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  • Writer's picturereshma khan

It’s not just ‘wear and tear’

Osteoarthritis (OA) is a common joint disease that affects most commonly middle age and elderly people. It is a most common cause of disabilities in elderly. It is commonly referred as a ‘wear and tear’ arthritis but we now know that it is a disease affecting entire joint involving cartilage, joint lining, ligaments and bone.

OA tends to affect commonly used joints such as the hands and spine, and the weight-bearing joints such as the hips and knees. Symptoms include:

  • Joint pain and stiffness

  • Occasional swelling at the joint (affected joints can also slowly become bigger)

  • Cracking or grinding noise with joint movement

  • Decreased function of the joint

Most commonly OA can affect patients over age 40. I often hear this from my patients,

“I must be getting old” or “It’s just an old age”

However OA can occur at younger age if you have risk factors. Risk factors other than older age include,

  • Having family members with OA

  • Obesity

  • Previous traumatic Joint injury or repetitive use (overuse) of joints

  • Joint deformity such as unequal leg length, bow legs or knocked knees

Your rheumatologist can diagnose OA based on your symptoms and physical exam. Sometimes blood work is required to rule out other types of arthritis as OA can occur together with other types of arthritis, such as gout or rheumatoid arthritis. In some cases, X-rays or other imaging tests may be useful to look for the extent of disease or to help rule out other joint problems.

There is no cure or treatment to reverse OA damage. The goal is to reduce pain and improve function. I usually recommend the combination of physical measures, drug therapy and rarely surgery for end stage arthritis if replacement of joint is required. Evolution of disease is very unpredictable but most people can have OA for many years before they require surgical measures. I recommend getting an evolution by a rheumatologist to explore your non surgical options if your OA is not severe. Surgical interventions are usually required once the non surgical options fail to improve or control your symptoms.

Physical measures: My recommendations are,

Weight loss: Excess weight is the main risk factor for osteoarthritis. This risk factor is not limited to the joints that bear the weight of the body (knee, hip), but also for non weight-bearing joints such as the fingers. Each extra pound of weight exerts 4 pounds of weight on your knee. So, for example if you are 10 pounds overweight, you are putting 40 pounds of extra weight on your knee with every step. Think about the premature damage you can do to your knees with each extra pound. But wait…. it’s not just that extra weight causing damage. The fat itself can cause release of inflammatory cytokines that can promote inflammation and can influence development of OA.

Exercise can improve your muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA. I strongly recommend that patients with knee and hip OA should participate in cardiovascular (aerobics) and resistance land based exercises. I also highly recommend aquatic exercises. I occasionally recommend gentle exercises such as tai chi in patients with moderate to severe knee OA.

Support devices, such as orthotics, braces, splints (for hand OA) or a walking cane can help. I also sometimes recommend TENS unit or Chinese acupuncture (limited data available).

Drug therapy:

  1. Oral medications: pain relievers such as acetaminophen and anti inflammatory. Opioids are usually not recommended. I also use cautions in using anti inflammatory in people with ‘stomach ulcers’ and ‘heart diseases’. I also avoid using oral anti inflammatory drugs in patients 75 years and older.

  2. Topical treatment

  3. Intra-articular injections of corticosteroid or hyaluronic acid

Supplements: Many over-the-counter nutrition supplements have been used for osteoarthritis treatment. Most lack good research data to support their effectiveness and safety. Consult your rheumatologist to discuss your options. I recommend glucosamine and chondroitin sulfate supplements(if no contraindications). Also read my article on anti inflammatory diet ‘Let food be thy medicine‘.

I also recommend physical therapy or occupational therapy to learn the best exercises and the use of assistive devices. It can also be helpful in learning joint protection techniques.

I also recommend you to visit the arthritis foundation’s website for more information and reading.

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