What Is Osteoarthritis?

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Overview

Did you know that osteoarthritis is the most common type of arthritis in the world? 

Osteoarthritis occurs when the cartilage that protects the end of bones wears away over time. This condition can affect any of your joints, but it most commonly affects joints in your hands, spine, knees, and hips. 

If you have osteoarthritis, you may experience pain, swelling, and tenderness in the affected joints. Many of these symptoms can be managed effectively, but joint damage caused by osteoarthritis cannot be reversed. It is important to understand the treatment, risk factors, and complications associated with osteoarthritis, all of which will be discussed further. 

Causes of osteoarthritis

Osteoarthritis happens when cartilage and other tissues within the joint break down. Although osteoarthritis is often referred to as ‘wear and tear’ of the joints, in reality, changes in your body tissues can cause the breakdown, which usually occurs over time. 

A combination of environmental and genetic factors may cause osteoarthritis. Environmental factors may include body mass index (BMI) and injuries. Genetic factors may account for up to 50% of hip osteoarthritis cases, and play a smaller role in the development of knee osteoarthritis.1 

Genetic factors may include: 

  • Chromosomal differences 
  • Sex
  • Bone metabolism 

Osteoarthritis may also be caused by other joint diseases (e.g. rheumatoid arthritis or gout).

Signs and symptoms of osteoarthritis

The main sign of osteoarthritis is difficulty moving the affected joints due to pain and stiffness. You may also experience symptoms such as:

  • Swelling
  • Tenderness
  • A cracking sound when moving the affected joint(s), also known as crepitus

Osteoarthritis severity can vary from person to person. For example, you may only have mild symptoms that do not impact your daily life. However, sometimes your symptoms may stop you from undertaking normal everyday tasks and can be debilitating. Oftentimes, osteoarthritis pain is worse at the end of the day once you have used the affected joint(s) for everyday activities. 

Certain factors may affect the intensity of osteoarthritis symptoms, but do not cause osteoarthritis themselves. Some people find that changes in the weather can make the pain from osteoarthritis worse, especially when the atmospheric pressure is falling. Some also find that their diet can affect their symptom severity. 

Management and treatment for osteoarthritis

Lifestyle changes & physical therapy

Osteoarthritis may be managed non-pharmaceutically (i.e. without medication). This type of management may look like:

  • Therapeutic exercise - this will be tailored to your needs. 2 supervised sessions a week for 6 weeks is recommended to see benefits.2 Walking and swimming are particularly associated with improvements in osteoarthritis symptoms. However, a variety of strengthening exercises, aerobic exercise, and range of motion exercises can be beneficial 
  • Weight management - losing 10% of your body weight is more beneficial than 5% for managing osteoarthritis.3 Reducing the amount of excess weight you carry can reduce the mechanical stress placed upon your arthritic joint(s)
  • Mobility aids - these may improve your quality of life and help you carry out daily tasks. For example, walking aids may be used for those with lower limb osteoarthritis
  • Manual therapy - this is a technique whereby your physiotherapist uses their hands to stretch, mobilise, and massage the affected areas
  • Hot or cold packs - these may be applied to the joints to relieve pain and other symptoms of osteoarthritis  

Types of electrotherapy are not routinely recommended for the treatment of osteoarthritis because there is not enough research to support the effectiveness of this therapy for osteoarthritis. 

Medication

Medications are often used as a short-term intervention to help you with non-pharmaceutical management techniques. 

The most common type of medication used to treat osteoarthritis are non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by blocking a group of enzymes known as cyclo-oxygenase enzymes (COX enzymes). COX enzymes play a role in producing an inflammatory compound, therefore reducing the pain and swelling you experience from osteoarthritis. 

NSAIDs may be given:

  • Topically - this means that the medication is applied onto the skin
  • Orally - when topical application is not effective, you may have to swallow pills. These are often taken with gastro-protective medications to make sure the lining of your stomach remains unharmed 

However, for those with asthma, a stomach ulcer, or angina, NSAIDS may not be suitable to take. They may also not be suitable if you have had a heart attack or stroke, or if you are taking a low-dose aspirin. 

When NSAIDS have not helped for the treatment of osteoarthritis, corticosteroid injections may be prescribed for a short duration. These injections help to reduce inflammation within the affected joints. 

Surgery

In severe cases when an individual has tried these management techniques with little relief, joint surgery may be the required treatment for osteoarthritis. These types of surgery may include:

  • Joint replacement surgery
  • Keyhole surgery techniques that wash out loose fragments of tissue and bone within the knee joint
  • Fusing the bones in a joint together, also known as joint fusion. This prevents movement of the joint and any pain caused by osteoarthritis

Diagnosis of osteoarthritis

When you see your doctor they may perform a physical examination where they check the affected areas for swelling, tenderness, redness, and flexibility. 

They may need to perform scans if you:3

  • Are under 45 years of age
  • Do not have activity-related joint pain
  • Have morning-related joint stiffness
  • Have atypical symptoms or symptoms that may indicate another condition

Scans take pictures of the affected joints and look at your cartilage, bones, and soft tissues. These tests may include X-rays and magnetic resonance imaging (MRI)

Blood tests may also be required to rule out other conditions that cause joint inflammation and pain.

Risk factors

Factors that may increase your risk for developing osteoarthritis include:

Ageing

This may be one of the primary risk factors for osteoarthritis. During the ageing process, the tissues around your joints can wear away. This usually occurs for those over 45 years of age.

