Osteoarthritis (OA) is the commonest form of arthritis, affecting 8.5 million people in the UK. 75% of these individuals report constant pain.
What is Osteoarthritis (OA)?
Joints in the body continually suffer micro-damage and then your body repairs this. OA occurs when this repair process fails.
The amount of pain and disability varies between each person, depending on the joint involved, the amount of cartilage loss, amount of synovitis (inflammation), bony changes, muscle wasting, how unstable the joint is.
So who gets OA?
There is currently no way of telling who exactly will get OA but it is more common in some people. OA is more common:
- As you get older
- If you are obese (BMI>30) eg knee OA is 14 times more common if you have a BMI>36 compared with someone with a BMI<30
- In women than men
- It runs in some families
- If you have injured the joint in the past
- In some occupations
Symptoms of OA
- Pain during activity. Burning pain at night/at rest
Tests for OA
In patients over 45yrs old, who have not suffered a recent injury and who have the symptoms mentioned above, OA can often be diagnosed without any specific blood tests or x-rays. X-rays are usually organised anyway to confirm the diagnosis and rule out rare causes of bone pain.
If you have a joint which is badly swollen, hot, red or if morning stiffness lasts longer than 1hr then you should see your GP who will arrange x-rays and blood tests to check for other causes of your symptoms such as inflammatory arthritis.
The “problem” with x-rays in patients with OA
- X-rays can be normal but you can still have bad symptoms from OA. This is because x-rays can’t pick up early cartilage loss, inflammation and muscle wasting.
- X-rays can show significant OA but yet you can be pain-free.
Treatment of OA
Treatment can be divided into treatment of an acute flare up of OA versus long term treatment of OA. Acute flare up treatment:
- Reduce your activity but don’t rest completely as this can cause increased stiffness in your joint
- Apply ice in a bag or a towel for 10-15mins – Do not apply ice directly to your skin or it will cause an ice burn. Do not fall asleep while applying or it can cause an ice burn
- Use anti-inflammatory gels
- Do not use heat rubs for an acute flare up
- Oral pain killers – you should seek advice from your GP. The strength and type of the pain killer you need will depend on how severe the pain is, your other medical problems and the other medications you are on. The commonly prescribed painkillers are paracetamol, co-codamol, ibuprofen, naproxen.
In my experience, the long-term management of OA by patients and by GPs is poor.
OA is the 11th leading cause of global disability. It is a condition that needs to be treated seriously. It will not kill you like a stroke, heart attack or cancer can but it can affect your ability to work, exercise and sleep. You can get into financial difficulties, become socially isolated and develop depression.
If managed correctly the risk of the above problems can be prevented or dramatically reduced. The best way to manage OA is as follows:
- Regular exercise – you need to pick an exercise that you enjoy, that you are able to do relatively pain-free and that you will do on a daily/regular basis. You need to incorporate it into your daily life or you will not do it often enough
- Muscle strengthening exercises – your doctor or physio will be able to give you exercises to strengthen the muscles around the painful joint
- Pain-killers – as above, the choice of pain killers depends on the level of your pain, the other medical problems you have and the other medication you are on. For chronic pain, the timing of your pain is important eg if you are wakening up at night with pain then your GP needs to prescribe you a slow release pain killer at night that is going to last 12 hrs. If you are having pain when you exercise then you should take pain-killers before you exercise. Initially the pain-killers can be taken when you need them. If the pain from OA gets worse then you will need to take the pain-killers on a regular basis to stay on top of the pain.
- Injections – I use steroid injections and on occasions hyaluronic acid injections where appropriate. These can be very effective in relieving the pain from OA. They do not reverse or slow down OA. Injections should be used as part of an overall rehabilitation programme to include exercise and weight loss.
- Weight loss – if you are overweight it is very important to lose weight. Many people, including many doctors have believed that OA is an inevitable part of getting older. We now know this is not the case. Research shows that if you are obese, you are 4 times more likely to develop knee osteoarthritis than you are to develop high blood pressure or diabetes. The heavier you are, the worse the pain, the more disabled and the less likely treatment will help. The good news is that with any amount of weight lost, the symptoms improve. Significant weight loss + exercise have been shown in some studies to produce as much symptom relief as joint replacement surgery, without the associated risks of this major surgery.
Four or five times your body weight goes through your knee with some day to day activities so if you are 1 stone overweight then 4-5 stone extra goes through your knee.
How to Calculate your BMI
So how can I lose weight if I can’t exercise due to pain? Weight should be lost with a combination of dietary changes and exercise:
- Dietary changes – discuss this with your GP or attend a local weight loss group. The basic principals are to reduce your portion size, eat a balanced healthy diet, reduce/stop unhealthy snacks between meals. Your GP can refer you to a dietician if you need additional help.
- Pain-killers – take appropriate painkillers as mentioned above
- Exercise – any exercise is better than none. Start off with low impact exercise as mentioned above, for a short duration. Build this up as pain settles
Joint Replacement Surgery
Joint replacement surgery is considered if you have:
- Severe OA AND
- Severe limitation to day to day activities despite strong regular analgesics AND
- You are medically fit for major surgery – depends on your other medical problems and if your weight is at target
If you meet these criteria your Sports Medicine Physician or GP can refer you for a consultation with an orthopaedic surgeon.Leave a reply →