According to Arthritis Ireland about 915,000 people in Ireland live with arthritis.Osteoarthritis is the most common form of the condition.In 2009 over 4500 hip replacement operations and over 1700 knee replacement operations were carried out in Ireland.
Three key characteristics of osteoarthritis are:
- mild inflammation of the tissues in and around the joints
- damage to cartilage, the strong, smooth surface that lines the bones and allows joints to move easily and without friction
- bony growths that develop around the edge of the joints
Osteoarthritis mostly occurs in the knees, hips and small joints of the hands and base of the big toe. However, almost any joint can be affected.
Who develops osteoarthritis?
Osteoarthritis usually develops in people over 50 years of age and is more common in women than in men. It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true. While in very old people the changes of osteoarthritis are visible on X-rays, they don't always have related pain or problems with joint function.
Younger people can also be affected by osteoarthritis, often as a result of an injury or another joint condition.
The symptoms of osteoarthritis vary greatly from person to person, and between different affected joints.
The amount of damage to the joints and the severity of symptoms can also vary. For example, a joint may be severely damaged without causing symptoms, or symptoms may be severe without affecting the movement of a joint.
There is no cure for osteoarthritis, but the symptoms can be eased with a number of different treatments. Mild symptoms can often be managed with exercise or by wearing suitable footwear. However, in more advanced cases of osteoarthritis, other treatments may be necessary.
Treatments include non-drug treatments, including physiotherapy and weight loss, medications such as painkillers, and surgery.
- Joints are the connection point between two bones that allow movement.
- Physiotherapy is a treatment that uses movement, massage and exercise to relieve illness or injury.
The main symptoms of osteoarthritis are:
- pain, especially when doing load-bearing activities, such as walking
- short-lived stiffness in the morning, which improves in 30 minutes or less when you start to move
- difficulty moving your affected joints or doing certain activities
However, in some cases of osteoarthritis, you may not have any symptoms at all, as the pain can come in episodes. Often, you will only experience symptoms in one joint or a few joints at any one time. Your symptoms may also develop slowly.
Other features you or your doctor may notice include:
- joint tenderness
- increased pain and stiffness when you have not moved your joints for a while
- joints appearing slightly larger or more 'knobbly' than usual
- a grating or crackling sound or sensation in your joints
- limited range of movement in your joints
- weakness and muscle wasting (loss of muscle bulk)
You are most likely to develop osteoarthritis in the joints of your knees, hips or hands.
Symptoms of osteoarthritis in the knees
If you have osteoarthritis in your knees, it is likely that both your knees will be affected over time, unless it has occurred as the result of an injury or another condition affecting only one knee.
Your knees may be most painful when you walk, particularly when walking uphill or going up stairs. Sometimes, your knees may 'give way' beneath you or make it difficult to straighten your legs. You may also hear a soft, grating sound when you move the affected joint.
Symptoms of osteoarthritis in the hips
Osteoarthritis in your hips often causes difficulty moving your hip joints. You may find it difficult to put your shoes and socks on or to get in and out of a car.
If you have osteoarthritis in your hips, you will usually have pain in the groin or outside the hip, which is worse when you move the hip. However, sometimes your brain will identify pain in your knee and not in your hip, because of the 'wiring' that transmits the pain signals. In most cases, pain will be at its worst when you walk, although it can also affect you when you are resting. If you have bad pain at night, your doctor may refer you to an orthopaedic surgeon, in case a joint replacement operation is needed.
Symptoms of osteoarthritis in the hands
Osteoarthritis often affects three main areas of your hand: the base of your thumb, the joints closest to your fingertips and the middle joints of your fingers.
Your fingers may become stiff, painful and swollen and you may develop bumps on your finger joints. However, over time the pain in your fingers may decrease and eventually disappear altogether, although the bumps and swelling may remain.
Your fingers may bend sideways slightly at your affected joints or you may develop painful cysts (fluid-filled lumps) on the backs of your fingers.
In some cases, you may also develop a bump at the base of your thumb where it joins your wrist. This can be painful and you may find it difficult to perform some manual tasks, such as writing, opening jars or turning keys.
As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body will repair the damage itself. Usually, the repair process will pass unnoticed and you will not experience any symptoms.
Osteoarthritis occurs when there is damage in and around the joint which the body cannot repair. This can include ligaments or tendon problems, inflammation in the joint itself or within the bone and damage to the protective surface (cartilage) that allows your joints to move smoothly.
Your joints may become knobbly where your bones begin to protrude, forming bony lumps called osteophytes. As your bones thicken and broaden, your joints will become stiff, painful and difficult to move. There may also be a build-up of fluid in your joints because of the inflammation, which can cause them to swell up.
It is not known why the breakdown in the repair process that leads to osteoarthritis occurs. However, it is thought that several factors probably contribute to the development of osteoarthritis. These are outlined below.
Joint injury or disease
Osteoarthritis can develop in a joint that has been damaged by an injury or operation. Overusing your joint when it has not had enough time to heal after an injury or operation can also contribute to osteoarthritis in later life.
