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Osteoarthritis

What is it?

Osteoarthritis is the most common form of arthritis that can affect any joint in the body. However, it is more likely to affect our weight-bearing joints, such as the hips and knees. It is one of the leading causes of pain and disability. It presents as joint pain and stiffness (and sometimes swelling), with varying degrees of functional limitation, that can negatively affect someone’s quality of life.

Osteoarthritis is a normal age-related change that happens to our joints, just like getting grey hairs and wrinkles on the outside of our body!

If you want information about how to manage pain for a specific joint, you may find useful information in our other sections, including: Knee, Hip, Ankle/Foot, Wrist/Hand, Neck, Low Back.

Osteoarthritis is usually thought of as an age-related process.

Within a joint, you have a tough slippery tissue called cartilage that covers the surface of the bones. This cartilage is there to protect the bones, help the bones to move against each other freely and to cushion the joint. Over the years, the cartilage gets thinner and the surface becomes less smooth. This can cause the joint to feel stiff, and you may notice creaking sounds when moving.

When the cartilage becomes worn, the body tries to repair the tissue, which causes all of the tissues in the local area to become more ‘active’. Despite changes to the joint, this repair process usually allows the joint to function normally without pain. This means that despite us all developing osteoarthritic changes in our joints as we get older, it does not mean that every joint will be painful or stiff.

Unfortunately, this repair process does not always work well, which means structural changes to the joint can end up causing pain, stiffness and/or swelling. Examples of changes that can happen to a joint:

·               Extra bony spurs develop at the edge of a joint (called osteophytes). These can restrict movement or rub against other soft tissue structures.

·               The soft tissue structure that lines the joint (call synovium) can become thicker and produce more joint fluid (synovial fluid), causing the joint to swell or appear larger.

·               Soft tissue structures that support the joint may become weaker.

 

The risk of developing osteoarthritic symptoms can be down to many different factors, including:

 

·               Age – symptoms of osteoarthritis can develop any time after the late 40s. This is because the body becomes less good at repairing itself the older it is.

·               Gender – osteoarthritis is more common in women. Women also tend to develop more severe symptoms.

·               Obesity – being overweight can put extra pressure through your weight bearing joints, such as your hips and knees. However, being overweight also raises the levels of inflammation in the body, which can make osteoarthritis worse in any joint.

·               Injury or operations – any trauma to a joint, through injury or surgery, can increase the chance of developing osteoarthritis in a joint.

·               Joint abnormalities – some people are born with joint abnormalities (eg perthe’s disease in the hip), which can lead to earlier and more severe osteoarthritis occurring within a joint.

·               Genetics – some people are more likely to develop symptoms of osteoarthritis purely because of the genes they have inherited, which could affect structures like collagen that support a joint.

·               Other disease – Other joint diseases can result in more severe osteoarthritic changes or symptoms, these could include rheumatoid arthritis or gout. Other diseases such as diabetes can also contribute to more severe osteoarthritic symptoms.

·               Weather – although this doesn’t contribute to any structural joint changes, many people say that their osteoarthritis feels worse when the atmospheric pressure drops – for example, during cold, damp or rainy weather.

·               Diet – again diet does not cause any structural change within a joint, but some people find that certain food groups can either make their symptoms feel better or worse.

·               There is a genetic component to some types of arthritis, however we think this is only a small part of the picture. We think that lifestyle plays a much bigger part in symptoms and progression than anything else. This includes exercise, diet, weight, smoking and many other factors.

·               Osteoarthritis is not always due to ‘wear and tear’ or overuse. This is demonstrated in a study on marathon runners that found that they were not more likely to develop knee osteoarthritis compared to anyone else. In fact, they were thought to be less likely to need joint replacement surgery because they have preserved their mobility and strength, whilst maintaining a healthy lifestyle.

 

For more information:

 https://journals.sagepub.com/doi/abs/10.1177/0363546516657531

·               If you have osteoarthritis, is it very important to keep moving. If you stop moving this can make things worse, as inactivity can lead to the body becoming weak and stiff and then it is hard for the body to function.

·               Lots of people who have osteoarthritis will never have a joint replacement. Their symptoms may not bad enough or they may be able to manage their symptoms well. Joint replacement is only one option in managing arthritis and isn’t right for everyone. Most people will manage their symptoms with medication and lifestyle changes.

·               The current national guidelines for managing osteoarthritis place a strong emphasis on: maintaining activity, keeping a healthy weight and using the appropriate pain medications. Walking aids can also be considered.

·               These guidelines also state that people with osteoarthritis should NOT be offered acupuncture or electrotherapy, insoles or braces/splints, or injections:

https://www.nice.org.uk/guidance/ng226/chapter/Recommendations

·               X-rays and scans are NOT needed to diagnosis osteoarthritis and rarely change the management of the condition.

