Osteoarthritis - Living with

 With the right support, you can lead a healthy, active life with osteoarthritis. Osteoarthritis doesn’t necessarily get worse and doesn’t always lead to disability.

Self-care

Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing with support from those involved in your care. Self-care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously if they receive support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and are more active and independent.

Living healthily

A good diet and regular exercise will help keep muscles strong and control your weight, which is good for osteoarthritis and also has other health benefits.

Take your medication

It is important to take your medication as prescribed, even if you start to feel better. Continuous medication can sometimes help prevent pain, although if your medications have been prescribed ‘as required’, you may not need to take them in between painful episodes. If you have any questions or concerns about the medication you're taking or any side effects you think you may be experiencing, talk to your healthcare team.

It may also be useful to read the information leaflet that comes with the medication, which will tell you about possible interactions with other drugs or supplements. Check with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements, as these can sometimes interfere with your medication.

Regular reviews

Because osteoarthritis is a long-term condition, you'll be in regular contact with your healthcare team. A good relationship with the team means that you can easily discuss your symptoms or concerns. The more the team knows, the more it can help you.

Vaccinations

People with long-term conditions such as osteoarthritis are often encouraged to get an annual flu jab each autumn to protect against flu.

You may also be advised to get a pneumoccocal vaccination. This is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia.

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Osteoarthritis - Prevention

 It is not possible to prevent osteoarthritis altogether. However, you may be able to minimise your risk of developing the condition by avoiding injury and staying as healthy as possible.

Look after your joints

Exercising regularly can help keep your joints healthy, but take care not to put too much stress on your joints, particularly your hips, knees and the joints in your hands.

Avoid exercise that puts strain on your joints and forces them to bear an excessive load, such as running and weight training. Instead, try exercises such as swimming and cycling, where your joints are better supported and the strain on your joints is more controlled.

Try to maintain good posture at all times, and avoid staying in the same position for too long. If you work at a desk, make sure your chair is at the correct height, and take regular breaks to move around.

Keep your muscles strong

Your muscles help support your joints, so having strong muscles may help your joints stay strong too.

Try to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week to build up your muscle strength and keep yourself generally healthy.

Exercise should be fun, so do what you enjoy, but try not to put too much strain on your joints.

Lose weight if you are overweight or obese

Being overweight or obese can increase the strain on your joints and increase your risk of developing osteoarthritis. Losing weight if you are overweight may therefore help lower your chances of developing the condition.

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Osteoarthritis - Causes

 Osteoarthritis occurs when there is damage in and around the joints that the body can't fully repair. The exact causes are not known but there are several factors thought to increase your risk of developing the condition.

As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body will repair the damage itself. Usually, the repair process will pass unnoticed and you will not experience any symptoms.

However, in cases of osteoarthritis, the damage to the joints is not fully repaired and instead some of the cartilage (the protective surface that allows your joints to move smoothly) in the joint can be lost, bony growths can develop, and the area can become slightly inflamed (red and swollen).

These changes are what cause the typical symptoms of pain, stiffness and swelling.

Contributory factors

It is not known why problems develop in the repair process in cases of osteoarthritis, although, several factors are thought to increase your risk of developing the condition. These include:

    Joint injury – Osteoarthritis can develop in a joint damaged by an injury or operation. Overusing your joint when it has not had enough time to heal after an injury or operation can also contribute to osteoarthritis in later life.
    Other conditions (secondary arthritis) – Sometimes, osteoarthritis can occur in joints severely damaged by a previous or existing condition, such as rheumatoid arthritis or gout. It is possible for secondary osteoarthritis to develop many years after the initial damage to your joint.
    Age – Osteoarthritis is not a normal part of ageing, but your risk of developing the condition does increase as you get older. Most cases affect adults who are 45 years of age or older.
    Family history – In some cases, osteoarthritis may run in families. Genetic studies have not identified a single gene responsible, so it seems likely that many genes make small contributions.
    Obesity – Research into the causes of osteoarthritis has shown that being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips. As a result, osteoarthritis can often be worse in obese people.

Although it is not possible to prevent osteoarthritis altogether, making some lifestyle changes to reduce your risk of joint injury and maintain a healthy weight may lower your chances of developing the condition.

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Osteoarthritis - Diagnosis

 There is no definitive test to diagnose osteoarthritis, so your GP will ask about your symptoms and examine your joints to help determine whether you have the condition.

Your GP may suspect osteoarthritis if:

    you are 45 years of age or older
    you have joint pain that gets worse the more you use your joints
    you have stiffness in your joints in the morning that lasts less than 30 minutes, or no stiffness at all

If your symptoms are slightly different from those listed above, this may indicate that you have another joint condition. For example, prolonged joint stiffness in the morning can be a sign of rheumatoid arthritis.

Further tests – such as X-rays or blood tests – are not usually necessary to confirm a diagnosis of osteoarthritis, although they may be used to rule out other possible causes of your symptoms, such as rheumatoid arthritis or a fractured bone.