Sometimes, osteoarthritis can occur in joints that have been severely damaged by a previous or existing condition, such as rheumatoid arthritis. Rheumatoid arthritis is a form of arthritis that is caused by your body's immune system.
Osteoarthritis that develops due to damage or another condition is known as secondary osteoarthritis. It is possible for secondary osteoarthritis to develop many years after the initial damage to your joint.
In some cases, osteoarthritis may run in families. Genetic studies have not identified a single gene responsible for any of the areas affected, so it seems likely that many genes make small contributions. This means it is unlikely that a genetic test for osteoarthritis will become available in the near future.
Research into the causes of osteoarthritis has shown that being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips. As a result, osteoarthritis can often be worse in people who are obese.
See your GP if you think you may have osteoarthritis. There is no definitive test to diagnose the condition, so your GP will ask you about your symptoms and carry out an examination of your joints and muscles.
Your GP may suspect that you have osteoarthritis if you:
- are over 50 years of age
- have persistent joint pain, which gets worse the more you use your joints
- have no stiffness in your joints in the morning, or stiffness that lasts no longer than half an hour
If your symptoms are slightly different from those listed above, your GP may think you have another form of arthritis. For example, if you have joint stiffness in the morning that lasts for longer than an hour, you may have a more inflammatory form of arthritis.
Further tests, such as X-rays or blood tests, are not usually required to confirm a diagnosis of osteoarthritis. However, you may have further tests if your GP wants to rule out other possible causes of your symptoms, such as rheumatoid arthritis or a fractured bone.
Osteoarthritis can be managed by improving your general health. Your doctor may recommend ways you can help yourself, such as taking regular exercise and losing weight.
Exercise is the most important treatment for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.
If osteoarthritis causes you pain and stiffness, you may think that exercise will make your symptoms worse. But usually, regular exercise that keeps you active and mobile and builds up muscle, thereby strengthening the joints, will improve symptoms. Exercise is also good for relieving stress, losing weight and improving your posture, all of which will ease symptoms.
Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from your exercise programme and can give you an exercise plan to follow at home. It is important to follow this plan because there is a small risk that the wrong sort of exercise may damage your joints.
Being overweight or obese makes osteoarthritis worse. The extra weight puts more strain on damaged joints, which have a reduced ability to repair themselves. Joints in the lower limbs, which carry your weight, are under particular stress if you are overweight or obese.
If you are overweight, try to lose weight by doing more physical activity and eating a healthier diet. Discuss any new exercise plan with your GP or physiotherapist before you start. They can help plan a suitable exercise programme for you. Your GP and practice nurse can also advise you about how to lose weight slowly and safely.
Medicines for osteoarthritis
Your doctor will talk to you about medicines to help control the symptoms of osteoarthritis, including painkillers. Often a combination of therapies, including medicines, devices or surgery, may be needed.
The type of painkiller (analgesic) your GP may recommend for you will depend on the severity of your pain and any other conditions or health problems you have.
If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter (OTC) in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable.
However, when taking paracetamol, always follow the dosage that your GP recommends and do not exceed the maximum dose stated on the pack.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are painkillers which work by reducing inflammation. There are two types of NSAID and they work in slightly different ways. These are traditional NSAIDs (such as ibuprofen, naproxen or diclofenac) and COX-2 inhibitors, often called coxibs (such as celecoxib and etoricoxib).
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available over the counter (OTC) without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.
Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it. NSAID tablets may not be suitable for people with certain conditions, such as asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke. Do not take over-the-counter ibuprofen if you have had any of these conditions. If you are taking low-dose aspirin, ask your GP whether you should use an NSAID.
If your GP recommends or prescribes an NSAID to be taken by mouth, they will usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining. COX-2 drugs have a lower risk of causing stomach problems, but still need to be used with a PPI if you take them regularly.
Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but they can also cause side effects such as drowsiness, nausea and constipation.
Codeine is found in combination with paracetamol in common preparations such as co-codamol. Other opioids that may be prescribed for osteoarthritis include tramadol (brand names include Zamadol and Zydol), and dihydrocodeine (brand name DF 118 Forte). Both come in tablet form and as an injection. Tramadol is not suitable if you have epilepsy, and dihydrocodeine is not recommended for patients with chronic obstructive pulmonary disease (COPD). Pregnant women should not take any opioids.
If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to treat any constipation.
If you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.
Capsaicin cream works by blocking the nerves that send pain messages. You may have to use it for a while before it has an effect. You should experience some pain relief within the first two weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-sized amount of capsaicin cream to your affected joints four times a day, but not more often than every four hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. However, avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.
If your osteoarthritis is severe, treatment using painkillers may not be enough to control your pain. In this case, you may be able to have a type of treatment where medicine is injected into the parts of your body that are affected by osteoarthritis. This is known as intra-articular treatment and is injected inside your affected joints.
If you need to have intra-articular injections, it is likely that you will have injections of corticosteroid, a medicine that reduces swelling and pain. However, the National Institute for Health and Clinical Excellence (NICE) does not recommend intra-articular injections of hyaluronic acid for osteoarthritis.
