What is osteoarthritis?

Osteoarthritis is the most common form of arthritis. Unlike other forms of arthritic diseases that may affect other parts of the body, osteoarthritis is primarily a disease of the joints.

What is joint cartilage?

Joint cartilage is the layer of robust slippery tissue that covers the ends of bones where they connect within a joint. Its purpose is to reduce the friction between apposing bone surfaces in order to allow bones to glide over each other during movement. During osteoarthritis the outer layer of cartilage becomes progressively weakened, starts to crumble and slowly breaks away. This eventually exposes the underlying bone and causes bone-to-bone friction during joint movement. Not surprisingly, bone rubbing on bone causes severe pain and reduces joint flexibility.

What causes osteoarthritis?

In the past, osteoarthritis was thought to be a natural consequence of the “wear and tear” process that results from ageing and frequent usage. Although partially true, new research by various investigators has since demonstrated that this is a somewhat simplistic outlook, and that the corrosive biochemical effects that inflammation has on cartilage plays a far bigger role than friction alone. This explains the reason why many marathon runners often have surprisingly low levels of osteoarthritis of their knees and hips at a later stage of their lives, especially when compared to some of their more sedentary peers. In addition, radiological evidence demonstrating the slow but steady destruction of the entire joint proves that osteoarthritis involves far more than just cartilage degradation.

Why does inflammation damage cartilage?

As part of the natural immune response, inflammation triggers the activation and release of several different enzyme systems that splice or cleave the bonds that join protein molecules together. Since cartilage is predominantly made from protein, these enzymes progressively corrode, and in the process, soften the cartilage. As a result, it becomes less resistant to impact and more prone to fragmentation. Of importance is that these enzymatic processes do not selectively degrade joint cartilage alone, but damage all other regional protein-based tissues, including ligaments, capsules, synovial membranes and adjacent bone.

What are the risk factors for developing osteoarthritis?

Various factors including genetic, biochemical, and mechanical factors play a role in the development of osteoarthritis. These determine to a degree how resistant cartilage will be against inflammatory damages, and why inflammation often lingers within a joint. The following play a role:

  • Getting older
  • Being overweight (increases friction)
  • Previous joint injury, fracture, or sprain (activates inflammation)
  • Previous joint infection (activates inflammation)
  • Joints that were not properly formed (increases risk of damage)
  • A genetic defect in joint cartilage (may cause structural weakness)
  • Extreme stresses on the joints – certain jobs and high-impact sports (increases friction)

What are the symptoms of osteoarthritis?

Osteoarthritis predominantly causes joint pain and stiffness. The following symptoms are common:

  • Pain aggravated by movement
  • Joint tenderness
  • Stiffness, especially after having rested
  • Joints appearing slightly larger or more ‘knobbly’ than usual, especially the fingers
  • Grating sensation or crackling sound with movement
  • Decreased range of movement
  • Weakness and muscle wasting

Which joints does osteoarthritis affect?

Almost any joint can be affected by osteoarthritis, but the knees, hips, and small joints of the hands are the most common.

  • Hands
    Osteoarthritis of the hands has a strong genetic basis. Women are more likely to develop osteoarthritis in the hands, especially if both your mother and grandmother were affected. Bony growths or nodules may develop on the finger joints. Nodules on the joints closest to the nails are called Heberden’s nodes whilst Bouchard’s nodes appear in the middle. This may cause the fingers to become gnarled and distorted. Additionally, the base of the thumb joint is commonly affected by osteoarthritis.
  • Knees
    Symptoms include stiffness, swelling, and pain, which makes it hard to walk, climb stairs, and get out of chairs.
  • Hips
    Symptoms include pain and stiffness of the hip joint itself, but pain can often be felt in the groin, inner thigh, or buttocks. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge.
  • Spine
    Symptoms include stiffness and pain in the neck, mid-back, or lower back. In most cases, osteoarthritis is associated with other degenerative conditions such as intervertebral disc degeneration or spondylosis.

How does one diagnose osteoarthritis?

If clinically suspected, X-rays may confirm the diagnosis and exclude other forms of arthritis. The radiological findings on X-ray include cartilage loss, bone damage, and joint distortion. The development of bony outcrops or protrusions called spurs or osteophytes are common.

How is osteoarthritis treated?

  • Step 1 – the alleviation of acute pain to improve your quality of life and help you to remain functional and productive.
  • Step 2 – the implementation of preventative self-help strategies to control your level of pain, maintain mobility, and reduce chronic inflammation.

Acute pain management

  • Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
  • Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
  • Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity
  • Rehabilitation therapies – Physiotherapy, biokinetics, or chiropractic therapy may prove helpful.

Preventative self-help strategies:

  • Exercise
    Research has shown that regular exercise provides numerous benefits for those suffering from osteoarthritis. Exercise can decrease pain, increase flexibility, strengthen the heart and improve blood flow, help maintain weight, promote general physical fitness and improve mood. Contracting muscles also release multiple substances, known as myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases.
  • Use supplements that combat inflammation
    Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin® is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical (plant based) compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin
  • Weight-control
    Being overweight causes increased friction on your hips and knees. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success. Read more about weight-loss strategies
  • Surgery
    In some cases of advanced osteoarthritic disease, surgery may be required.