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The term arthritis means inflammation of the joints, and refers to a group of over 200 diseases of the joints.
Osteoarthritis is the most common type of arthritis. Osteoarthritis is uncommon in people under the age of 40 but becomes more common with age. The majority of people with this condition are over 65 years.
Osteoarthritis (OA) is a degenerative disease that most commonly affects joints in the hands, knees, hips, feet and spine. As the disease progresses, the cartilage that protects the bone becomes roughened, then thins and wears away. The body tries to compensate for this, which causes the outer edges of the bones to thicken and change shape so that outgrowths, known as osteophytes, form at the outer edges. At the same time, the membranes lining the joints can become inflamed.
Chalky deposits of calcium crystals can form in the cartilage in severe osteoarthritis. This is called calcification. These calcium crystals can shake loose from the cartilage, and cause the joint to become hot, red and swollen (pseudogout).
What increases the chance of osteoporosis?
The risk factors associated with osteoarthritis include:
- obesity (which puts added strain on some joints)
- joint injury or overuse (professional sportspeople are particularly prone)
- family history of osteoarthritis
Sometimes people with rheumatoid arthritis develop so-called secondary osteoarthritis in the joints where their rheumatoid arthritis was active.
The main symptoms of osteoarthritis are pain, stiffness and swelling of the joints. The joint may have limited motion, and there may be tenderness or deformity. The joint may also crack or creak (this is called crepitation).
When the joint becomes severely damaged, it may become misshapen, with bony swellings, and unstable. This puts stress on the ligaments and tissues surrounding the joints and can lead to deformity.
The doctor will take a medical history and examine the affected joints, looking for any sign of bony swellings, creaking and instability of the joint, as well as reduced movement.
There is no blood test for osteoarthritis, but blood may be taken to exclude other types of arthritis. The most useful test for osteoarthritis is an X-ray. This can show the narrowed space between the bones in a joint due to cartilage loss. It can also identify any calcification that has occurred.
Reducing stress on affected joints is one of the most important things you can do to relieve osteoarthritis. You can reduce stress on painful joints in your feet, knees, hips and back by:
- keeping to your ideal weight - if you are overweight, try to reduce your weight. This will probably involve changing your eating habits.
- wearing good shock absorbent shoes with thick, soft soles - trainers are ideal
- trying to avoid activities which put undue strain on your joints, such as prolonged kneeling
- use a stick to take some of the weight off your joints
Regular exercise is also important, regardless of your age. Activities such as swimming and cycling are ideal, as they do not put a strain on the joints. You will not wear out your joints still further by exercising - exercise can help keep the joints moving and as supple as possible. If in doubt, talk to your doctor or physiotherapist, who will help you to plan an exercise routine tailored to your needs.
The aims of medical treatment are pain relief, optimising joint function and limiting deterioration. Pain relief is the main reason people seek help for their osteoarthritis.
A simple painkiller such as paracetamol is usually tried first. Combined painkillers - such as co-proxamol, co-codamol or co-dydramol- may be effective. These are a combination of paracetamol and codeine, a stronger painkiller, and are available on prescription from a doctor.
If there is inflammation as well as pain in the joints, you may be prescribed a non steroidal anti-inflammatory drug (NSAID) such as ibuprofen. All NSAIDs have analgesic and anti-inflammatory properties to reduce pain, stiffness and swelling. They are used widely in osteoarthritis and are a great help to some people. However, they can cause gastro-intestinal side-effects, such as indigestion and diarrhoea, and with regular use there is also a risk of bleeding in the stomach. Also, in people with asthma, they can trigger attacks.
Cream and gels containing NSAIDs can help and do not usually have the same gastro-intestinal side-effects.
This relatively new class of medicines is related to NSAIDs but is intended to have fewer gastro-intestinal side-effects. These include rofecoxib (Vioxx) and celecoxib (Celebrex).
Steroid injections, usually into a knee or the spine, may be an effective way of reducing the pain and swelling associated with osteoarthritis. This treatment is usually reserved for very painful joints. The effects of the injection will eventually wear off after 1- 4 weeks, and the procedure will have to be repeated. An injection of another drug called hyaluronic acid into the knee joint may reduce pain for 1-6 months.
Surgery can be successfully used in osteoarthritis either to replace a hip or knee joint with an artificial one (a prosthesis) or to fuse joints in the spine to alleviate pain and create stability.
Hip replacements can give people a new lease of life, with improved mobility and relief of pain. Hip replacements are usually effective for at least 10 years, after which time they generally need to be replaced. Replacing the knee is a more complicated procedure, since the joint is more complex than the hip, but can also bring great improvements in quality of life.
However, the operations carry the risks associated with major surgery, such as infection and deep vein thrombosis.
1. Will eating oily fish or taking fish oil supplements help osteoarthritis?
There isn't any evidence to show that fish oils are helpful in improving osteoarthritis.
Fish oils contain omega-3 polyunsaturated fatty acids. Some research has suggested that these fatty acids may have a beneficial effect in inflammatory forms of arthritis, including rheumatoid arthritis, reactive arthritis, psoriatic arthritis and ankylosing spondylitis. There is evidence to suggest that omega-3 fatty acids may help to reduce the inflammation associated with these forms of arthritis.
However, studies looking at the effect of fish oils on osteoarthritis have produced disappointing results and more research is needed.
2. I don't like swimming. Is there another form of exercise that will help osteoarthritis?
Yes. A mix of different types of exercise is ideal. However, before you start, get advice from your GP, physiotherapist or occupational therapist so that an exercise programme can be tailored to your needs.
When you're in pain you may not feel like exercising but there are three types of exercise that can bring real benefits.
- Strengthening exercises target the muscles around affected joints and improve your stability. They can also help to reduce pain.
- Exercises that involve moving your joints through their full range of movement help you to stay flexible and improve your strength and posture. Slowly build up and increase how far you move your joints. Aim to do these exercises in each joint of your body every day.
- Aerobic exercise that increases your heart rate and makes you slightly out of breath can help reduce pain, and also improves your general health and wellbeing. Walking, cycling, dancing or everyday activities such as housework can help.
Some tips that may help you when exercising include the following.
- Make exercise part of your daily routine and build up slowly.
- Have a warm bath or shower, or place a hot water bottle on affected joints before exercising.
- Never force a painful joint. It's common to feel some pain as you build up your exercise programme. However, if any pain lasts longer than two hours after exercising, contact your GP.
- Always wear cushioned and supportive footwear.
3. Can I take glucosamine if I have a shellfish allergy?
Generally no. Glucosamine is usually made from shellfish, so you shouldn't take it if you're allergic to shellfish.
Some vegetarian versions of glucosamine are available that may be suitable if you have a shellfish allergy. It's important to speak to your GP before taking any sort of glucosamine.
Glucosamine may provide some pain relief for people with osteoarthritis, although there is only limited evidence that it's effective. If you have an allergy to shellfish, it's best not to take glucosamine at all. The supplement is made from shellfish shells. Some experts say shellfish allergy is caused by shellfish flesh rather than the shell, but it's possible that you will have an allergic reaction to glucosamine if you have a shellfish allergy. Speak to your GP if you're considering taking glucosamine.
The supplement chondroitin, often taken with glucosamine, isn't made from shellfish. However, there is only limited evidence to show that chondroitin is effective in treating osteoarthritis.
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