Osteoarthritis

What are the signs & symptoms of Osteoarthritis?

Arthritis is an umbrella term used to describe several types of arthritis causing inflammation and stiffness of joints. Osteoarthritis is the most common type of arthritis which mainly affects people over the age of 65 according to research and females are twice as likely to develop it compared to males. Osteoarthritis is a wear and tear process that affects the synovium and synovial fluid of the joints leading to cartilage destruction and joint modification. Osteoarthritis is a condition that takes many years to develop with genetic, environmental, gender, hormonal, occupational and traumatic factors playing a big role in its progression. Joints most affected include the hip, knee, ankle, foot, hand and spine.
The way osteoarthritis differs from other types of arthritis and wear and tear conditions are:

• Asymmetrical signs of joint OA.
• Often related to history of abnormal joint loading rather than frictional wear and tear.
• No systemic illness signs and not a primarily inflammatory condition.
• A progression of the condition showing evidence of destruction, repair and remodeling.

Osteoarthritis can be further broken down to primary and secondary. Primary osteoarthritis is the breaking down of cartilage caused by the wear and tear process that occurs progressively with age.
Secondary osteoarthritis is caused by specific events or factors that exacerbate the cartilage breakdown. Some of the causes are the following:

• Obesity: The extra body weight places a lot of extra forces and weight on joints like the knee, hip and low back. Also, research has shown that the extra body weight is exponentially more when compared to the weight going through the joints. This speeds up the wear and tear process of the cartilage of these joints.
• Inactivity: Inactivity and limited use of the joints and muscles of the body can lead to osteoarthritis. This is because there is decreased blood and lymph flow through the joints which helps to keep the joint healthy. Also, inactivity decreases the muscle mass meaning that joints get less support from the surrounding muscles and more forces are going through these joints.
• Trauma & Injuries: Joint injuries from sports, falls and road traffic collisions, along with bone fractures and operations increase the risk of developing osteoarthritis at an earlier age.
  · Inflammatory conditions: Chronic inflammatory conditions, especially the ones of the joints such as rheumatoid arthritis, psoriatic arthritis, gout and others once again speed up the destruction of the joint potentially leading to the earlier development of osteoarthritis.
• Genetics: Recent scientific evidence has shown that there is a genetic factor playing role in the development of osteoarthritis.

Signs and symptoms of osteoarthritis affect most individuals very similarly. The symptoms develop slowly over a period of time and usually worsen over time. Symptoms will be listed in a time order from the early signs of osteoarthritis to the latest signs of osteoarthritis.

• Pain: Pain is one of the most common symptoms someone with OA will experience. Usually, the pain is not constant and is not severe at the start however, over time it can get progressively worse. Pain can be worse following periods of excess activity and is relieved by periods of rest.
• Stiffness: Following pain, joints affected by OA start to become progressively stiffer. The most noticeable time is following periods of inactivity, especially in the morning after waking up. The stiffness period usually lasts less than 30 minutes.
• Loss of flexibility: Due to the stiffness experienced around the joints, a decreased range of motion is often seen by OA sufferers. This further increases the joint stiffness and is often accompanied by mild soft tissue swelling and mild muscle atrophy around the affected area.
• Crepitus: Crepitus describes any grinding, clicking, cracking or popping sounds and sensations felt in a joint. Causes include the friction between articular cartilage, the flickering of a muscle tendon against the bone and irregularities of the bone of the affected joint.
• Bone spurs: Due to the loss of articular cartilage, bony surfaces can start to be more in contact. This will lead to some bone modification. Bone spurs in particular are extra bits of bone that develop along bone edges. Bone spurs can cause no symptoms but usually with time they might grow and affect the surrounding anatomy including tendons, ligaments and other soft tissue. Enlarged bone spurs can further decrease the range of motion of a joint and if found around the spine, they can pinch on nerve roots causing neurological radicular symptoms such as numbness and weakness.

