Arthritis is one of the most common terms we hear in the medical world.

Arthritis can cause varying degrees of joint pain and stiffness.

You CAN help ease and manage the symptoms associated with arthritis.

Arthritis is a general term used to describe pain and stiffness in the joints. There are more than 100 different types of arthritis and they all differ in cause, presentation and treatment. The 2 most common types of arthritis are: Rheumatoid arthritis and Osteoarthritis and for the purpose of this blog I am going to focus on the latter.

WHAT IS OSTEOARTHRITIS (OA)?

Osteoarthritis most commonly effects synovial joints. A joint is a space between 2 bones and an example of a synovial joint is the knee joint which is a space between the thigh bone (or femur) and the shin bone (or tibia). Bone is a living tissue. It has a blood and nerve supply. The lining of bones is called the periosteum and it contains numerous receptors that are sensitive to changes in load and pressure. Continuous with the periosteum is a fibrous capsule. This forms the outer layer of the synovial capsule.

To protect our bones there is a lining of articular cartilage which is designed to absorb some of the loads imposed on our joints during our daily activities. This cartilage is also lubricated with a fluid (synovial fluid) that ensures the joint moves smoothly. Similar to WD40! It also provides the joint with all the nutrients it needs to function.

During osteoarthritis the articular cartilage that lines the ends of your bones degrades and the bone underneath is remodelled. This occurs due to certain cells becoming overactive. The cells release enzymes that cause the breakdown of the cartilage structure. This in turn exposes the bone beneath and it effects the load bearing capacity of the joint structure. The process of sclerosis then occurs (which is an abnormal hardening of the bone structure) and osteophytes (small bony lumps or spurs) develop as well as cysts.  The space within the joint gradually breaks down and the joint struggles to function effectively.

WHAT SYMPTOMS DOES OSTEOARTHRITIS CAUSE?

The main symptoms that develop as a result of this process include:

Pain: this can vary between individuals and overall the source of pain is not particularly well understood. Articular cartilage does not contain a blood or nerve supply so it can not directly create the symptoms of pain and stiffness or any of the others issues associated with the condition. It is the periosteum (lining of the bone) and the bone beneath the cartilage in addition to other structures in the joint that are full of nerve endings and blood supply. These are the multiple sources of pain.  You must remember that pain is subjective and there are numerous factors that contribute to it. I have treated some patients that are diagnosed by X ray with severe osteoarthritis and suffer very little pain and others that have low grade osteoarthritis and unfortunately have significant pain.

Pain is obviously the first reason we tend to seek professional input. It is often described as a deep aching sensation around or in the effected joint. It usually occurs with activity but in more advanced cases it will also be present during rest. With many factors influencing the cause of pain each patient with osteoarthritis may present differently and what helps one individual may not help another. As a result a bespoke treatment programme is always best advised to get the best results.

Stiffness and reduced range of movement; as the joint space reduces and sclerosis sets in the joint will start to stiffen. The ability to fully straighten the knee is one of the most common changes I see during the early stages of osteoarthritis but prior to this patients tend to notice that their joints feel quite stiff, especially first thing in the morning or after a period of rest or inactivity. A feeling of ‘giving way’ can also sometimes be described.

Swelling/ joint changes: the effected joints can start to appear slightly thicker. There may be a soft fluid around the joint which develops as the joint becomes inflamed and irritated. This is seen commonly in the fingers. Swelling can restrict the range through which you can move the joints.

WHAT CAUSES OSTEOARTHRITIS?

Osteoarthritis is still a huge area of medical research. To be honest, we still don’t really know why it effects some people and not others. There certainly seems to be a genetic link. Some rare forms of osteoarthritis are linked to mutations of single genes that effect the protein collagen that is present in articular cartilage.  The following are also similar trends that are seen in those with osteoarthritis:

Age and gender: the majority of patients with osteoarthritis tend to be in their 40s or above and the condition tends to be more common in women.

Previous injury or trauma: those that have suffered previous trauma to their joints including surgical interventions can be at greater risk of developing osteoarthritis.

Joint abnormalities: congenital joint disorders can result in altered joint loads which in turn increases risk of osteoarthritis.

