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Interpreting the early signs of osteoarthritis and managing them effectively4th April 2017
Osteoarthritis, often referred to as OA or osteoarthrosis, is the most common type of arthritis. It is often thought of as an old person’s disease, affecting only granny or grandpa. While it is true that the occurrences of osteoarthritis increase with age, anyone at any can develop the disease at any stage in life. Symptoms usually appear after the age of 40.
There are primary and secondary osteoarthritis. Primary is most commonly diagnosed and develops due to loss of cartilage, advancing age and joint degeneration. It is generally not associated with any other cause. Secondary osteoarthritis is almost always associated with another cause, such as obesity, joint injury or another condition of the joints.
It is important to note that before many people experience any symptoms whatsoever, there has already been a degree of damage done to the joint. Osteoarthritis is generally a slow developing disease, although many factors can influence the speed of degeneration, and there are ways to slow down this process. This is why it is important for us to recognise and notice the first signs of this disease, in order to gain an early diagnosis and receive professional advice and treatment that is essential in slowing down the cartilage degradation process, allowing for a better quality of life, for longer.
Symptoms associated with osteoarthritis
As cartilage is lost in a joint through the aging process, symptoms begin to present themselves. Symptoms of osteoarthritis to look out for include:
Joint Pain: Pain in the joint is the primary symptom associated with this disease and is caused by functional impairment. Pain in osteoarthritis generally appears slowly and gradually, starting with mild irritation and discomfort, and becoming steadily worse over time. With mild to moderate osteoarthritis, pain will generally feel worse with activity, as you use the joint. Pain then improves with rest. As the disease progresses, pain can become constant and more persistent, and rest may no longer relieve it. Other conservative osteoarthritis treatments may also not relieve the pain at this point. It is therefore important to recognise the early symptoms of the disease to slow down the degeneration process. Pain at rest can signal an advanced or a more severe stage of osteoarthritis. However, it can also be a sign that there is inflammation in the joint. Osteoarthritis pain is not a direct result of cartilage loss, as cartilage has no nerve tissue - it is neural. The pain is more likely caused by adjacent structures in the joint, such as synovitis, subchondral bone microfractures, and bony enlargements causing the joint capsule to stretch, as well as other structural changes.
Joint Tenderness: It is common to experience tenderness or pain when the joint area is touched or palpated in cases of osteoarthritis. Structures surrounding the joint called periarticular structures can also exhibit tenderness caused by tendinitis or bursitis in the adjacent joint areas to the joint.
Joint Stiffness: Stiffness of the joint in the morning is common with osteoarthritis. However, rheumatoid arthritis morning stiffness typically lasts much longer. It is more common for people with morning stiffness from osteoarthritis to find it lasts 30 minutes or less, before wearing off with gentle movement. Joint stiffness can also appear throughout the day, particularly if there have been long periods of inactivity. This stiffening after inactivity is called gelling. It is common for people with this disease to complain of joint pain when stormy weather is approaching. This is due to changes in barometric pressure affecting the synovial fluid and joint.
Crepitus: This grinding or cracking sensation can be audible or palpable. The sensation is a result of rough or irregular joint surfaces coming into contact with each other, or from debris inside the joint. Cartilage provides a smooth surface for your joints to pass over each other, but as the cartilage degenerates, crepitus can occur.
Limited Range of Motion: As the disease progresses, it is normal to experience a loss of mobility in the affected joints. This is a result of the swelling and pain, and any abnormalities associated with the loss of cartilage such as mechanical inhibition due to loose bodies and joint malalignment.
Swelling of the Joint: The swelling in a joint caused by osteoarthritis is called effusion. This joint effusion is created by an accumulation of excess fluid in and around the joint. These effusions are typically non-inflammatory and are generally not red, or warm to the touch.
Joint Instability: Joint pain, joint deformity and joint stiffness can cause unstable joints. This can feel like a joint is going to give out or buckle, especially a weight-bearing joint such as the knee or hip. A joint such as the knee can also lock, affecting stability.
Local Inflammation: While with osteoarthritis there may be effusion or soft tissue swelling, it is not a systemic inflammatory disease. Instead, any inflammation is localised and less impactful than in other forms of inflammatory arthritis.
Enlargement of the Joint: A typical characteristic of osteoarthritis is joint enlargement and is often associated with joint effusion or bony enlargement. This type of symptom is most common in osteoarthritis of the hand, in particular the proximal interphalangeal joints (PIP) and distal interphalangeal joints (DIP). Bone spurs or bony outgrowths known as osteophytes can develop in the joint area, and be felt under the skin. These may also contribute to joint or bony enlargement. Typical osteophytes associated with osteoarthritis are Bouchard’s nodes and Heberden’s nodes.
Joint Malalignment or Deformity: When the loss of cartilage in the affected joint becomes severe, the result may be a deformity or malalignment. In knees, this could present itself as valgus (knock-kneed) or varus (bow-legged), although varus can present itself in mild to moderate cases of the disease also. It is imperative to recognize the symptoms of osteoarthritis as early as possible, to receive treatment that can slow down the cartilage degradation process as quickly and early on in the disease as possible.
Diagnosis and treatment of osteoarthritis
Osteoarthritis most commonly affects the hips, knees, spine, feet and hands. The affected joints can become symptomatic, or there may only be evidence of the disease via an x-ray. Usually, the disease will present with symptoms and by x-ray.
Once your doctor has performed a physical examination of your joints, and possibly a blood test and x-ray, they should be able to provide a diagnosis. Even though osteoarthritis is an incurable condition, treatments are available to improve the condition, ease your symptoms and prevent it from getting worse.
Treatment options include non-surgical solutions such as medication, bracing and exercise, and for severe cases, surgical options include tibial osteotomy, arthroscopy and full knee or hip replacements. Treatment prescribed will depend on the level of severity of the disease, which joint is affected in the body, and the symptoms you are experiencing.
Your GP will look at your whole lifestyle, age, weight and circumstances to determine the best course of treatment for you. This may include one or several of the treatments listed above. Surgery will only be contemplated once other less invasive treatments have been tried and found to be ineffective.
It is vital to pay attention to early signs of this disease, and to consult your doctor or a specialist as early as possible for diagnosis and treatment. The aim is to reduce and manage pain, minimise functional limitations, and ultimately prevent disability. By minimising the impact of this disease as much as possible, a longer, fuller and healthier life can be expected and achieved.