Osteoarthritis (OA) is the most common type of arthritis. Osteoarthritis affects the joint cartilage and the bone tissue adjacent to the cartilage.

What causes osteoarthritis?

All joints and the tissues adjacent to normal joints are constantly undergoing restoration. This is due to the wear and tear to which they are exposed through daily human activities. However, for some, this reform process appears to be becoming weak and flawed. This may be caused by severe wear and tear on the joints or a problem with the restoration process, leading to the development of arthritis.

In joints affected by osteoarthritis, the joint cartilage is damaged and eroded. The bone tissue adjacent to the cartilage can also be affected and bone spurs can develop around the edges of the joint. These protrusions are called osteophytes and can be seen on X-rays. The joints and the tissues surrounding the joints can also become inflamed. This inflammation is called synovitis.

Factors that may play a role in osteoarthritis include:

Age

Osteoporosis becomes more common with age. The joint’s blood supply and natural repair mechanisms are less efficient in some people as they age.

Genetics

There is an inborn tendency to develop osteoarthritis in some people.

Obesity

Knee and hip osteoarthritis are more likely to develop or be more severe in people who are obese. This is due to the increased pressure on the joints.

sex

Women are more likely than men to develop osteoarthritis.

Previous injuries to the joint, such as bruises, fractures, or joint deformity

For example, a previous fracture of the bones around the joint, or a previous injury to the ligaments that caused instability of the joint.

Occupational overuse of the joint

Knee osteoarthritis is more common in professional athletes and elbow arthritis may be more common in people who work with pneumatic drills.

How common is osteoarthritis?

Arthritis causes joint pain in about 8.75 million people in the UK. About 32.5 million adults in the United States have arthritis, according to the Centers for Disease Control and Prevention (CDC).

• Primary osteoarthritis develops in joints that were previously healthy. Most cases develop in people over 50 years of age. By age 65, at least half of people will end up with osteoarthritis in some joints. It is mild in many cases; However, 1 in 10 people over 65 years of age has a significant disability due to arthritis.

Secondary osteoarthritis develops in joints affected by previous injury, wear, or deformity. This can happen to younger people.

Symptoms

• Joint pain, stiffness, and range of motion

These are typical symptoms of osteoarthritis. Osteoarthritis pain usually occurs during activities; Like walking and running. Symptoms tend to be worse after morning awakening. Then it tends to get better after half an hour or so.

• Swelling and inflammation

It is not very common for a joint to be swollen, red, or warm.

• Attacks of symptomatic episodes

People with osteoarthritis often have ’bouts’ of symptoms – the pain, stiffness, and swelling of the joints sometimes becoming worse for several days. This usually settles within a week or two. During a flare, people with arthritis may need to take more painkillers than usual.

A joint affected by osteoarthritis tends to appear slightly larger than usual. This is due to an overgrowth of bone (beaks) next to the damaged cartilage.

• Joint deformities

Joint deformities due to osteoarthritis are uncommon but can sometimes occur, and there may be impaired mobility and problems walking if the knee or hip is severely affected by arthritis. This may make the patient more likely to fall and cause joint bruising, and the patient may have difficulty wearing shoes and socks, getting in and out of the car, and engaging in physical activities. In women, restricted hip movement can make sex difficult and painful.

• Asymptomatic

Symptoms may not occur. A large number of people have X-ray changes that indicate some degree of osteoarthritis and have no clinical symptoms, or very mild symptoms. The opposite can also be true. This means that there may be very severe symptoms affecting the patient’s quality of life but with minimal changes on the X-ray.

• Secondary symptoms

Some people with arthritis may develop other problems because of their symptoms. For example, pain can affect sleep in some people. Mobility problems may affect the ability to work and carry out family duties. Some people may become frustrated or even depressed because of their pain and other symptoms.

What joints are most affected by osteoarthritis?

Any joint can be affected by osteoarthritis (OA), but the hip, knee, finger, and lower spine joints are most commonly affected. In some patients, arthritis develops in many joints.

How is the diagnosis made?

A doctor can often make a diagnosis of osteoarthritis based on age, typical symptoms, and an examination of the affected joints. Sometimes your doctor may suggest X-rays or other tests if he or she isn’t sure of the diagnosis and wants to rule out other problems.

Treatment

There is no cure for osteoarthritis, but there are several things that can be done to relieve symptoms and reduce pain. For anyone with arthritis, treatment goals should be:

• Helping the patient understand the situation and how to manage it.

• Reduce pain and stiffness.

• Maintaining and improving joint mobility.

• Reducing any damage to the joint.

• Minimize any disability that may result.

• Reducing the side effects of the medicines used.

Be aware that something can be done to help. Osteoarthritis is more common with age, and you don’t have to live with pain or disability. Various treatments may help with this.

Sports

If possible, exercise regularly. This helps strengthen the muscles around the joints affected by osteoarthritis, to maintain fitness and maintain a good range of motion in the joints. Exercise can reduce joint pain, swelling, and stiffness. Swimming is ideal for most joints. Other good exercises include walking and cycling. Any exercise is better than none. Many people can walk regularly

Weight control

The extra burden on the back, hips, and knees can increase the risk of developing osteoarthritis or worsen its symptoms. Even a simple weight loss can make a big difference.