Obesity: any increased weight imposed onto the joints will increase the strain they are put under and thus the more load the cartilage has to withstand. Reducing weight can help ease the symptoms of osteoarthritis.

DIAGNOSIS OF OSTEOARTHRITIS AND THE ROLE OF SCANS AND IMAGING

In clinical practice a detailed examination is required to confirm the diagnosis of osteoarthritis. This will involve taking a detailed history of your symptoms and a thorough physical examination. Imaging in the form of an X ray or MRI will then help to confirm the proposed diagnosis and rule out any other suspected conditions. It is important to understand that a full clinical picture must be made. Radiographs can be insensitive to the early changes seen in osteoarthritis so a clear X -ray does not rule out the condition. Conversely, a positive X ray does guarantee that osteoarthritis is the cause of symptoms. We can always find abnormalities on scans. None of us are a perfect, walking human specimen. A detailed examination and understanding of your symptoms is essential before a solid diagnosis is made.

Some of the possible physical features seen in a patient with osteoarthritis include:

  1. Tenderness, usually around the joint line.
  2. Reduced muscle bulk around the effected joint and reduced muscle strength.
  3. Altered walking pattern.
  4. Swelling of the effected joint(s).
  5. Giving way
  6. Reduced joint range.
  7. Deformity or change in appearance of the effected joint. (Some can become quite thickened).
  8. A feeling of grinding within the joint.

WHAT CAN I DO TO HELP MANAGE OSTEOARTHRITIS?

Though it may become quite painful to move your joints when you have osteoarthritis physical activity is actually the best treatment! It is the type of exercises and the amount that you do that is the secret and this will differ from one person to the next. Working with a healthcare professional in the early stages will help you develop the best management strategy.

Non-impact exercise like cycling on a static bike can be very effective in reducing joint stiffness and the cyclical movement helps to lubricate the joint surface. This is often the best alternative to impact exercises like running that can become painful. Starting with a gentle 10 minutes 3-4 times a week and building to 30 minutes on an interval programme (low to moderate resistance, as able) is a protocol I recommend frequently.

As osteoarthritis develops muscle bulk also decreases around the effected joints. Your muscles are essential in helping absorb some of the loads that our joints are subjected to so reduced muscle mass results in increased joint stress. Resistance based exercises can be selected to specifically load the muscles in a gentle, pain free manner. As muscle builds it will help reduce the burden imposed on the joints.

Exercise in combination with a good diet will also help with weight management which in turn further reduces joints stress. Consider gentle walks, tai chi, swimming and aqua classes. Overall some form of change needs to be imposed within your lifestyle if you wish to see a change in your symptoms. It is often frustrating that the one type of exercise you like to do becomes difficult to participate in but it is possible to find alternatives. The most important thing is that you maintain some form of physical activity.

If you find that movement is simply too painful then medication and other alternatives can be used to tackle this. Half the battle is trying to find that window of reduced pain so that exercise becomes easier. Over time the improvement in mobility and strength should then see further reductions in pain levels.

Diet plays an important role. Your body will use the nutrients that you provide it to ensure all the structures e.g. bone, ligaments and cartilage are in optimal working order. Eating a healthy, balanced diet should ensure you get all you need. There are certain studies that have shown the specific effects of certain nutrients on bone health e.g. foods rich in vitamin C, especially fruit and vegetables and Omega-3 fatty acids found in fish and fish oils but variety is the key. Regular consumption of fast foods or processed meals will only concentrate higher amounts of unwanted nutrients like salt and additives in your body leading to poor joint health.

Remember that if symptoms have developed something is going to need to change to address them. Take a proactive approach as early as possible and do not be afraid to ask for help. Physical therapists specialise in the treatment of conditions such as arthritis and can provide you with all the support you need. It can be a very isolating condition and surrounding yourself with those who understand you can be very comforting.

SO IN SUMMARY……….

  • There are many different types of arthritis and knowing how to address symptoms will be individual to you.
  • Osteoarthritis most commonly effects the hips, knees and hands.
  • Though movement can become uncomfortable physical exercise is proven to be the most effective treatment. Knowing what to do and how much of it is the first factor to address.
Davina Sherwood
Specialist Musculoskeletal Physiotherapist