If you get a prolonged response to the injection, it may be repeated. If you do not respond to the injection, or have a joint like the hip, which needs a guided injection, then your doctor can refer you for a guided injection.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) uses a machine that may help ease the pain caused by your osteoarthritis. It works by numbing the nerve endings in your spinal cord which control pain, so you can no longer feel it.
Treatment with TENS is usually arranged by a physiotherapist. Small electrical pads (electrodes) are applied to the skin over your affected joint. These deliver small pulses of electricity from the TENS machine. Your physiotherapist can advise on the strength of the pulses and how long your treatment lasts.
Hot or cold packs
Applying hot or cold packs (sometimes called thermotherapy or cryotherapy) to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain. Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.
Not using your joints can cause your muscles to waste and may worsen stiffness caused by osteoarthritis. Manual therapy is a treatment provided by a physiotherapist. It uses stretching techniques to keep your joints supple and flexible.
If your osteoarthritis causes mobility problems or if performing everyday tasks is difficult, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes. Footwear with shock-absorbing soles can help relieve some of the pressure on the joints of your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.
If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.
A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks far more manageable. Your occupational therapist can give you help and advice about using these devices in your home or workplace.
Surgery for osteoarthritis is only needed in a small number of cases. It can sometimes be helpful for osteoarthritis that affects your hips, knees or joints, particularly those at the base of your thumb. Your GP may suggest surgery if other treatments have not been effective, or if one of your joints is severely damaged.
If you may need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon.
Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life. However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness due to your condition.
There are several different types of surgery for osteoarthritis. You may have surgery to smooth the surfaces of your joints or restore cartilage (arthroscopy). Or you may have surgery to replace your whole joint, the weight-bearing surface (resurfacing), or to fuse it into position.
Joint replacement therapy, also known as an arthroplasty, is most commonly carried out to replace hip and knee joints.
During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years. However, it may eventually need to be replaced.
There is also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.
If joint replacement is not suitable for you, your surgeon may suggest an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.
If you have osteoarthritis in your knees but you are too young for knee replacement surgery (arthroplasty), you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.
This helps realign your knee so that your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
Complementary and alternative therapies
Many people with osteoarthritis try complementary and alternative therapies. There is evidence that some of these may help symptoms, but experts disagree whether they slow down progress of the disease.
Acupuncture, aromatherapy and massage are some commonly used complementary therapies for osteoarthritis. Some people may find that they help, although they can be expensive and time consuming.
A number of nutritional supplements are available for treating osteoarthritis. Two of the most common supplements for osteoarthritis are chondroitin and glucosamine.
Glucosamine hydrochloride has not been shown to have any beneficial effects, but there is some evidence that glucosamine sulphate and chondroitin sulphate help symptoms and do not cause many side effects. These supplements can be expensive. The National Institute for Health and Clinical Excellence (NICE) has recommended that chondroitin or glucosamine should not be prescribed, but patients often choose to take them as over the counter preparations.
Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. Several rubefacients can be used to treat joint pain caused by osteoarthritis.
Research has shown that rubefacients have little or no effect in treating osteoarthritis, so their use cannot be recommended
It is not possible to prevent osteoarthritis altogether. However, you may be able to minimise your risk of developing it by following the advice below.
Look after your joints
Do some regular exercise, but try not to put excessive stress on your joints, particularly your hips, knees and the joints in your hands.
Avoid exercise that puts strain on your joints and forces them to bear an excessive load, such as running and weight training. Instead, do exercises such as swimming and cycling, where your joints are better supported and the load is more controlled.
Try to maintain good posture at all times, and avoid staying in the same position for too long. If you work at a desk, make sure that your chair is at the correct height, and take regular breaks to move around.
Keep your muscles strong
Your muscles help support your joints, so having strong muscles will help your joints stay strong too. Try to exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week to build up your muscle strength. Exercise should be fun, so do what you enjoy, but try not to do overload the joints.
Lose weight if you are overweight or obese
Being overweight or obese can make your osteoarthritis worse.
If you have osteoarthritis, you may sometimes find it difficult to move around. This can increase the risk of accidents and injuries such as trips and falls.
Osteoarthritis of the feet most commonly affects the base of the big toe. It can cause pain when you walk and lead to a bunion (a bony outgrowth) at the affected joint. The type of shoes you wear can influence this, so avoid shoes with a raised heel. A leg brace may ease the symptoms.
If you have had joint replacement surgery (arthroplasty), your replacement joint could become infected. This is a severe complication and requires emergency treatment in hospital.
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Talk to others
Many people find it helpful to talk to other people who are in a similar position to them. You may find support from a group or by talking individually to someone who has osteoarthrits.
Understanding your feelings
A diagnosis of osteoarthritis can be initially confusing and overwhelming. Like many people with a long-term health condition, those who find out they have osteoarthritis may feel anxious or depressed. But there are people you can talk to who can help. Talk to your GP if you feel you need support to cope with your illness.
Work and money
If you have more severe osteoarthritis and are still working, your symptoms may interfere with your working life and may affect your ability to do your job. Arthritis Ireland www.arthritisireland.ie has useful advice on how you can make simple adjustments at work to make it easier to do your job.