What is Osteoarthritis (OA)?
Do you know what osteoarthritis(OA) is?
This medical term is derived from:
Osteo = Bone; Arthritis = Inflammation in the Joint
It is one of the most commonly diagnosed arthritis. It can be called degenerative joint disease or “wear and tear” arthritis. Hands, hips and knees are usually affected. It is a myth that Arthritis is an old age problem. It is not a normal ageing process. In fact, arthritis is a chronic degenerative disorder involving cartilage damage.
The risk of getting this disorder is increased in older age groups, but don’t think you are not at risk. You will be shocked to know that Arthritis has been diagnosed in the younger generation as well.
One in four adults will develop symptoms of hip OA by age 85
One in two adults will develop symptoms of knee OA during their lives
One in 12 people 60 or older have been diagnosed with OA
More than 80 percent of people over age 55 show indications of OA on an X-ray
How does it happen?
Osteoarthritis occurs when the cartilage (i.e. a protective Cushion at ends of bones) breaks down over a period of time. When the cushioning is damaged, there is no protection from friction. Even slight movement of the joint will lead to rubbing of the ends of bones together. The underlying bone begins to change its form. Certain chemical called cytokines get released. They cause inflammation, pain, stiffness and swelling. These develop slowly and worsen over time. Functioning of the joint reduces along with disability. The effects are so intense that some patients cannot even perform their day to day tasks.
- Affected joints might hurt during or after movement.
- Joint stiffness maybe most noticeable in the morning or when inactive.
- Applying light pressure causes the joint to feel tender.
- Loss of flexibility: Unable to move your joint through its full range of motion.
- Grating sensation: You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
- Bone spurs: Extra bits of bone, feeling like hard lumps, form around the affected joint.
- Soft tissue inflammation around the joint causes local inflammation.
Mostly arthritis of the hands is inherited in the families. You are at greater than average risk of having arthritis if your mother or grandmother has arthritis in their hands. Arthritis in hands is more common in women than in men. In most women, it has developed after menopause.
When arthritis occurs in the hands, small, bony knobs might appear at the end joints (those closest to the nails) of the fingers. These are known as the Heberden’s nodes. Similar knobs, termed as Bouchard’s nodes, may appear on the middle joints of the fingers. In this condition fingers can become enlarged and gnarled, causing pain or be stiff and numb. Also the base of the thumb joint is commonly affected by arthritis.
Knees are the most commonly affected joints by osteoarthritis. Stiffness, swelling, and pain, which makes it hard to walk, climb, and get in and out of chairs and bathtubs are the common symptoms of knee osteoarthritis . Osteoarthritis in the knees might lead to disability.
Hips are also amongst the common sites of osteoarthritis. The symptoms of hip osteoarthritis also include pain and stiffness of the joint itself as with knee osteoarthritis. Although sometimes pain is felt in the groin, inner thigh, buttocks, or even the knees. Hip OA may limit moving and bending which may make daily activities such as dressing or putting on shoes a challenge.
Pain and stiffness in the neck and lower back appears in Osteoarthritis of the spine. Sometimes these arthritis related changes in the spine build pressure on the nerves where they exit from the spinal column, leading to tingling or numbness and weakness of the arms and legs . OA in spine, can even affect bladder and bowel function in severe cases.
Factors that increase your risk of osteoarthritis include:
Old age: As the age increases the risk of having OA increases. It is commonly observed in the old age population.
Risk increases with older age. Old age females are at higher risk compared to males.
Weight: Joints like hips and knees experience stress due to increased weight, so if you are overweight you are at higher risk of developing OA. Fat tissue have the tendency to produce proteins which may lead to inflammation in and around your joints.
Joint injuries: You can develop injuries from various sources like while playing sports or from an accident etc. These injuries might increase the risk of osteoarthritis.The injuries occurred few years ago that seems to have healed can also increase your risk of osteoarthritis.
Repeated stress on the joint: The joint that experiences stress repetitively and regularly is at higher risk of developing OA.
Genetics: Sometimes it is hereditary. Some people inherit a tendency to develop osteoarthritis.
Bone deformities: Some people are born with malformed joints or defective cartilage.
Certain metabolic diseases: People suffering from metabolic disorders like diabetes and hemochromatosis are at greater risk.
