- Osteoarthritis is the most common form of joint disease and is thought to affect around 8 million people in the UK alone.
- Wear and tear of our joints is a perfectly normal progress as we get older. Think of it in a similar way to getting grey hairs.
- Whilst we may all develop some form of joint change, some are affected more than others.
- Osteoarthritis is not always symptomatic. Some people can have severe changes on an X-ray or MRI scan and yet they experience very little pain. Whereas others can have a similar level of change and develop a lot of pain and disability.
In summary Osteoarthritis can be defined as “A condition that affects the joints, causing pain and stiffness” (Arthritis Research UK).
So, what exactly happens to our joints when we develop OA?
Let’s start simply – a joint is the term given to a point in the body where two bones meet. The amount of movement the joint has is determined by the structures around it such as ligaments and tendons. Some joints have more range than others. For example a shoulder is very mobile, whereas the elbow is only able to bend/straighten.
On the surface of the joint, we can a smooth layer of cartilage acting as a shock absorber and creating a friction-free surface for the bones to glide on as we move.
When a joint begins to develop OA, some or all of the cartilage begins to roughen and gradually becomes thinner. Simultaneously, the bone underneath this cartilage becomes thicker. The body is not able to produce new cartilage. In response, our body increases the activity of the surrounding tissues, in an attempt to try and heal the sore joint (see image below). This results in a thickening of the synovium (connective tissue that covers our joints) and can create swelling and inflammation – a typical symptom of OA.
The capsule and the ligaments can also tighten, in an attempt to stabilise the irritated joint. This can lead to stiffness, particularly in the mornings or after a period of inactivity.
You may also experience some growth of the bone edges, called Osteophytes. These can get in the way of normal movement and cause pain. A good example is Osteophyte development on the spine. It may cause some compression and irritation to the nerves and cause leg pain when standing and walking. This is often relieved with sitting or leaning forward as the pressure of the Osteophyte is taken off the nerve.
Who develops arthritis?
Anyone can develop arthritis. However it is thought to be more likely if you fall into one or more of the categories below:
· Over the age of 40-45
· You are overweight
· You’ve had a previous trauma to the area e.g. a bad fall onto the knee
· You’re job or career has been very manual, involving a lot of repetitive movement
· Joint abnormalities: present from birth
· It is more common in women
· There may be a hereditary link
What are the symptoms?
· Pain when moving the joint
· Achy or sore at night
· Unpredictable pain: good and day days are very common
· Damp weather makes the pain worse (thought to be due to changes in atmospheric pressure)
· Weakness in the muscles around the joint
Which joints are affected?
Almost any joint can develop arthritis but there are some that are more commonly affected.
· The knee – this joint takes a lot of pressure over the course of our life. It is a very load bearing joint and so OA can sometimes develop in this joint sooner than others. OA can affect both knees and the pain is normally felt over either side of the knee or over the front. It can be particularly bad when standing after sitting for a long time and can take a few minutes to ‘loosen off’.
· The hip – pain is normally felt deep into the joint or into the groin. It can sometimes refer pain into the thigh or buttock. This can also feel worse with walking after a long period of sitting or driving.
· The hands – the cause of this is normally due to a type of arthritis called ‘Nodal osteoarthritis’. This is more common in women around the age of 40/50 or close to the time of the menopause. The base of the thumb and the joints are the ends of the fingers are most commonly affected.
· The spine – The neck and back are usually the problem areas. The changes to the vertebrae are similar to the changes in other parts of the body. However in the spine, you also develop degeneration of the discs. If the OA is more severe, you may also experience referral pain. This can be felt into the arms, buttocks or legs. It occurs due to compression or irritation of the nerves exiting the spine and supplying our limbs.
How is arthritis diagnosed?
· It is important that a correct diagnosis is made.
· There is more than one type of arthritis and all have slightly different management plans.
· Osteoarthritis is diagnosed based on your history, symptoms and a detailed physical examination.
· This examination can be carried out by your doctor, a consultant and a Physiotherapist.
· An X-ray can help to confirm a diagnosis, although they are not often needed. As mentioned before, X-rays should not be the primary and main focus when it comes to diagnosis. Severe changes on a scan can be seen in those that do not suffer with much pain and vice versa.
· A blood test cannot be used to diagnose Osteoarthritis. It would instead be used to rule out the possibility of other forms of arthritis such as Rheumatoid Arthritis (An auto-immune, inflammatory condition).
Stay tuned for the next post, where I will discuss all the ways you can help your OA and what role Physiotherapy plays in the treatment and management.
Thanks for reading!