Patient Information Leaflet
Osteoarthritis / Osteoarthrosis (OA)
‘Osteoarthritis’ means ‘inflammation of the bones and joints’, but often inflammation is not the main problem so ‘osteoarthrosis’ which means ‘problem with the bones and joints’ is more accurate and more encompassing. However, loosely, the two terms are used interchangeably to mean a problem with the joints that is part of an overuse/misuse process and we will refer to it as ‘OA’ from here on.
OA can affect any joint but those most commonly affected are the knees, hips, lumbar and cervical spine and the small joints of the hands and feet.
Most people over the age of 40 will have some evidence of OA. This led to the traditional model of OA as ‘wear and tear’ related to ageing and degeneration. However, this model does not fit most people’s experience of OA as an episodic problem – flare-ups which get better over time rather than a continuous gradual deterioration.
Currently we view OA using the ‘flair and repair’ model- a slow repair process that results in a structurally altered but pain-free joint. The process is imperfect and probably becomes less effective with age. This may eventually lead to continuing tissue damage, loss of function and joint failure.
The main factors that predispose to OA are: Obesity and Injury (overuse / accidental / surgical)
OA is likely to be diagnosed in people over 45 presenting with joint pain of more than 3 months duration that is worse with use. X-Ray is generally not required to make the diagnosis because nearly everyone over 45 has X-Ray changes of OA and the degree of X-Ray change has almost no relationship to symptoms.
OA is managed most effectively by keeping the joint moving by doing aerobic exercise (walking, swimming, cycling) and by off-loading the joint by weight loss in people who are overweight or obese.
Perception of pain and tolerance of pain vary enormously from person to person for what objectively seems to be the same degree of OA. Some of this difference is psychological and some is behavioural. For example, if you believe that your OA experience will improve over time you will be psychologically better able to cope with your pain than if you believe that you will experience inexorable deterioration – the pain signal from the joint may be the same but the meaning it has to us is an individual experience open to individual interpretation. Similarly someone who is determined to get their joints moving despite discomfort in doing so will have more mobile and less painful joints (and is likely to live longer) than someone who decides their joint is too painful to move, resulting in stiffness and increasing pain.
Pain relief is usually recommended but has very variable effectiveness.
Paracetamol is generally recommended as first choice because it is thought to be safe - but clinical trials suggest that only 1:7 people actually benefit from this treatment.
Topical non-steroidal anti-inflammatory drugs (NSAID) (eg ibuprofen gel) are also safe and may be helpful particularly for the small joints of the hands and feet and for knees, and they have better evidence of effectiveness than paracetamol for treating these joints.
If the above treatments are ineffective paracetamol/codeine mixtures or oral NSAIDs (eg ibuprofen) may work and these can be taken in combination.
Steroid injection may be helpful for some people as may transcutaneous nerve stimulation (TENS).
There is some evidence that using a walking stick for OA of the knee is a more effective means of pain relief than any of the drug treatments listed above. The stick length should reach your wrist crease when you are standing straight and should be used on the side opposite the affected joint.
There is good evidencethat Glucosamine, Acupuncture and wedge shoe insoles are not effective treatments.Arthroscopic wash-out is only of benefit if there is a good history of the joint locking.
Joint replacement surgery is generally effective in the treatment of severe OA and should be considered if OA is having such an impact on your quality of life that you would be prepared to risk the possible adverse consequences of surgery – (these risks need to be assessed on an individual basiseg obese smokers have much higher anaesthetic and post-operative risks than non-smokers at ideal weight).
More information can be found at:
Dr CPM Lewis
08/12/2014