OA gradually worsens with time, leading to chronic pain. There is difficulty in performing daily tasks due to severe stiffness and pain in the joint. Pain and disabilities develop depression and disturbance in sleep.
How is OA Diagnosed?
The Orthopaedical physician or Rheumatologist diagnose OA based on the symptoms, physical examination, X-rays and lab tests.
The doctor may recommend you to get pictures of the affected joint.
- X-rays: Cartilage is not seen in the X-ray images, but its loss is identified by the narrowing of the space between the bones in your joint. An X-ray also reveals the bone spurs around the joints
- Magnetic resonance imaging (MRI): MRI is used to develop a detailed image of bones and soft tissues, including cartilage. Generally MRI is not used for the diagnosis of OA, it is used in severe cases of OA to identify its complexity
Analysis of your blood or joint fluid will help to confirm the diagnosis.
- Blood tests: There is no blood test for osteoarthritis, but certain tests help in identifying other causes of joint pain, e.g. Rheumatoid arthritis test
- Joint fluid analysis: In this test doctor withdraws the fluid from your affected joint using a needle. Various tests are conducted from this fluid to determine the cause of your pain, i.e. whether the pain is due to gout or inflammation or infection rather than OA
Your doctor might use a needle to draw fluid from an affected joint. The fluid is then tested for inflammation and to determine whether your pain is caused by gout or an infection rather than osteoarthritis.
Benefits of Exercise in OA
Regular physical activity can:
• Make you feel better by release of chemicals in your brain that reduce pain and boost your mood, such as, serotonin
• Help you sleep better and give you more energy
• Loosen stiff joints and help keep them moving
• Strengthen and stretch muscles that help support and move your joints
• Improve overall fitness
• Make your heart and lungs stronger
• Help you get to and stay at a healthy weight
The Role of Physical Activity
One of the most beneficial things one can do to manage OA is to simply move.It may sound counterintuitive, especially when your body hurts, but moving is truly the best medicine for pain.
Unlike many diseases, exercise is considered as an option of treatment for OA – perhaps the most effective one. The American College of Rheumatology recommends exercise – particularly aquatic exercise – in its guidelines for treating knee and hip OA.
In fact, research shows that exercise may actually affect the course of OA. In a review of 28 studies of knee OA, exercise was found to be associated with an increased amount of cartilage within knee joints and fewer cartilage defects. Another study discovered a surge of anti-inflammatory activity within the knee joints of women with knee OA immediately after performing intense thigh strenghtening excercises.
You should, of course, discuss starting an exercise program with your health care team. They can advise you on how to manage limitations and help create an easy-to-follow plan.
Try to incorporate the following three types of regular physical activity into your routine:
Stretching. Slow, gentle stretches, such as those that comprise yoga and tai chi, can help prevent joint stiffness and make it easier to get moving. These forms of exercise can improve flexibility, increase muscle strength and help you relax.
Aerobic activity. Engaging in regular physical activity is an important part of controlling OA symptoms. Aerobic exercise – any activity that gets your heart rate going – will strengthen your heart and lungs. Water exercises, walking and riding a stationary bicycle are less stressful on your joints than other aerobic activities.
Strengthening exercises. Activities that maintain and/or build strength and endurance in the muscles around affected joints are equally important. When muscles around a joint weaken,the joint loses its ability to function properly. The Arthritis Foundation offers land-based and waterbased exercise classes. For more information,contact your local office.
Flexibility and balance exercises. To help prevent falls, try to do gentle stretches or flexibility exercises every day. When doing muscle-strengthening exercises, you could mix in a few stretches; always stretch muscles while they are warm to reduce injury. Finally, add in exercises that help in increasing balance to help reduce the risk of falls.
How Much Activity Is Right for You?
- Two and a half hours (150 minutes) a week of moderate-intensity aerobic physical activity
- One hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity
- An equivalent combination of moderate and vigorous-intensity aerobic physical activity
- Aerobic activity should be performed in intervals of at least 10 minutes, preferably spread throughout the week
- Muscle-strengthening activities that involve all major muscle groups two or more days per week
Nutrition and Weight Loss
Another key tactic to managing OA is staying at your recommended healthy weight or losing weight if you are overweight or obese.
