Osteoarthritis Explanation
Osteoarthritis Explanation
Osteoarthritis Explanation
Osteoarthritis
Osteoarthritis causes pain and stiffness in joints. Symptoms may be helped by exercises, some physical devices and treatments, and losing weight if you are overweight. Paracetamol will often ease symptoms. Other medicines are sometimes advised. Joint replacement surgery is an option for severe cases.
What is osteoarthritis?
Arthritis means inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis in the UK. OA mainly affects the joint cartilage and the bone tissue next to the cartilage.
Understanding joints
A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is caused by muscles which pull on tendons that are attached to bone. Cartilage is a hard, smooth tissue that covers the end of bones. Between the cartilage of two bones which form a joint, there is a small amount of thick fluid called synovial fluid. This fluid lubricates the joint which allows smooth movement between the bones. The synovial fluid is made by the synovium. This is the tissue that surrounds the joint. The outer part of the synovium is called the capsule. This is tough and helps to give the joint stability. Surrounding ligaments and muscles also help to give support and stability to joints.
Age. OA becomes more common with increasing age. It may be that the state of the blood supply to
the joint and the state of the natural mechanisms of repair become less efficient in some people as they become older. Genetics. There may be some inherited tendency for OA to develop in some people. Obesity. Knee and hip OA are more likely to develop, or be more severe, in obese people. This is because there is an increased load on the joints and a potential for more joint damage. Your sex. Women are more likely to develop OA than men. Previous joint injury, damage or deformity. For example, this may include previous joint infection, a previous fracture (break in the bone) around a joint, or a previous ligament injury that caused a joint to become unstable.
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Occupational overuse of a joint . For example, OA of the knee may be more common in elite
athletes and elbow OA may be more common in people working with pneumatic drills.
Primary OA develops in previously healthy joints. Most cases develop in people over 50. By the age of
65, at least half of people have some OA in some joint(s). It is mild in many cases, but about 1 in 10 people over 65 have a major disability due to OA (mainly due to OA of one or both hips or knees). Secondary OA develops in joints previously abnormal for a variety of reasons. For example, it may develop in injured or deformed joints. This can occur in younger people.
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Weight control
If you are overweight, try to lose some weight as the extra burden placed on back, hips, and knees can make symptoms worse. Even a modest weight loss can make quite a difference.
Walking aids
If you have OA of your hip or knee, when walking try using a cane (walking stick). Hold it in the hand on the opposite side of the body to the affected joint. This takes some pressure off the affected joint and helps to ease symptoms in some cases.
Physiotherapy
Sometimes advice or treatment from a physiotherapist is helpful. For example: For advice on which exercises to do to strengthen the muscles above the knee (quadriceps) if you have OA of the knee. Strengthening the quadriceps has been shown to improve symptoms caused by OA of the knee. For advice on how to keep active and fit. For advice on shoes insoles, knee braces, taping to the knee, and how to use walking aids properly (to make sure you have one of the correct height).
Occupational therapy
Page 4 of 6 An occupational therapist may be able to help if you need aids or modifications to your home to cope with any disability caused by OA. Special devices, such as tap turners to help with turning on a tap, may mean that you can carry out tasks around the house more easily.
Other therapies
Some people have found that transcutaneous electrical nerve stimulator (TENS) machines help to ease pain from OA. A TENS machine delivers small electrical pulses to the body via electrodes placed on the skin. Some people get some pain relief from using hot or cold packs on the affected joint(s). This is also called thermotherapy. You can use a hot water bottle filled with either hot or cold water and apply it to the affected area. Or, special hot and cold packs that can either be cooled in the freezer, or heated in a microwave, are also available.
Anti-inflammatory painkillers
You may find that a topical preparation of an anti-inflammatory painkiller that you rub onto the skin over affected joints is helpful instead of, or in addition to, paracetamol tablets. This may be particularly helpful if you have knee or hand OA. Compared to anti-inflammatory tablets, the amount of the drug that gets into the bloodstream is much less with topical preparations, and there is less risk of side-effects (see below). Anti-inflammatory painkillers that are taken by mouth are not used as often as paracetamol. This is because there is a risk of serious side-effects, particularly in older people who take them regularly. However, one of these medicines is an option if paracetamol or topical anti-inflammatories do not help. Some people take an antiinflammatory painkiller for short spells, perhaps for a week or two when symptoms flare up. They then return to paracetamol or topical anti-inflammatories when symptoms are not too bad. There are many different brands of anti-inflammatory painkillers. If one does not suit, another may be fine. Side-effects may occur in some people who take anti-inflammatory painkillers: Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are over 65, or have had a duodenal or stomach ulcer, or if you are also taking low-dose aspirin. Stop the medicine and see a doctor urgently if you develop indigestion, upper abdominal pain, or if you vomit or pass blood. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers. Read the leaflet that comes with the medicine for a list of other possible side-effects.
Codeine
Codeine is sometimes used for added pain relief. Constipation is a common side-effect from codeine. To help prevent constipation, have lots to drink and eat a high fibre diet.
Capsaicin cream
This cream is made from chilli peppers and it works by blocking the nerve signals that send pain messages to the brain. It may be helpful if you have knee or hand OA. It takes a while for the effects of this cream to build up and may take around one month to get the maximum benefit. You should rub in a pea-sized amount of cream around the affected joint four times a day, and not more often than every four hours. Don't use this cream on broken or inflamed skin. You may notice some burning after you apply the cream but this tends to improve the longer you have used it. Avoid having a hot bath or shower, before, or after, applying the cream because it may make the burning sensation worse. Wash your hands after applying the cream. Because it is made from chilli peppers, it can cause burning if it gets into your eyes, mouth or around your genitals.
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Note: you should not take glucosamine if you are allergic to shellfish. Glucosamine may also interact with
warfarin. You should talk to your doctor or pharmacist before you take glucosamine if you are on warfarin treatment.
Hyaluronic acid
Regular injections of hyaluronic acid directly into a joint is a relatively new treatment that has been tried for OA. The theory is that it may help with lubrication and shock absorption in a damaged joint. It may produce a small beneficial effect in some people. However, NICE has looked at hyaluronic acid as a possible treatment for OA and does not recommend its use. This is because there is little evidence that it is effective and there may be a risk of problems after the treatment.
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Arthritis Care
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Original Author: Dr Tim Kenny Last Checked: 21/02/2012 Current Version: Dr Tim Kenny Document ID: 4304 Version: 42 Peer Reviewer: Dr Beverley Kenny EMIS
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