What is Osteoarthritis (OA)?
Osteoarthritis (OA) is the most common lifestyle disease in people over 65 years of age, has been a leading cause of disability globally and one of the most common reason people in Australia see their GP. OA leads to social, psychological and financial difficulties impacting everyday life. 1,2
OA is a degenerative joint disease that refers to the deterioration of the joint cartilage and the underlying bones of the joint, most common in hips, knees and hands. It is characterised by disorders of the synovial joint, including structural defects of the cartilage, loss of bone under the cartilage, joint space narrowing and the formation of osteophytes (bone spurs) on the bone. This leads to instability of the joint due to pain, swelling and decreased mobility. 3
WHAT CAUSES OSTEOARTHRITIS (OA)?
There are many different factors which can contribute to OA with the exact cause unknown. Risk factors of OA include: 2-4
Overweight – being overweight can place additional stress on the joints and contribute to aggravating damage and interfering with the bone remodelling process.
Gender – OA is more common in women than men which has been found to be due to thinner cartilage, tendency for varus alignment of the joints, uneven mechanical loading and due to the decline in sex hormones during menopause.
Age – the risk of developing OA increases as a person ages due to the degenerative changes present in our joints.
Overuse or previous injuries – studies have shown that joints that have undergone trauma are more likely to develop OA compared to joints that haven’t been injured. Therefore, previous injuries or overuse to the joints is a risk factor for developing OA due to previous damage or strain on the joint.
Family history – if one or both parents have osteoarthritis, the risk of their child having OA as an adult is increased. The best way to modify this genetic link is to adopt a healthy lifestyle.
These risk factors can contribute to increased pain and disability in people with OA. Pain is complex and everyone has various attitudes and beliefs towards pain which can influence the level of disabilities. Some more factors include stress, depression, fear of damage, lack of joint confidence, poor sleep and poor mood. 3
WHAT ARE THE SIGNS AND SYMPTOMS?
The signs and symptoms of OA vary greatly between individuals, depending on the many factors mentioned above. 1-4 Some signs and symptoms include:
Pain – pain can be produced with movements or while resting and may be sharp or a constant ache.
Swelling – as part of the inflammatory response with OA, the joint may become hot or swollen.
Stiffness – commonly OA can result in stiffness in the morning or after long periods of sitting.
Reduced range of motion – OA can make it difficult to move the joints resulting in a loss of movement.
Crunching or clicking in the joint – when completing everyday activities the joint may feel like it clicks or crunches rather than moving smoothly.
As a result of the signs and symptoms, OA can impact many everyday activities such as:
Putting on socks and shoes
Standing up from a chair
Standing or walking for a long time
Going up or down stairs
Running
Gardening
Leisure activities and sports
HOW CAN YOU MANAGE OSTEOARTHRITIS (OA)?
OA is commonly believed to be caused by wear and tear of the articular cartilage within the joint but is now more commonly referred to as a chronic whole joint disorder. 5
OA impacts the whole joint including the cartilage, menisci, articular capsule, synovial fluid, ligaments and muscles. Articular cartilage in the joints allows the bones slide easily when moving, absorbs shock, distributes load and has no nerves or blood supply. OA impacts the articular cartilage and changes the structure of the joint, causing pain and dysfunction. 5,6
The ends of the bone are covered in cartilage which are surrounded by articular capsule which produces synovial fluid. Synovial fluid in our joints lubricates and nourishes the cartilage as cartilage has no blood supply. To provide nourishment to the cartilage you need dynamic load (walking/physical activity) with cycles of loading and unloading of the joint. The cartilage acts similar to a sponge with pressure pushing fluid in and when the pressure is released the cartilage absorbs the fluid. 6
REHABILITATION/PHYSIOTHERAPY:
The treatment principles for OA are to reduce pain and stiffness while maintaining function. The first part of treatment for OA is patient education which has been shown to greatly influence pain and function in the short term. 6,7
There is strong evidence for education, exercise and weight control to the first line of treatment for patients suffering from OA. By providing an understanding of the condition, the anatomy of the joints and why the pain is occurring the patient is able to appreciate the management plan moving forward. This is an important aspect of the treatment to promote positive and optimistic attitudes towards the condition, empowering the patient to help manage their pain. 5,6,8
The education aspect of OA also details lifestyle habits, regular exercise, pharmaceutical approaches, weight management and assistive devices that could be used throughout the rehabilitation. Weight loss can help reduce the symptoms of OA by decreasing the amount of strain on the joints. The rehabilitation process also involves providing guidance on maintaining healthy lifestyle habits and assisting with weight loss. Assistive devices can often be needed to compensate for decreased strength and impaired pain during exercise. Common devices include crutches, walking sticks, knee braces or taping to reduce the pain and swelling associated with OA. 7,8
According to the recommendations from the International Association for the Study of OA (OARSI), exercise is considered a core approach to the treatment of OA and is recommended for all patients.6 Exercise therapy or physiotherapy is part of the first line treatment of OA because of the ease of access, low cost, reductions in pain experienced and improved physical function.
