too long.
For most people with osteoarthritis, the best advice is ‘little and often’ – a little rest, followed by a little exercise. For example, do the housework or cleaning jobs in short spells interrupted by short rests. Avoid sitting in one place for too long – get up and stretch the joints from time to time. Break up a long car journey with frequent stops to walk around. Activities which cause severe pain afterward are probably best avoided. If for some special reason you do need to do a lot extra, it can help to take a painkiller before you start. Swimming is good for the joints as water supports the body’s weight so that little force goes through the joints as you exercise. Also, warm water relaxes muscles and joints and is very soothing, allowing joints to move more freely. Even if you do not know how to swim a little walk in the waist deep water helps your knee and hip joints. It is better not to take short naps during the day as it may spoil sleep at night when patients may feel the pain most. One important aspect of managing with any painful condition is to stay relaxed and not to get depressed. The depression makes the pain worse. Yoga and meditation can help overcome this situation.