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PDF file Osteoarthritis

ARTHRITIS FOUNDATION OF VICTORIA
www.arthritisvic.org.au  ... (Copy reviewed 2005)

OSTEOARTHRITIS ..

Osteoarthritis is the most common form of arthritis and the one that is often associated with the changes of ageing. Although it affects a large percentage of people over 60, problems of osteoarthritis can often be found in younger people.

People frequently see osteoarthritis as being a progressive and disabling disease. Some people certainly do experience symptoms of severe pain and stiffness. But for many, symptoms are mild and cause only temporary and occasional problems.

Osteoarthritis is a condition involving the breakdown of the protective cushion of the cartilage covering the ends of the bones where two bones meet to form a joint.

How do healthy joints work?

Most of our joints consist of two or more bony surfaces which are carefully shaped to fit together to bear weight and to move freely. The bone ends, known as the articular surface, are covered with a shiny, gristly material called cartilage. Cartilage acts as a shock absorber and provides a smooth surface between the bones to allow easy movement.

The joint is enclosed and held together by a tough, fibrous capsule. This capsule is lined with a tissue called synovial membrane (not unlike the type of tissue lining the mouth!). The synovial membrane is vitally important as it produces synovial fluid which nourishes the cartilage and lubricates the joint. It is interesting to note that cartilage has no blood vessels and relies on the synovial fluid moving in and out to provide nutrients and take away the waste products. This fact has highlighted the important place of exercise in the management of osteoarthritis. Encouraging joint movement through appropriate exercise helps improve cartilage nutrition and health.

What happens in osteoarthritis?

The current thinking is that osteoarthritis is due to changes within the cells of the cartilage which lead to a loss of elasticity. These changes in turn lead to splits in the cartilage and inflammation of the synovial membrane. As the cartilage breaks down, pieces may break off into the synovial fluid in the joint space. This will lead to further irritation and inflammation.

Over a period of time, the cartilage thins and may even break down to leave the bones unprotected. As a result, the joint loses its smooth functioning. The bone loses shape and thickens at the end to produce bony spurs called osteophytes.

The term degenerative and secondary arthritis are sometimes used as osteoarthritic changes are more likely to occur when there has been previous injury, unrecognised defects in the structure of the joint or poorly healed sporting injuries.

Which joints are most commonly affected?

Although any synovial joint in the body may be affected by osteoarthritis, certain groups of joints are more usually affected.

  • Osteoarthritis of the hands occurs commonly in women, frequently within families and most often affects the end finger joints producing bony growths or nodules known as Heberden’s Nodes.
  • The base of the thumb is another site seen commonly in men and women.
  • Osteoarthritis of the spine occurs in the neck or lower back region. In this case there is also wearing of the discs between the spinal bones or vertebrae. This type of osteoarthritis is called Spondylosis or Spondylitis.
  • The third group of joints involved are the large weightbearing joints, the hips and the knees. Osteoarthritis of the hip tends to affect the middle-aged and older people and may be quite severe.
  • Osteoarthritis of the knee in some cases may be attributed to previous injury. Continual mechanical stress such as being overweight will certainly make this condition worse.
  • Other joints such as the ankles, feet, toes and shoulders may also be affected.

What are the symptoms?

The surprising thing about osteoarthritis is the sheer variability of the symptoms.

For some people the changes within the joint may lead to quite severe pain and stiffness around the joint. Pain may even be present at rest as well as on movement. For others, symptoms may be very mild and occasional, perhaps being brought on by periods of increased use or some minor injury. Muscle weakness may ultimately lead to the joint feeling unsafe and unstable, as if about to give way. Symptoms will also vary both with the joints involved and their use.

In Osteoarthritis of the hands the pain, redness and swelling may only be present for a short while as the bony growths develop. However, osteoarthritis of the base of the thumb may cause ongoing problems when people try to grip or hold things.

Pain from Osteoarthritis of the hip may be felt in the groin or the front of the thigh to the knee, most commonly during walking and standing but, for some, even at rest. Stiffness may also lead to increased difficulty with mobility.

In Osteoarthritis of the knee pain may also be felt when standing or walking and it may take a while to "loosen up" after sitting or standing.

In Osteoarthritis of the spine there may be pain and stiffness in the neck or lower back and what is known as referred pain down the arm or leg due to irritation of the nerves supplying the area.