Muscle weakness is a frequent and early finding for patients with OA which predicts more pain and greater functional decline in symptoms. The most common exercises used to treat OA include aquatic exercise, aerobic exercise, resistance exercise, multimodal exercise and combination exercise. Resistance exercise or strength training is the most effective against muscle weakness and aerobic exercise is the most commonly used to help reduce pain and improve physical function. The research around the exercises suggests a combination of exercises is most effective for OA to improve strength, flexibility and mobility of the joints. By improving these factors, the patient is able to gain more confidence in their joints and experience less symptoms in their everyday activities. 6,7,8
The second line of treatment can involve some pharmaceutical relief provided by GP or doctor to help manage the pain and inflammation in the knee. If the knee is not progressing with the education, exercise or medication use the last line of treatment is surgery for a replacement. Arthroscopes or small surgeries are not recommended as it does not fix the underlying issue. Therefore, a replacement surgery is recommended after 6 months of conservative treatment hasn’t improved and whose condition severely affects daily living. 5,6
REFERENCES:
Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., & Lu, H. (2020). Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine, 29-30(100587), 100587. https://doi.org/10.1016/j.eclinm.2020.100587
Du, X., Liu, Z., Tao, X., Mei, Y., Zhou, D., Cheng, K., Gao, S., Shi, H., Song, C., & Zhang, X. (2023). Research Progress on the Pathogenesis of Knee Osteoarthritis. Orthopaedic Surgery, 15(9), 2213–2224. https://doi.org/10.1111/os.13809
Yao, Q., Wu, X., Tao, C., Gong, W., Chen, M., Qu, M., Zhong, Y., He, T., Chen, S., & Xiao, G. (2023). Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduction and Targeted Therapy, 8(1). https://doi.org/10.1038/s41392-023-01330-w
Scheuing, W. J., Reginato, A. M., Deeb, M., & Acer Kasman, S. (2023). The burden of osteoarthritis: Is it a rising problem? Best Practice & Research Clinical Rheumatology, 37(2), 101836. https://doi.org/10.1016/j.berh.2023.101836
Gibbs, A., Gray, B., Wallis, J., Taylor, N. F., Kemp, J. L., Hunter, D. J., & Barton, C. J. (2023). Recommendations for the management of hip and knee osteoarthritis: a systematic review of clinical practice guidelines. Osteoarthritis and Cartilage, 31(10). https://doi.org/10.1016/j.joca.2023.05.015
Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., Kraus, V. B., Lohmander, L. S., Abbott, J. H., Bhandari, M., Blanco, F. J., Espinosa, R., Haugen, I. K., Lin, J., Mandl, L. A., Moilanen, E., Nakamura, N., Snyder-Mackler, L., Trojian, T., & Underwood, M. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11). https://doi.org/10.1016/j.joca.2019.06.011
Geng, R., Li, J., Chen, Y., Zhang, C., Chen, F., Chen, J., Ni, H., Wang, J., Kwon Kyoo Kang, Wei, Z., Xu, Y., & Jin, T. (2023). Knee osteoarthritis: Current status and research progress in treatment (Review). Experimental and Therapeutic Medicine, 26(4). https://doi.org/10.3892/etm.2023.12180
Henriksen, M., Christensen, R., Kristensen, L. E., Bliddal, H., Bartholdy, C., Boesen, M., Ellegaard, K., Guldberg-Møller, J., Hunter, D. J., Altman, R., & Bandak, E. (2023). Exercise and education versus intra-articular saline for knee osteoarthritis: A 1-year follow-up of a randomized trial. Osteoarthritis and Cartilage, 31(5), S1063-4584(23)000213. https://doi.org/10.1016/j.joca.2022.12.011
