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What is it, and how can I manage it?

Osteoarthritis is the most common form of arthritis.  It is a long-term condition that causes the gradual breakdown of soft tissue in certain joints, such as knees, hips and fingers.

Symptoms include pain, stiffness, and swelling, while treatment will focus on reducing pain and disability through lifestyle changes (diet, exercise), physical and occupational therapies, medication, and (in some cases) surgery. 

About one in ten adult New Zealanders is affected by the condition. 

Causes

Cartilage is a firm rubbery substance that covers the end of bones and acts as a cushion or shock absorber between bone ends. Osteoarthritis causes the progressive breakdown and wearing away of the cartilage, leaving the bone ends unprotected. 

Osteoarthritis can occur at any time of life but the incidence increases with age.

Osteoarthritis usually occurs in the hands and weight-bearing joints such as hips, knees, feet, and spine. Osteoarthritis of the neck is called cervical spondylosis. Osteoarthritis does not usually affect the shoulder, wrist, elbow, or jaw unless as a result of unusual stress or injury.

Risk Factors

Age - The older people are, the greater the risk they are of experiencing osteoarthritis

Weight – extra body weight increases the stress on weight-bearing joints, such as the knees and hips, and fat tissue produces inflammatory substances that harm joints 

Gender – osteoarthritis is more common and more severe in women.

Heredity – osteoarthritis, particularly where it affects the hands and fingers, tends to run in families.

Joint injuries – sports or other accidental injuries can increase the risk of developing osteoarthritis later in life.

Signs and symptoms

Pain: the most common symptom of osteoarthritis. It is usually made worse by moving the joint or placing weight on it, and it is usually relieved by rest. As the condition progresses and inflammation develops, pain may become constant.

Stiffness: of the affected joint is often noticed first thing in the morning, and after resting.

Swelling:  someimes warm to touch, may be noticeable in an arthritic joint.

Deformity: can occur with osteoarthritis due to bone growths (bone spurs) and cartilage loss. Degeneration of knee cartilage can result in the outward curvature of knees (bow-leggedness).

Creaking and cracking: may be noticed when an arthritic joint is moved. This is caused by bone rubbing against bone or roughened cartilage. 

Loss of flexibility makes it more difficult to move an arthritic joint through its full range of motion. 

Diagnosis

Osteoarthritis is often able to be diagnosed by its characteristic symptoms of pain, decreased movement, and/or deformity.

Osteoarthritis may be confirmed with an x-ray or MRI scan. Blood tests may be used to exclude other possible conditions but they cannot diagnose osteoarthritis. 

Treatment

There is no cure for osteoarthritis but the progression of the disease can be slowed and pain and disability reduced. Treatment will depend on the nature and severity of the condition and treatment will be tailored to the individual. Treatment options include:

Exercise

Exercise can assist with weight loss and the maintenance of muscle strength and the mobility of arthritic joints. Activity at a level that does not cause pain is not thought to worsen osteoarthritis. Non-weight-bearing exercises such as swimming or aqua jogging in a heated pool may be beneficial, as may gentle forms of exercise or stretching such as yoga and tai chi.

Physiotherapy 

Physiotherapists can advise on appropriate exercises to improve mobility, increase muscle strength, and decrease pain with the aim of improving function and maintaining independence. Heat or ultrasound treatment may also be used to relieve pain and relax muscles. 

Medications 

Medications can play an important role in the management of pain caused by osteoarthritis. There are different classes of medications that have proven useful. These include simple pain relievers (eg: paracetamol), non-steroidal anti-inflammatory drugs (NSAID's: eg: ibuprofen) and oral corticosteroids (eg: prednisone). 

Supplements

Supplements such as glucosamine and chondroitin have been reported to relieve the pain of osteoarthritis in some clinical studies but not others. It is advisable to consult a medical practitioner before taking these supplements.

Surgery

When osteoarthritis has caused extensive joint damage and produces severe pain and restriction of movement, joint replacement surgery may be necessary. The most common procedures are hip joint replacement and knee joint replacement. 

Because an artificial joint does not last forever, joint replacement is often delayed in very young people to minimise the need for repeated replacements.