How is osteoarthritis diagnosed?

In order to make a diagnosis of osteoarthritis, the doctor puts together the patient’s own description of the signs and symptoms with a physical examination. X-rays may be taken to assist in deciding whether or not the condition could be Osteoarthritis. Although X-rays show joint changes, some people with a joint that looks worn on X-ray may not experience pain. The doctor may prescribe other tests such as blood tests or taking fluid from the joint for analysis. These are mainly used to rule out the possibility of other types of arthritis.

What can be done about Osteoarthritis?

There is a lot that can be done to reduce the effects of osteoarthritis. In fact, the outlook for people with osteoarthritis is far better today than it has ever been!

Within the community, general practitioners, physiotherapists, occupational therapists, podiatrists, health educators, rheumatologists and orthopaedic surgeons form part of a wide network of caregivers who can help the person with osteoarthritis. The development of Education Programmes has also enabled people to take a more involved, informed approach to their problem.

Self help and osteoarthritis

You can have much more control over your osteoarthritis than you may think. Although there is no cure for osteoarthritis there is a variety of known treatments and management techniques that help people control and reduce the effects of the disease. Research has shown that people who exercise regularly, practise relaxation and/or use any other self management techniques have less pain and are more active than those people who are not self managers. Active exercise may need to be curtailed sensibly and when a joint is inflamed, as is sometimes the case osteoarthritis. Self help courses are now available which are designed to give people the skills needed to take a more active part in their arthritis care together with the Health care team. Click here for details on upcoming courses.

Exercise

There is a very positive relationship between exercise and the management of osteoarthritis. Exercise has many benefits for the person with osteoarthritis.

Exercise will help to:

  • decrease pain;
  • keep joints mobile;
  • increase muscle strength;
  • strengthen bones and ligaments;
  • prevent joint deformities;
  • provide nourishment to joints;
  • increase general fitness and wellbeing;
  • maintain and increase your ability to perform daily tasks.

There are many appropriate exercise programmes for people with arthritis available in the community including fitness activities such as swimming or walking, gentle exercise classes, Tai Chi and even sports such as tennis, table tennis and bowls. Water exercise is of particular benefit to people with osteoarthritis as the warmth and buoyancy of the water makes movement much easier.

Medication

Medication is often prescribed in osteoarthritis. Paracetamol can be used for the effective relief of pain and discomfort associated with osteoarthritis and has no harmful side effects on the stomach.

Aspirin and medications known as Non Steroidal Anti Inflammatory drugs (NSAID’s) can be used to treat inflammation and pain. Individual reactions to these medications vary, but irritation of the stomach is the most frequent side effect. Therefore, these drugs should be taken with meals. Rarely, there can be serious bleeding from the stomach or upper intestine.

Be sure to discuss each and every medication you take with your Doctor and your Pharmacist.

Joint Protection

Joint protection is a term used to describe ways of looking after your joints. It means reducing the stresses that can cause more pain, damage, and even eventual loss of function.

You need to become "tuned in" to what you do and how you do it and become aware of positions, activities and stresses that cause pain.

Planning ahead, reducing body weight, balancing rest and activity, simplifying work and using labour saving devices are a few of the ways by which you can take care of your joints.

Changes to the house such as replacing steps with a ramp is one example. The advice of an occupational therapist is useful in this area.

Diet

Contrary to popular belief, there is no diet that will cure osteoarthritis. It is advisable to maintain a balanced healthy diet and control body weight. There is a great deal of excellent material on healthy eating now available within the community.

Surgery

The development of highly successful surgical techniques has led to an increase in the number of joint replacements especially of hips, knees and, less commonly, shoulders, that are now being performed. For many, this has meant a dramatic improvement in quality of life.

Be sure to discuss all your concerns and questions with your surgeon before entering hospital.

Sources of help within the community

Arthritis Victoria has a wide variety of resources and information covering all aspects of arthritis together with education and exercise programmes.

Rheumatology clinics, community health centres, major hospitals, local councils, citizens advice bureau are only a few of the organisations able to provide further advice and information.

NEVDGP entry - Check out "slow moving weight bearing exercise" Australian video
www.osteoexercisevideo.com

Date Last Reviewed by NEVDGP: 20 August, 2006

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