It is not uncommon for people to experience a flare up of osteoarthritis, which can result in increased joint pain, stiffness or swelling. Most often this will settle down, but can take up to 3 months to do so. It would be very normal to have ‘good’ and ‘bad’ periods over the weeks as the joint settles down over this time.

For most people, osteoarthritis does not continue to worsen over time. Sometimes the symptoms reach a ‘peak’ a few years after onset, and then remain the same or may even improve over the following years. Others may experience on and off flares of pain over the years.

Common symptoms of osteoarthritis are:

-          Joint pain that is often worse with specific movements, or towards the end of the day after you have been using the joint a lot.

-          Joint stiffness, which is usually worse first thing in the morning, or after a period of prolonged rest. This stiffness usually improves within 30 minutes of movement.

-          When moving a joint you may hear creaking or cracking noises (this is called crepitus).

-          The joint may start stiffening up and may not be able to move as far as before.

-          Difficulty with functional activities including:

·                        Hip – putting shoes and socks on, getting in/out of a car

·                        Knee/ankle – walking, stair climbing

·                        Shoulder – reaching up or out to objects

·                        Hands – gripping items or dexterous activities

·                        Disturbed sleep.

In line with national guidelines: (https://www.nice.org.uk/guidance/ng226/chapter/Recommendations), osteoarthritis should be diagnosed clinically WITHOUT imaging. This means that a healthcare professional should be able to accurately diagnose osteoarthritis by asking you some questions about your pain and doing some tests to the joint in clinic.

Everyone above the age of about 30 will have some age-related changes in their joints that can be seen on imaging. These changes do NOT mean that the joint is painful or not functioning well.

Also, imaging is rarely useful, as there is a poor link between osteoarthritic changes visible on an x-ray and the symptoms felt; minimal changes can be associated with a lot of pain, or modest structural changes to joints can occur with minimal accompanying symptoms.

This means that an x-ray result will likely not influence your treatment, and your management plan will be based instead around your pain, level of function and what you have tried so far.

Movement and activity

-           When you first start noticing a flare of pain, it may help to reduce your activity for a short amount of time to allow the pain to settle.

-            However, there is a lot of strong evidence that says by keeping moving and slowly returning to your normal levels of activity will actually help the flare to settle quicker.

-           Complete rest for too long has been found to be bad for the body and lead other issues in the future.

-          Activity and exercise can help management by keeping the joint moving, the muscles strong and the blood flowing around your body.

-           Evidence says there is not one exercise that is better than another, so the best thing to do is movement and activity that you most enjoy!

 

Work

-            If you are still working, try to stay at work if you are able to. This will help you to keep moving, but it can also help with money, socialising and keeping a routine.

-            You may want to talk to your work about changing how you do your job for a period of time. This can be guided by a health care professional if needed.

-            What to do if you are off work due to your symptoms:

·         If you are off for less than 7 days, you can self-certify.

·         If it has been over 7 days, you may need a fit note

·         https://www.nhs.uk/common-health-questions/caring-carers-and-long-term-conditions/when-do-i-need-a-fit-note/

 

Pain management

The following can help you to reduce the pain, which will help you to keep moving and manage the symptoms more effectively:

-            Put hot or cold on the area of pain. A heat pack (e.g a hot water bottle or a wheat bag) can be used for up to 20 minutes, or an ice pack can be used for up to 10 minutes. This can be done on a regular basis each day. *It is important to put hot/cold over clothing or some towel to make sure that you do not burn your skin.*

-            Take simple pain relief medication for a few days. It is sensible to talk to a local pharmacist about what medication is best for you. Always read the packet instructions and leaflet when you take over the counter medications. If you need more long-term pain relief medication, this is best discussed with your GP.

-            Walking aids: a stick or crutches can be useful to keep you moving in a normal way, with less weight going through the painful area.

-            Get a good night sleep (over 8 hours) – sleep is very important for recovery and less than eight hours sleep has been shown to slow recovery. Using pillows under or between the knees can make you more comfortable at night.

-            Having a healthy lifestyle – e.g. managing stress levels, eating healthy, drinking water, reducing your body weight, lowering alcohol and/or cigarettes intake.

 

In Suffolk, it is the responsibility of the NHS Physiotherapy team to manage all patients with osteoarthritis symptoms. This includes diagnosis, trialling different management strategies and progressing care if needed, including referring to a surgeon when considering joint replacement surgery.

In Suffolk you can self-refer to physiotherapy without speaking to your GP or any other healthcare professional. To self-refer to physiotherapy please visit: URefer