X-rays can also allow doctors to assess the level of damage to your joints, but this is rarely helpful as the extent of damage visible on an X-ray isn’t a good indicator of how severe your symptoms are.

tags: Osteoarthritis - Diagnosis, Diagnosis, Osteoarthritis, There is no definitive test to diagnose osteoarthritis, so your GP will ask about your symptoms and examine your joints to help determine whether you have the condition.

Osteoarthritis - Symptoms

 The main symptoms of osteoarthritis are pain and stiffness in your joints, which can make it difficult to move the affected joints and do certain activities.

The symptoms may come and go in episodes, which can be related to things such as your activity levels and even the weather. In more severe cases, the symptoms can be continuous.

Other symptoms you or your doctor may notice include:

    joint tenderness
    increased pain and stiffness when you have not moved your joints for a while
    joints appearing slightly larger or more 'knobbly' than usual
    a grating or crackling sound or sensation in your joints
    limited range of movement in your joints
    weakness and muscle wasting (loss of muscle bulk)

Osteoarthritis can affect any joint in the body, but the most common areas affected are the knees, hips, and small joints in the hands. Often, you will only experience symptoms in one joint or a few joints at any one time.

Osteoarthritis of the knee

If you have osteoarthritis in your knees, it is likely both your knees will be affected over time, unless it has occurred as the result of an injury or another condition affecting only one knee.

Your knees may be most painful when you walk, particularly when walking up or down hills or stairs.

Sometimes, your knees may 'give way' beneath you or make it difficult to straighten your legs. You may also hear a soft, grating sound when you move the affected joint.

Osteoarthritis of the hip

Osteoarthritis in your hips often causes difficulty moving your hip joints. For example, you may find it difficult to put your shoes and socks on or to get in and out of a car.

You will also usually have pain in the groin or outside the hip. This will often be worse when you move the hip joints, although it can also affect you when you are resting or sleeping.

Osteoarthritis of the hand

Osteoarthritis often affects three main areas of your hand: the base of your thumb, the joints closest to your fingertips and the middle joints of your fingers.

Your fingers may become stiff, painful and swollen and you may develop bumps on your finger joints. But over time the pain may decrease and eventually disappear altogether, although the bumps and swelling can remain.

Your fingers may bend sideways slightly at your affected joints or you may develop painful cysts (fluid-filled lumps) on the backs of your fingers.

In some cases, you may also develop a bump at the base of your thumb where it joins your wrist. This can be painful and you may find it difficult to perform some manual tasks, such as writing, opening jars or turning keys.

When to seek medical advice

You should see your GP if you have persistent symptoms of osteoarthritis so they can try to identify the cause.

To help determine whether you have osteoarthritis, your GP will ask you about your symptoms and examine your joints.

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Osteoarthritis - Treating osteoarthritis

 There is no cure for osteoarthritis, but the condition doesn’t necessarily get any worse over time and a number of treatments are available to help relieve the symptoms.

The main treatments for osteoarthritis include lifestyle measures – such as maintaining a healthy weight and exercising regularly – medication to relieve your pain, and supportive therapies to help make everyday activities easier.

In a few cases, where other treatments have not been helpful, surgery to repair, strengthen or replace damaged joints may also be considered.

Exercise

Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.

If osteoarthritis causes you pain and stiffness, you may think exercise will make your symptoms worse.

But usually, regular exercise that keeps you active and mobile and builds up muscle, thereby strengthening the joints, will improve symptoms.

Exercise is also good for losing weight, improving your posture and relieving stress, all of which will ease symptoms.

Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from your exercise programme and can give you an exercise plan to follow at home.

It's important to follow this plan because there is a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints.

Losing weight

Being overweight or obese often makes osteoarthritis worse as it can place some of your joints under increased strain.

If you are overweight, try to lose weight by doing more physical activity and eating a healthier diet.

Discuss any new exercise plan with your GP or physiotherapist before you start. They can help plan a suitable exercise programme for you. Your GP and practice nurse can also advise about how to lose weight slowly and safely.

Medication

 Your doctor will talk to you about medicines which can control symptoms of osteoarthritis, including painkillers.

Sometimes a combination of therapies – medicines, exercise, assistive devices or surgery – may be needed to help control your pain.

Painkillers

The type of painkiller (analgesic) your GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are described below.

Paracetamol

If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable.

However, when taking paracetamol, always follow the dosage your GP recommends and do not exceed the maximum dose stated on the pack.

Non-steroidal anti-inflammatory drugs (NSAIDs)

If paracetamol does not effectively control the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are painkillers that work by reducing inflammation. There are two types of NSAID and they work in slightly different ways:

    traditional NSAIDs – such as ibuprofen, naproxen or diclofenac
    COX-2 inhibitors – often called coxibs – such as celecoxib and etoricoxib

Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.

Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.

NSAID tablets may not be suitable for people with certain conditions, such as asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke. If you are taking low-dose aspirin, ask your GP whether you should use an NSAID.

If your GP recommends or prescribes an NSAID to be taken by mouth, they will usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.

