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    Osteoarthritis

    Overview
    Causes
    Symptoms
    Risk Factors
    Diagnosis
    Treatment Options
    Where To Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Orthopaedic Surgery

    Overview

    The most common form of arthritis, Osteoarthritis (OA) affects an estimated 40% of the adult population. Of these, only 10% seek medical advice and only 1% are severely disabled.


    Causes


    Osteoarthritis (OA) means inflammation of the joints although it is better known as a degenerative disease due to the inflammation of the joints with thinning of the articular cartilage. The cartilage in our joints allows for the smooth movement of joints. When it becomes damaged due to injury, infection or gradual effects of ageing, joints movement is hindered. As a result, the tissues within the joint become irritated causing pain and swelling within the joint.


    Symptoms

    In OA, you will have no problem in the morning on arising but as the day progresses your discomfort will increase.

    In the evening, there will be a dull ache in the area of the affected joint.

    Other symptoms include:

    • Pain
    • Swelling of the affected joints
    • Changes in surrounding joints
    • Warmth - The arthritic joint may feel warm to the touch
    • Crepitation - A sensation of grating or grinding in the affected joint caused by the rubbing of damaged cartilage surfaces
    • Cysts - In OA of the hand, small cysts may develop, which may cause the ridging or dents in the nail plate of the affected finger

    The changes associated with degenerative arthritis tend to involve similar joints. Whereas in post-traumatic degenerative arthritis where there is a history of acute or chronic trauma, the changes tend to be isolated to the specific joints injured.


    Risk Factors

    Old age
    As a person grows older, it becomes more likely that the cartilage may be worn away. OA is uncommon in people below 40 years of age.

    Gender
    Women are more likely to suffer from OA, especially after menopause.

    Previous joint injury
    Someone with a previous injury to the cartilage within the joint, e.g. after a fracture involving the joint or after a sporting injury to the joint will have a higher risk of developing OA later in life.

    Weight
    A greater than normal body weight puts more stress on the weight-bearing joints such as the hip and knee, increasing the likelihood of developing OA in these joints.

    Bone deformities
    People born with deformed joints or abnormal cartilage have an increased risk of OA.

    Other diseases that affect the joints
    Bone and joint diseases that increase the risk of OA include other arthritic conditions such as rheumatoid arthritis and gout.

    Genetics
    Genetic factors may predispose to the development of OA.


    Diagnosis

    The specialist will begin by taking a detailed history of your problem and past medical problems, followed by a physical examination. He may then proceed to other tests, such as:

    X-rays
    This is the most commonly performed test to evaluate the status of the affected joint and the alignment of the joint. Normal x-rays are safe, simple and pain-free.

    Blood tests
    Depending on the clinical findings, blood may be drawn for special testing, to rule out other causes of joint pain, e.g. due to rheumatoid arthritis, gout or infection.

    Joint aspiration
    Occasionally, especially when the joint is very swollen, the doctor may choose to suck some fluid out of the swollen joint for special testing. Removal of joint fluid also sometimes relieves pain.


    Treatment Options

    The goals for treatment for osteoarthritis are:

    i. Pain relief
    ii. Maintenance of function
    iii. Prevention of associated deformities
    iv. Patient education

    The treatment for OA depends on the severity of the disease and the patient’s own lifestyle expectations.

    Early cases of OA can generally be treated with:

    • Rest and lifestyle modification, such as weight loss and cessation of smoking
    • Use of aid (e.g. a walking stick). Use of good shoes is also helpful for relieving symptoms in some
      cases of OA
    • Exercise and physiotherapy to strengthen muscles and improve joint flexibility
    • Medication

    In OA of the hand, rest can be accomplished by selectively immobilising the joint in a splint. Splinting is initially done for a period of 3 - 4 weeks, during which the splint is worn continuously.

    This is usually combined with non-steroidal anti-inflammatory medication (NSAIDs) taken at the same time. If there is improvement in symptoms, use of the splint during the day is progressively diminished over the course of the coming month/s.

    Use of NSAIDS
    Gastrointestinal intolerance remains one of the major factors limiting the prolonged use of NSAIDs and may require temporary or permanent discontinuation of the anti-inflammatory agent. Concomitant use of H2 blockers, omeprazole, or misoprostol, a prostaglandin analogue that counteracts the mucosal effects of NSAIDs, may mitigate some of the gastrointestinal effects. Nephrotoxicity is a well-known complication of NSAIDs, and patients with pre-existing renal insufficiency should not take NSAIDs for extended periods.

    Types of medication
    There is presently no medication that can cure OA or regrow the cartilage in osteoarthritic joints.

    The most commonly prescribed medications are painkillers. The type of painkiller prescribed depends on
    the severity of the pain. For early disease with mild and occasional pain, simple painkillers such as paracetamol (Panadol®) can be effective, although more severe pain may require the use of non-steroidal anti-inflammatory drugs (NSAID’s) for relief. Analgesic (painkillers) creams and adhesive patches can also be used.

    Glucosamine, with or without chondroitin, has also become a popular drug treatment in recent
    years. It can be purchased without a doctor’s prescription.

    However, it is ineffective in many patients, especially those with severe OA. The duration of its symptomatic relief also tends to be temporary. There is no evidence that glucosamine or chondroitin is able to result in cartilage repair.

    Injections
    For the treatment of OA, your doctor may sometimes recommend a steroid injection into or around the joint if you have not responded to conservative treatment indicated above. While pain relief can be impressive, it is usually only temporary, and your doctor will limit the number of steroid injections that you can receive as repetitive injections can weaken tendons further worsening the already damaged cartilage.

    Surgery
    Surgery is usually only offered for severe disease that has not responded to conservative treatments mentioned. Both the type of surgery and the decision for surgery are made following careful discussions between you and your doctor.

    For many joints in the hands, arthodesis or fusion of the joint is the method of choice. In joint fusion, the arthritic surface is removed and bones on either side of the joint are fused to eliminate movement from the problem joint.

    There may be some loss of movement but the pain ablation and stability may functionally improve the joint that is severely affected by the degenerative joint disease.



    Need indepth information?

    Access our Conditions & Treatments sections for related topics on Knee Injuries and Arthroscopy - Minimally Invasive Knee Surgery. Read Medical Procedures for Treatment for Knee Pain - Knee Replacement Surgery.

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