Some research trials have shown that the following may help relieve symptoms in the knee in some cases:

• Wear a knee brace.

• Use insoles.

• Use of a special adhesive tape that pulls the patella lateral.

Walking assistance

Use sticks when walking. It should be held in the hand opposite the painful extremity (hip or knee). This takes some pressure off the affected joint and helps relieve symptoms in some cases.

Physiotherapy

It is useful for:

• Get advice on exercises to do to strengthen the muscles above the knee (quadriceps femoris)

• Get tips on how to keep active and fit.

• Get advice about shoes, knee braces, and laces, and how to use the walking aids correctly (correct height of the aids).

Other treatments

Transcutaneous electrical nerve stimulation (TENS) may help relieve pain caused by osteoarthritis

Medicines

Paracetamol

Paracetamol is commonly used to treat osteoarthritis (OA). Paracetamol is considered a safe drug with few side effects if taken in the recommended dosage. Especially for short-term pain relief and other options that are not appropriate.

Non-steroidal anti-inflammatory

Topical anti-inflammatories are applied to the skin over the affected joints. This can be in place of or in addition to paracetamol tablets. Examples include ibuprofen gel and diclofenac (topical). Compared to anti-inflammatory tablets, the amount of medicine that enters the bloodstream is much lower with topical preparations. There is also a lower risk of side effects.

Oral NSAIDs are often used with paracetamol. It can cause side effects, especially in elderly people who take it regularly. However, one of these medications is an option with paracetamol or topical anti-inflammatories. Anti-inflammatories should be taken for short periods, perhaps for a week or two when symptoms are severe. Then back to paracetamol or topical anti-inflammatories. There are many different types of anti-inflammatories. If one does not fit, the other may be suitable. Ibuprofen is a commonly used anti-inflammatory drug.

Side effects

may occur in some people who take anti-inflammatories:

• Bleeding from the stomach is the most serious possible side effect

• This is more serious if the patient is over 65 years old, has a duodenal or stomach ulcer, or is also taking low-dose aspirin.

• Anti-inflammatories are often taken with another medicine that protects the stomach lining, such as omeprazole or lansoprazole.

• Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatories.

Codeine

Opiates such as codeine are sometimes used as a pain reliever in osteoarthritis if paracetamol or topical anti-inflammatory drugs are not sufficient.

Steroid injection

Injections directly into the joint may be an option if the joint has become severely swollen (inflamed) due to osteoarthritis. However, steroid injections may be either completely ineffective or effective for a relatively short period, usually two to ten weeks.

Herbal creams and gels

• Arnica gel is likely to effectively improve symptoms.

• Comfrey extract gel may relieve pain.

• Jelly extracted from capsicum.

However, capsaicin gels and creams have been recommended to reduce osteoarthritis (OA) pain, especially for knee or hand osteoarthritis. Capsaicin is a herbal medicine extracted from hot peppers.

Supplements

Various nutritional supplements that you can buy at health food stores and pharmacies have been recommended to help treat osteoarthritis. In particular, glucosamine and chondroitin supplements are becoming popular. Glucosamine and chondroitin are chemicals that are part of normal cartilage formation. The theory is that taking one or both of these supplements may help improve and repair damaged cartilage.

However, their usefulness is controversial.

Surgery

In some cases, arthritis can become severe. Some joints can be replaced with artificial joints. Hip and knee replacement surgery have become a standard treatment for severe osteoarthritis.

Joint replacement surgery has a high success rate. However, like any surgery, joint replacement surgery has caveats.

Other treatments

Some treatments have become trendy Such as:

Hyaluronic acid

Regular injections of hyaluronic acid directly into the joint is a relatively new treatment that has been tried in osteoarthritis. The theory is that it may help with lubrication, relief of inflammation, and shock absorption in a degenerating joint.

Laparoscopic washing and debridement

This is a process to wash the joint and trim the cartilage from the joint. NICE recommends that this not be offered as part of treatment for osteoporosis.

Magnetic resonance therapy

This is a new treatment that uses a magnetic device to try to improve pain and healing in the joint. NICE in the UK looked at the evidence for this in 2021 and concluded that while there was no evidence of harm, there was also insufficient evidence that it was helpful in osteoarthritis. NICE recommends that this treatment should only be given as part of a research study.

Geniculate artery embolism

This treatment aims to reduce blood flow to the damaged part of the knee joint, to reduce further damage and pain. NICE looked at the evidence in 2021 and concluded that while there were no short-term safety concerns, there was not enough evidence for long-term safety, and insufficient evidence to show it worked. NICE recommends that this treatment should only be given as part of a research study.

Spread of Osteoarthritis

There is a common misconception that osteoarthritis is always a serious and progressive disease. The severity of symptoms varies. In many people it is mild, it doesn’t get worse and it doesn’t disable any more than it is. However, in some people, the severity of arthritis and the disability it causes are disproportionate to their age. One or more joints may be affected particularly severely.

Symptoms often diminish and go away. It is common for symptoms to flare up for days to weeks. Sometimes this is related to things like the weather. Symptoms often improve in the warmer months. A bout of bad symptoms may be followed by a relatively good period.