COX-2 drugs have a lower risk of causing stomach problems, but still need to be used with a PPI if you take them regularly.

Opioids

Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.

Codeine is found in combination with paracetamol in common preparations such as co-codamol.

Other opioids that may be prescribed for osteoarthritis include tramadol (brand names include Zamadol and Zydol), and dihydrocodeine (brand name DF 118 Forte). Both come in tablet form and as an injection.

Tramadol is not suitable if you have uncontrolled epilepsy, and dihydrocodeine is not recommended for patients with chronic obstructive pulmonary disease (COPD).

If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.

Capsaicin cream

If you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.

Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first two weeks of using the cream, but it may take up to a month for the treatment to be fully effective.

Apply a pea-sized amount of capsaicin cream to your affected joints up to four times a day, but not more often than every four hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.

Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours. However, it will not cause any damage.

You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.

Corticosteroid injections

If your osteoarthritis is severe, treatment using painkillers may not be enough to control your pain.

In this case, you may be able to have a type of treatment where medicine is injected into the joints affected by osteoarthritis. This is known as intra-articular injection.

If you need intra-articular injections, it is likely that you will have injections of corticosteroid, a medicine that reduces swelling and pain.

If you get a prolonged response to the injection, it may be repeated. Ideally, you should have no more than three corticosteroid injections a year, with at least a three-month gap between injections.

Supportive treatments

In addition to lifestyle changes and medication, you may also benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) uses a machine that sends electrical impulses through sticky patches, called electrodes, attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.

Treatment with TENS is usually arranged by a physiotherapist, who can advise on the strength of the pulses and how long your treatment should last.

Hot or cold packs

Applying hot or cold packs (sometimes called thermotherapy or cryotherapy) to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.

Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.

Manual therapy

Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a treatment provided by a physiotherapist. It uses stretching techniques to keep your joints supple and flexible.

Assistive devices

If your osteoarthritis causes mobility problems or difficulty performing everyday tasks, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.

If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes. Footwear with shock-absorbing soles can help relieve some of the pressure on the joints of your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.

If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.

A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.

If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks far more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace.

Surgery

Surgery for osteoarthritis is only needed in a small number of cases where other treatments have not been effective or where one of your joints is severely damaged.

If you may need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life. However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness due to your condition.

There are several different types of surgery for osteoarthritis. Some of the main types of surgery carried out are described below.

Arthroplasty

Joint replacement therapy, also known as an arthroplasty, is most commonly carried out to replace hip and knee joints.

During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years, although it may eventually need to be replaced.

There is also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.

Arthrodesis

If joint replacement is not suitable for you, your surgeon may suggest an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

If you have osteoarthritis in your knees but you are not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.

This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.

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Osteoarthritis

 Osteoarthritis is a condition that causes the joints to become painful and stiff. It is the most common type of arthritis in the UK.

The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints. For some people, the symptoms may be mild and may come and go, whereas others can experience more continuous and severe problems.

Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips, and small joints of the hands.

The pain and stiffness in the joints can make carrying out everyday activities difficult for some people with the condition.

Read more about the symptoms of osteoarthritis.

When to seek medical advice

You should see your GP if you have persistent symptoms of osteoarthritis so they can try to identify the cause.

To help determine whether you have osteoarthritis, your GP will ask you about your symptoms and examine your joints.

Read more about diagnosing osteoarthritis.

What causes osteoarthritis?

Osteoarthritis occurs when there is damage in and around the joints that the body cannot fully repair.

It's not clear exactly why this happens in some people, although your chances of developing the condition can be influenced by a number of factors, such as your age and weight.

Osteoarthritis usually develops in people over 45 years of age, although younger people can also be affected.

It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true. You may in fact be able to reduce your chances of developing the condition by doing regular, gentle exercises and maintaining a healthy weight.

Read more about the causes of osteoarthritis and preventing osteoarthritis.

Managing osteoarthritis

Osteoarthritis is a long-term condition and can't be cured, but it doesn't necessarily get any worse over time and it can sometimes gradually improve. A number of treatments are also available to reduce the symptoms.

Mild symptoms can sometimes be managed with simple measures including regular exercise, losing weight if you are overweight, wearing suitable footwear and using special devices to reduce the strain on your joints during your everyday activities.

If your symptoms are more severe, you may need additional treatments such as painkilling medication and a structured exercise plan carried out under the supervision of a physiotherapist.

In a small number of cases, where the above treatments haven't helped or the damage to the joints is particularly severe, surgery may be carried out to repair, strengthen or replace a damaged joint.

Read more about treating osteoarthritis.

Living with osteoarthritis

As osteoarthritis is a long-term condition, it is important you get the right support to help you cope with any issues such as reduced mobility and advice on any necessary financial support.

As well as support from your healthcare team, it is important to look after your own health and wellbeing. This includes taking your medicine regularly and adopting as healthy a lifestyle as possible.

Some people may also find it helpful to talk to their GP or others who are living with the same condition as there may be questions or worries you want to share.

Read more about living with osteoarthritis.

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