Osteoarthritis - Causes, Symptoms, Treatment and Prevention

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. It is a degenerative joint disease that occurs over time as joint cartilage undergoes wear and tear.

The cartilage in our joints allows for the smooth movement of the joints. When it becomes damaged due to injury, infection or the gradual effects of ageing, the movement of the joint is hindered. As a result, the tissues within the joint become irritated causing pain and swelling within the joint.

Osteoarthritis is characterised by joint swelling and inflammation, loss of joint cartilage and narrowing of joint spaces, which may result in pain and stiffness over joints, as well as loss of finger movements. Bone spurs may also develop within the joint, resulting in pain over the finger joints upon movement and causing difficulties in the management of daily tasks.

With osteoarthritis, you will have no problem on arising in the morning, 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: Discomfort that increases throughout the day.

Swelling of the affected joints: Inflammation and enlargement of the joint area.

Changes in the surrounding joints: Structural alterations in nearby 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 osteoarthritis 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.

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

Gender: Women are more likely to suffer from osteoarthritis, 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 osteoarthritis 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 osteoarthritis in these joints.

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

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

Genetics: Genetic factors may predispose a person to the development of osteoarthritis.

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.

The goals of treatment for osteoarthritis are:

• Pain relief
• Maintenance of function
• Prevention of associated deformities
• Patient education

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

Treatment approaches vary depending on pain level:

For Severe Pain:

• Cold compress (5 minutes) if there is warmth and swelling
• Rest and avoid forceful exertion of the hand
• Gentle active finger exercises to maintain finger movements
• Incorporate joint protection principles into daily activities

For No or Slight Pain:

• Heat therapy (hot pack/warm towel)
• Active finger exercises to maintain finger movements
• Incorporate joint protection principles into daily activities

Early Treatment Options

Early cases of osteoarthritis can generally be treated with:

Rest and lifestyle modification: Such as weight loss and cessation of smoking.

Use of aids: Use of aids (e.g. a walking stick). Use of good shoes is also helpful for relieving symptoms in some cases of osteoarthritis.

Exercise and physiotherapy: To strengthen muscles and improve joint flexibility.

Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) and other pain relief medications.

Splinting for Hand Osteoarthritis

In osteoarthritis 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 an improvement in symptoms, use of the splint during the day is progressively diminished over the course of the coming months.

Use of NSAIDs to Treat Osteoarthritis

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.

Why Is Joint Protection Important?

Joint protection is important because it:

• Reduces load and stress on affected joints, thereby relieving pain and inflammation
• Can help to improve or maintain function of affected joints, as well as prevent the development or progression of joint deformities
• Involves changing how you perform your daily activities or modifying your environment to make the tasks easier on the affected hand joints

Joint Protection Principles

Learn to respect your pain: Adjust or modify activities according to your pain levels.

Use larger upper limb joints when carrying loads: For example, using shoulder or elbow joints to carry bags instead of using the fingers.

Distribute the load over several joints: Spread the weight across multiple joints rather than concentrating it on one.

Use assistive devices: If possible, when performing strenuous activities in the day (e.g. using a jar or bottle opener to open jars or bottles).

Avoid gripping objects too tightly: Maintain a relaxed grip to reduce joint stress.

Avoid staying in one position for too long: Change postures frequently.

Avoid poor body postures, positioning and poor handling techniques: Maintain proper ergonomics.

Balance rest with exercise: Allow adequate recovery time between activities.

Move your joints regularly: To maintain joint movements and flexibility.

In general, using good joint protection techniques will minimise excessive stress on your joints.