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Discover the Progression of Osteoarthritis Treatment

20th February 2018

Osteoarthritis is one of the biggest causes of pain and misery in adults worldwide, affecting millions of mainly older people across the globe and costing governments and health providers billions of pounds.

Overall, the condition - which is often abbreviated to OA - is estimated to affect more than 630 million people globally. More women than men are affected, and it is more likely to be seen in people over the age of 60 (though conditions can begin to materialise from 40 onwards).

In the UK, around eight million adults have OA - nearly five million of whom have arthritis of the knee.

What do the history books tell us?

The word osteoarthritis was first used in the late 19th century, when modern medicine was beginning to be developed as a more advanced science; however, we know that the various forms of arthritis have been around for much, much longer.

Evidence from literature, historical accounts, visual representations in books and paintings, analysis of skeletal remains of various ages and new understandings of the causes of arthritis mean we know that people have been suffering from the condition for as long as humans have been around.

What are the causes?

Unlike rheumatoid arthritis (RA), which is an autoimmune illness, osteoarthritis is primarily caused by wear and tear of the joints, which is why it is more commonly found in populations with longer life spans. The older you are, the more likely you are to develop OA; indeed, a large percentage of elderly people have at least some indication of OA.

OA happens when the everyday use of the joint leads to its protective cartilage, which is found at the end of the bones, breaking down. This can result in the development of bony growths, which cause the joints to swell and trigger pain and lack of movement.

We still do not know exactly what brings OA on - apart from wear and tear - but certain things can make it more likely to strike. These include injury and overuse of the joint, being overweight - which puts extra strain on the joints - and genetic factors. Unfortunately, if members of your close family suffer from OA, you are more likely to develop it yourself.

Most common in the knees, hips and hands, OA causes redness, stiffness and pain in the joints, resulting in reduced movement. Symptoms can be mild, but in the most serious instances will result in difficulty undertaking everyday tasks. OA pain and stiffness is usually worse upon waking or after exercise.

How is it diagnosed?

Doctors usually diagnose OA through examining the joints and questioning the patient on their symptoms and family history. There is no need for specific tests, although your doctor may ask you to go for an x-ray or blood tests if he or she suspects there may be another explanation for the symptoms, such as a fracture or rheumatoid arthritis.

Non-surgical treatment options

There is no cure for osteoarthritis; therefore, most treatments focus on easing the symptoms. Pain relief is one of the main treatments on offer, although most medical practitioners will also encourage their patients to take a range of steps to prevent the condition worsening.

These steps include a range of exercises designed to increase strength and flexibility, such as resistance exercise, walking, tai chi and swimming, and weight management to reduce any added strain on the joints.

Some sufferers of OA in the knee will benefit from corticosteroid injections in the joint. Cortisone is a type of steroid - a drug that lowers inflammation - and is used to reduce swelling in the joint and therefore lessen the pain.

Other modern biomechanical interventions include the use of special shoe inserts or wearing a specially-designed knee brace.

Knee braces can help to reduce pain by shifting the weight away from the most damaged portion of the joint. This often improves a patient’s ability to get around and increases the distance they can comfortably walk without experiencing pain.

Modern knee braces come in a range of designs, although most are made from a combination of flexible and rigid materials, such as metal or plastic to provide support combined with rubber or foam to provide padding and comfort.

When is surgery offered / suggested?

The worst cases of OA - those that are creating considerable pain or restricting a patient’s everyday activities more than is acceptable - could be referred for surgery.

Today, hip and knee replacements are common and highly successful operations that improve the lives of thousands of people every year, who find their mobility vastly improved by the procedure.

The first knee replacement was performed way back in 1968. Early artificial knees were made like hinges; therefore, they would not allow the knee to move in a natural way. Perhaps unsurprisingly, many artificial knees failed soon after surgery; as a result, surgeons tended to only perform them in older patients, where a second operation would not be required.

Over the decades, the artificial knee joints have been greatly developed, with improvements in both techniques and the materials used meaning that knee implants are now routinely performed on younger patients.

Hip replacements have an even longer history, with the first attempt carried out in the US in 1940. In the UK, the first hip replacement was performed under the NHS in 1948. This is now one of the most common operations both in Britain and elsewhere.

Constant developments and improvements mean both hip and knee replacements continue to become more effective; in addition, new, longer-lasting materials mean the operation no longer has to be repeated every ten years or so.

Joint replacement is quite a recent development, of course, so how did ancient civilisations cope with the ravages of osteoarthritis?

Although we know people have been suffering from OA for thousands of years, we know very little about how it was treated. Even if the condition was recognised as being anything other than the aches and pains associated with working hard or growing older, there is little evidence for specific treatments apart from different types of basic pain relief.

Ancient Egyptians, for instance, treated joint pain with various ointments made from naturally-occurring materials, such as animal fat, honey and bone marrow. Due to their fastidiousness in recording the lives of everyday peoples, we do know that many Egyptian scribes would have suffered from OA due to their propensity to sit cross-legged on the floor when writing their manuscripts.

Later civilisations had their own approaches to pain relief. These included acupuncture, which is still widely used to treat pain today, and various potions consisting of plant materials such as willow bark in the 17th and 18th centuries. Wealthy sufferers would have recourse to other ‘cures’, including thermal treatment.

Times have certainly changed. In the distant past, osteoarthritis was seen as an inevitable consequence of injury or getting older and something to be endured. Until quite recently, patients would have been told to rest, avoiding the exercise we now know to be beneficial.

What does the future hold? Although a cure is still nowhere in sight, researchers are constantly considering new and innovative ideas for both relieving pain and stopping further joint damage. These include engineering pieces of cartilage to replace tissue damaged through injury, with the aim of preventing more damage.

Whatever the future holds, it seems certain - unfortunately - that osteoarthritis is here to stay.

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