Osteoarthritis (OA) is the most common type of arthritis and can cause joints to feel stiff and painful. It is more common in older people but can also affect younger people especially if there has been an injury to a joint. Sometimes OA causes the joints to swell and change shape, especially the finger joints, and sometimes the joints make creaking or cracking noises.
The symptoms of osteoarthritis can vary a lot. Sometimes there is no pain at all and sometimes the pain can be severe and moving them is difficult. There can be loss of muscle around the joints and this can make them feel weaker. Almost all joints can develop osteoarthritis but the most common places are the fingers, thumbs, knees and hips as well as the low back and neck.
What causes osteoarthritis?
Osteoarthritis used to be called “wear and tear” arthritis because it was thought that the joints gradually wore out with use and that this was inevitable as we get older. It is now known that the process of osteoarthritis is much more complicated. Inside the affected joints there is quite a lot of healing and repair going on, also called inflammation and this can include the formation of new bone which can contribute to some of the pain and stiffness. Although the risk of osteoarthritis increases as we get older, osteoarthritis is not inevitable. The other good news is that the pain of osteoarthritis can come and go and will not inevitably get worse.
Inside a joint with osteoarthritis there is loss of cartilage which surrounds the ends of the bones and acts as a shock absorber, and the formation of new bone which can cause the joints to look lumpy or become bent.
No-one knows exactly what causes osteoarthritis but it may be due to repeated small injuries that happen as part of daily life that don’t heal completely. Osteoarthritis can also run in families and injuries such as a broken bone or sporting injury can lead to osteoarthritis later in life. Being overweight puts extra strain on the weight-bearing joints, especially the knees and hips and this can lead to more severe osteoarthritis.
Is osteoarthritis caused by too much exercise?
Osteoarthritis is not caused by too much exercise and hard work does not damage the joints. People who have had sporting injuries are more likely to develop osteoarthritis in that joint but even extreme sportsmen and women are not more usually more prone to osteoarthritis.
If anything, exercise may help protect against osteoarthritis because strong muscles help to support the joints and people who exercise may be slimmer than those who don’t and keeping to a healthy weight can also help protect the joints from osteoarthritis.
Latest research suggests that exercise can actually increase the level of anti-inflammatory chemicals inside the joints and these can protect against cartilage loss and joint damage.
What joints are affected by osteoarthritis?
Osteoarthritis is most common in the ends of the fingers, the thumbs, the hips, knees, neck and low back.
What are the symptoms of osteoarthritis?
Sometimes osteoarthritis causes no pain at all but the most common symptoms are:
- Joint stiffness, especially in the morning and lasting for less than 30 minutes
- Joint pain, especially on movement and after exercise, for example knee pain when walking upstairs, thumb or wrist pain after gardening
- Joint tenderness
- Stiffness and loss of movement in the joint
- Bony swelling around the edges of the joints, especially in the fingers
- A creaking or grating noise coming from the joints
- Loss of muscle around the joint and a feeling of weakness, for example difficulty gripping
Most people with osteoarthritis find that they have good days and bad days and sometimes the pain goes away completely.
How is osteoarthritis diagnosed?
Osteoarthritis is likely if:
- You are over 45
- You have pain and stiffness in one or more of the joints commonly affected by osteoarthritis
- The stiffness in the morning lasts for less than 30 minutes
- The stiffness and pain are worse with exercise or using the joints, for example after gardening
Often no special tests are needed to diagnose osteoarthritis, but sometimes blood tests may be taken to make sure that nothing else is wrong and sometimes X-rays can help confirm the diagnosis. Sometimes MRI scans are used but these are usually not necessary. X-rays of the neck and low back are not useful in diagnosing osteoarthritis because they often show changes that happen normally with age and many people with these changes have no pain.
What can I do to help myself?
There is nothing that you can do to completely prevent osteoarthritis but there are lots of things that you can do to reduce your risk of developing osteoarthritis in the first place, and to reduce pain and improve function if you already have osteoarthritis.
- Try to keep to a healthy weight – For every pound that you are above a healthy weight, an extra 4 or 5 pounds of weight goes through your hips knees and feet and this can increase the pain. Reducing weight by just 10% can help a lot with pain.
- Keep your muscles strong and do some exercise – Exercise that increases muscle strength can really help support the joints and reduce the pain of osteoarthritis. Exercise can increase chemicals inside the joint that cause inflammation and this can reduce cartilage damage. Exercise can also help the joints because it assists with weight loss, helps improve posture and flexibility and reduces stress. You should try to balance active (aerobic) exercise with increasing strength (resistance) exercise plus work on flexibility (stretching) to get the best results.
- Keep to a healthy diet – Eating healthily can help maintain muscle and bone strength and help you keep to a healthy weight.
- Try to relax to help manage the pain better. Distraction, meditation, reducing stress and trying to help your sleep can all help reduce pain.
- Painkillers and anti-inflammatory medicines are often prescribed to help with the pain and stiffness of osteoarthritis. These can be taken when needed or before activity that you know can trigger the pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can be very effective for helping pain and stiffness but they should be used in the lowest possible dose for the shortest possible time as they can increase the risk of irritation of the stomach including ulcers as well as cardiovascular disease such as heart attack and stroke.
- Physical therapies such as physiotherapy, osteopathy and chiropractic treatment can all help, and therapists can give you exercises to help you manage your pain and improve your function.
- Joint injections of a corticosteroid and local anaesthetic can sometimes help individual joints that are especially painful, and the benefits can last for many months or even longer.
- Self-management – Self-management is about taking control of your symptoms and lifestyle in order to live a better life with less pain and improved function.
I have been told that I have osteoarthritis because of my x-ray results. Does this mean that I will have to have surgery?
Not necessarily. Some people with osteoarthritis can have no pain at all, yet their X-rays can look very abnormal, and some people with normal x-rays can have a lot of pain. Joint replacement surgery is done to improve pain and function and the decision to have surgery is never just based on x-ray results, so if you can manage your pain and stiffness well by yourself, then you may never need to have surgery.
If your pain is severe and you have tried all the simple self-management techniques that you can to improve the pain, then you may benefit from joint replacement surgery. The most commonly replaced joints are the hips and knees but other joints such as the shoulders, elbows, ankles and wrists and even the small finger joints can now be replaced. Joint replacement surgery can be extremely effective at reducing pain and more than 90% of people who have a hip or knee replaced are happy or very happy with the results. Modern joint replacements can last for 20 years or more.