- Preventing knee OA if not already diagnosed with.
- Easing pain by reducing stress on the weight bearing joints (hips, knees, back and feet)
- Enhancing overall feeling of well-being.
Unfortunately, there is no magic formula to help you lose weight. The basic rule for weight loss is eating in a calorie deficit and increasing physical activity. Your health care team can help you develop a safe, simple weight-loss program.
There is no “OA diet,” either, but in general you should eat a balanced diet which, according to the Food and Drug Administration, should be centered on plant-based foods. Approximately two-thirds of your diet should come from fruits, vegetables and whole grains. The other third should include fat-free or low-fat dairy products and lean sources of protein
Assistive devices are often used by people whose pain or instability limits physical activity, who are not eligible for surgery, who do not wish to undergo surgery or to delay it. These tools can help to decrease pain and improve ability to move.
The tools may include supports, braces, splints and shoe orthotics as well as canes and walkers, which help support joints and/or provide rest to the joint while you go about your everyday activities.
Physical and Occupational Therapy
You may find that OA limits certain activities, such as walking, bathing, dressing, climbing stairs and doing household chores. Physical and occupational therapists can help improve your ability to perform these activities and help you manage OA by designing a program that may include:
- Improving your joint range-of-motion muscle strength and endurance
- Providing and fitting assistive devices to make daily activities easier
- Showing you how to use heat therapy and cold therapy – applying simple heat packs or cold packs to relieve pain
- Education regarding principles of proper joint use and energy conservation
The Four-Pound Rule
Research has shown that every excess pound places an extra four pounds of pressure on your knees, so losing even a few pounds can make a significant difference in prevention of OA.
Controlling pain is the hardest part of managing OA.
Pain creates a vicious circle of inactivity, which leads to greater pain, and thus greater inactivity.
However, studies show most people note improvement in their OA symptoms with physical activity, physical therapy or occupational
therapy, or the other techniques just discussed.
Medication can also help you control pain enough to start an exercise program.
Your doctor will work with you to decide what’s best for you.
Non-Opioid and Opioid Analgesics
Analgesics are medications used for pain relief. Acetaminophen (Tylenol) is a non-opioid (or non-narcotic) analgesic often used for pain relief. It doesn’t reduce the inflammation or swelling sometimes associated with OA, but it is helpful when pain is the main problem and can be safer than other medications used to treat OA.
While the number of potential side effects due to acetaminophen are small, there is a risk of liver damage or failure when taking high doses. Do not take more than 4,000(mg) total per day
Nonsteroidal anti-inflammatory drugs, or NSAIDs, help reduce joint pain, stiffness and swelling. Aspirin,ibuprofen and naproxen sodium are examples of NSAIDs that are available over the counter. Oral and topical prescription NSAIDs are also available to treat OA. Oral NSAIDs can cause side effects such as pain or bleeding in the stomach. If you experience these side effects, or have an increased risk for a stomach ulcer or bleeding, your doctor may prescribe other medications that may help reduce the risk of these problems.
Glucosamine and chondroitin sulfate are nutritional supplements derived from cartilage, are believed to offer relief from OA pain by many people.
Topical Pain Relievers
Topical pain relievers are available as creams, gels, patches, rubs, drops or sprays that are applied on the skin over a painful joint. They may contain combinations of salicylates, skin irritants and local anesthetics to relieve pain.
Joint injections are often used by people with OA. Often, injections straight into the joint can help with symptoms without some of the side effects that other treatments may have.
Non-Medicinal Pain Relief
In addition to staying active and losing weight, you can fight OA pain with some tried-and-tested remedies, including:
Hot and cold treatments: Usually applied directly to the pain site, heat may be more useful for chronic pain; cold packs may provide relief from acute pain. Bags of frozen vegetables, such as peas, make excellent, easily moldable cold packs.
Relaxation techniques: Techniques such as deep breathing, guided meditations and visualization, help in relaxing the mind and reducing stress.
Massage. Research shows massages can help ease arthritis pain, improve joint function and ease stress and anxiety.
Acupuncture: Acupuncture, the practice of inserting fine needles into the body along special points called “meridians,” has been shown to relieve and control pain.
Positive attitude: Many studies have demonstrated that a positive outlook can bolster the immune system and increase the ability to handle pain.