Osteoarthritis is a wear and tear process which is normal as we age. There is a genetic correlation however, this is not the only cause as many environmental and lifestyle factors play a very important role. A list of the most common causes of osteoarthritis can be found below:

• Age: As we get older chances of developing osteoarthritis increase proportionally.
• Gender: According to research women are more likely to develop osteoarthritis at a younger age than men. A common period for early signs of osteoarthritis can be seen in women that are post-menopausal from a younger age (around 40s) than men (around 50s).
• Obesity: Obesity has been seen to correlate with osteoarthritis. This is explained due to the fact that certain joints have to carry a heavier load, which puts more force on them.
• Inflammatory conditions: Conditions such as rheumatoid arthritis, gout and others can potentially cause joint damage and lead to early onset osteoarthritis.
• Joint injury: Trauma to joints from sports, falls, road traffic collisions and other causes can increase the chances of developing osteoarthritis
• Repeated joint injury: Repetitive joint movements over a long period of time can once again increase the chances of developing osteoarthritis. This is commonly seen in the athletic population and certain workers that do specific and repetitive movements.
• Diabetes and certain bone diseases: Diabetes and conditions affecting the levels of calcium and iron in the body can lead to osteoarthritis.

Osteoarthritis is often diagnosed by your GP or by an orthopedic specialist. A physical exam will consist of the specialist having a feel of how the joint is moving, how far it can move, if there is any swelling, heat, crepitus, clicking, popping or tenderness. They will also ask you to do a few active movements and do some muscle testing. The gold standard for clinically diagnosing osteoarthritis is through X-ray.
If there is any doubt about what is going on the specialist may refer you back to your GP who can order a few tests to be done. This may include a blood test or a joint fluid analysis. Further tests may include an X-ray of the affected joint to see the progression of osteoarthritis or an MRI that will provide a detailed insight of the ligament, tendons and surrounding muscles.

Treatment options for the management of osteoarthritis include medication management, surgical management and a physical therapy approach.
Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) in small dosage can help with the management of pain and any low-level inflammation of the affected joint.
Duloxetine is another medication used for the management of pain and it works by affecting the central nervous system.
Low-level opioids are less commonly used for the management of pain in later stages of osteoarthritis.
Corticosteroid injections are only used at late stages of osteoarthritis and once all the other medications have failed.
Surgical: Joint surgery is often used when osteoarthritis has caused damage to the joint and the pain is disabling for the patient.
Joint replacement surgery or lubrication injections may be used in severe cases.
Physical Therapy: Physiotherapy and osteopathy are often used to relieve the symptoms often experienced by osteoarthritis and to help with the recovery or prevention of further joint damage.
Manual therapy will aim at increasing the quantity and quality of movement of the affected joint whilst relaxing all the surrounding muscle tissues.
Rehabilitation exercises in the form of an individualised exercise plan can be formed by your therapist which will help to strengthen and stretch certain muscles around the joint to provide better support and help the joint move through a greater range of motion.

Once a joint has been diagnosed with osteoarthritis it is irreversible. However, this does not mean that symptoms cannot be improved, and the individual cannot carry on normally with their daily activities. An individualised management plan must be formed to help slow down the progression of osteoarthritis.

Once someone has been diagnosed with osteoarthritis it cannot be prevented, however an early diagnosis can help form the correct treatment and management plan that will prevent osteoarthritis from getting worse, thus affecting the individual with their daily activities.

Your physiotherapist and osteopath will form a specific exercise plan for your needs depending on the joint affected and the stage of osteoarthritis of this joint. Exercises will aim to strengthen the surrounding muscles of the joint affected to provide better support. Stretches will be used to improve the range of motion of the joint and to allow for more blood flow to the area which helps with recovery.
Pilates, yoga and tai chi are often used by people suffering from osteoarthritis to once again improve their quality and quantity of movement and help with postural and balance issues that may arise.

Iliotibial syndrome is not an emergency that needs urgent GP intervention. You might try first to rest, carry out some self care adise (e.g. icing, stretching) and exercises. If improvements are not witnessed, your GP might suggest a referral for some physical therapy to better address the syndrome and manage the biomechanical abnormalities that might still persist.

Anandacoomarasamy, A. and March, L., 2010. Current evidence for osteoarthritis treatments. Therapeutic Advances in Musculoskeletal Disease, 2(1), pp.17-28.

Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. and Im, H., 2017. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Research, 5(1).

Hunter, D., McDougall, J. and Keefe, F., 2008. The Symptoms of Osteoarthritis and the Genesis of Pain. Rheumatic Disease Clinics of North America, 34(3), pp.623-643.

Zhang, Y. and Jordan, J., 2010. Epidemiology of Osteoarthritis. Clinics in Geriatric Medicine, 26(3), pp.355-369.