Sex

People assigned female at birth (AFAB) are more likely to be affected by osteoarthritis than people AMAB. In particular, people AFAB are twice as likely to develop osteoarthritis of the knees

Although there has been no clear explanation as to why there is a higher prevalence of osteoarthritis cases within people AFAB, there may be a variety of factors that influence this onset. These may include: 

  • Changing hormone levels 
  • Biomechanical differences
  • Tendency to carry excess weight 

Obesity

Carrying excess weight can increase the amount of mechanical stress placed on your joints.4 As osteoarthritis can decrease your physical activity levels, osteoarthritis is also thought to contribute to increased obesity. 

Bone density

Bone density plays a role in your joint health and the onset of osteoarthritis. When your bone density is too high, there may be an increased risk for osteoarthritis. This is because high bone density can cause bony outgrowths (also known as bone spurs).5

Repeated stress on the joint

This may be particularly prevalent within those who exercise frequently. It is thought that these stresses may heighten microtraumas (small injuries), structural damage, and force placed on the joints, all of which can lead to the development of osteoarthritis.

Genetics

Osteoarthritis is not always hereditary, however, experts believe that this condition may have a genetic component. In particular, if you have a close relative who has osteoarthritis, you may be more likely to develop osteoarthritis later in life.

Metabolic diseases

Osteoarthritis may be associated with metabolic syndrome and other metabolic abnormalities. It is thought that both metabolic abnormalities and osteoarthritis share the same characteristic of chronic-low grade inflammation, which may contribute to the development of osteoarthritis.6

Complications

Osteoarthritis can impact your everyday life. Mental health problems are often seen within individuals with osteoarthritis. In addition, physical issuescan also arise from untreated osteoarthritis, including: 

  • Increased risk for falls - Inflexibility and difficulty moving your joints may increase your risk for falls, particularly when you have lower limb osteoarthritis 
  • Decreased sleep quality caused by painful joints. Fatigue can occur if you don’t get enough sleep, which in turn can make joint pain feel worse
  • Absenteeism from work and social activities. Experiencing joint pain can make it difficult to get up in the morning and do a full day’s work. In addition, you may cancel social plans if you are in pain 
  • Weight gain due to restricted physical activity. Weight gain can further exacerbate the symptoms of osteoarthritis 

FAQs

How can I prevent osteoarthritis?

There is no way of preventing osteoarthritis. However, you may be able to minimise your risk for developing the condition through a healthy lifestyle and avoiding injury. 

How common is osteoarthritis?

Within the UK, it is thought that 8.75 million adults who are 45 years and older have sought treatment for osteoarthritis. In addition, 1 in 5 adults in their 50s have osteoarthritis in their knee.

When should I see a doctor?

If you are experiencing symptoms of osteoarthritis, including pain, swelling, and inflammation within one or more of your joints, you should consult your doctor. Although your quality of life may not be affected, it is important to seek guidance from a healthcare professional early to avoid osteoarthritis complications. 

Summary

Osteoarthritis is the most common type of arthritis in the world. It occurs when the protective cartilage at the end of bones wears away. This can cause pain, tenderness, stiffness, and swelling within one or more of your joints. Any of your joints may be affected by osteoarthritis, and you may experience osteoarthritis multiple joints at the same time. 

Some genetic and environmental factors may increase your risk for developing osteoarthritis, including sex, age, BMI, and injury. However, there is no one way that you can prevent osteoarthritis. 

Diagnosis of osteoarthritis may include physical examination, scans, and lab tests. Oftentimes, management is a combination of medication and lifestyle changes. However, sometimes joint replacements may be required. 

Osteoarthritis can decrease your quality of life and lead to mental health problems, weight gain, and increased risk for falls. 

References

  1. Cicuttini FM and Spector TD. What Is the Evidence That Osteoarthritis Is Genetically Determined. Baillière's Clin Rheumatol [Internet]. 1997 Nov [cited 2023 May 19];11(4):657-669. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0950357997800027 
  2. Skou ST and Roos EM. Physical Therapy for Patients with Knee and Hip Osteoarthritis: Supervised, Active Treatment Is Current Best Practice. Clin Exp Rheumatol. 2019;37 (suppl. 120):S112-17
  3. Osteoarthritis: Care and Management [Internet]. NICE. 2014 Feb 12 [cited 2023 May 19]. Available from: https://www.nice.org.uk/guidance/cg177.
  4. Spector TD and MacGregor AJ. Risk Factors for Osteoarthritis: Genetics. Osteoarthr Cartil [Internet]. 2004 [cited 2023 May 19];12:39-44. Available from: https://www.oarsijournal.com/article/S1063-4584(03)00253-X/fulltext 
  5. Hardcastle SA, Dieppe P, Gregson CL, Smith GD, Tobias JH. Osteoarthritis and Bone Mineral Density: Are Strong Bones Bad for Joints? Bonekey Rep [Internet]. 2015 Jan 21 [cited 2023 May 19];4:624. Available from: https://pubmed.ncbi.nlm.nih.gov/25628884/ 
  6. Sellam J and Berenbaum F. Is osteoarthritis a metabolic disease? Joint Bone Spine [Internet]. 2013 Dec [cited 2023 May 19];80(6):568-573. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1297319X13002169?via%3Dihub

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Kristy Maskell

Master of Science – Nutrition and Dietetics, University of Hull
Bachelor of Science with Honours – Exercise and Health Science, University of Brighton

Kristy is a Dietetics master’s student which has allowed her to develop clinical knowledge of nutrition for a variety of populations. She is passionate about making evidence-based nutrition information accessible and loves to write this for everybody to read. Kristy looks forward to qualifying as a registered dietitian in the near future and having the opportunity to provide the best possible patient-centred care.

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