Osteoarthritis is the most common form of arthritis worldwide. I have been referred patients with osteoarthritis to manage their chronic pain on many occasions. This is a distressing disease for the patients, which hinders day to day life.
The patients with knee pain find it difficult to walk and do things, such as cleaning and washing. Especially, in the West the elderly are independent. There are no domestic helpers for them. Day-to-day work, such as shopping becomes extremely difficult for them. Some patients may be lucky where the Government can support their day-to-day life by employing support workers to visit and assist them for a few hours each day.
Osteoarthritis is more common among women than men. It is also known as a wear and tear disease. Besides, the damage to the cartilages, it can affect the whole joint, including the connective tissues of the joint that joins the muscle to the bone.
Osteoarthritis occurs when the cartilage which cushions down the ends of the long bones wears down.
Osteoarthritis can affect any joint but more commonly the knees, hip, spine and the hands.
The damage to the joints cannot be reversed. Our readers should recognise the fact that there is no nittawata Suvaveema or permanent cure for the disease other than a joint replacement.
Symptoms and signs
The symptoms of osteoarthritis develop slowly and worsen over time.
Pain - affected joint can be painful especially, after movement. For example, knee pain during walking and afterwards
Stiffness - Joints can be stiff, especially in the mornings after waking up which will loosen up with movement.
Swelling - Skin can be swollen around the joint.
Warmth - Joints can be worn due to inflammation.
Loss of flexibility - The joints can be less mobile and full range of movement can be difficult.
Grating - Might hear cracking and grinding when the joint is moved.
Bone spurs - Extra bony growth can be felt as lumps and bumps which are hard.
Risk factors
- Older age
- Sex - Women more prone than men
- Weight - Increase in weight exerts pressure on the weight bearing joints and increases the severity, especially in the knee and hip.
- Injuries, such as sports injuries and injuries due to road traffic accidents can increase chances of developing osteoarthritis.
- Genetics - some persons have a genetic tendency to develop the disease. The Caucasians have increase risk of developing osteoarthritis of the hip than the Asians. We have a tendency to develop more knee osteoarthritis.
- Diabetics
Osteoarthritis of the hip joint
Complications
The disease can lead to chronic pain over time which affects the lifestyle. It can lead to sleep disturbances and depression.
Osteoarthritis of the spine
Treatment
- Lifestyle changes
- Progress of the disease can be slowed down by weight reduction.
- Walking helps the knee. It increases the blood supply to the knee.
- Exercise
Complementary
therapy
Complementary therapies, such as physiotherapy, Acupuncture, hydrotherapy can ease the pain.
Medication
Vitamins and minerals, such as calcium.
Glucosamine 1500 mg daily.
Pain killers, such as the anti-inflammatory drugs. Needs to be careful with the side effects of long term anti-inflammatory drugs.
Opiate drugs - Codeine , Morphine, Fentanyl patches.
International
therapy
- Steroid injections to the joint
- Hyaluronic acid injections to the joint
- PRP - Platelet rich plasma injection to the joint
- Nerve blocks such as a Genicular nerve block. By freezing the nerves with special techniques (radio frequency denervation) can help.
- Surgery
- Total knee replacements
Surgery
As a last resort, surgery may be the way forward. Bear in mind that every surgery does not go well.
Unicompartmental knee replacements, such as the Oxford knee replacement.
Total hip replacements.
Dr Namal Senasinghe MBBS (SL) FFARCS, Dip in Pain Medicine, FFPMCA, CCST (U.K.) is a consultant in pain medicine with specialist registrations in the general medical council, United Kingdom and the Sri Lanka Medical Council.