Osteoarthritis is believed to affect approximately 10% of the English population. The risks increase with advancing age and this condition affects a large majority of over 70 year-olds. What causes osteoarthritis? Can it be prevented or slowed down? What treatments are available and how is it diagnosed? Senior Home Plus can answer your questions and provide advice.
Osteoarthritis is caused by excessive wear and tear of the cartilage. It leads to considerable joint pain and is debilitating to varying degree.
These risks obviously increase with age, since a large majority of individuals over 70 are affected by osteoarthritis. Although no cure has been found for this condition so far, several medical treatments, amongst others, can provide substantial pain relief.
Good outcomes can be achieved with hip and knee replacements in particular, in a bid to avoid paralysis. This will hopefully allow elderly people with osteoarthritis to remain independent for many years to come.
What is osteoarthritis and what are the symptoms?
Osteoarthritis is a condition caused by the degeneration of joint cartilage. It is a chronic disease. Prevention and care are essential to improve the daily lives of elderly individuals. Early diagnosis is fundamental for improved disease management.
The symptoms of osteoarthritis vary from one individual to the next, but generally involve the following:
Joint pain on executing a movement. This pain usually increases throughout the day and can even disrupt sleep.
The appearance of excess bone growth.
Joint sensitivity on applying pressure.
A cracking sensation.
Stiffness and a lack of flexibility in the joint, particularly in the morning, as this type of stiffness usually occurs after a period of immobility.
Uncomfortable flexing of the joints during temperature variations.
Inflammation triggering pain, redness and swelling.
How is osteoarthritis diagnosed?
Osteoarthritis is diagnosed from a clinical examination of the joints in order to detect potential malformations. A full radioscopy will confirm the diagnosis.
The following four signs appear on examination:
Joint impingement due to destruction of the cartilage.
A hole in the bone surrounding the joint.
Bone growth or osteophytes.
Condensation of the bone beneath the cartilage.
What are the different types of osteoarthritis?
Two types of osteoarthritis have been identified:
Primary osteoarthritis in an individual who has no history of the disease and is not predisposed to the condition.
Secondary osteoarthritis occurs in individuals with an existing joint disease such as gout, lupus or rheumatoid arthritis. It can occur in younger people following accidents in the workplace or due to sport.
Diseases such as diabetes and hemochromatosis can also lead to osteoarthritis. Certain surgical procedures performed on the joints may also trigger osteoarthritis. It is also important to note that the disability caused by osteoarthritis is a risk factor for other diseases such as diabetes, thrombosis and myocardial infarction.
What causes osteoarthritis?
Worn out as a result of natural wear and tear, injury or because of excess weight, a considerable reduction in the cartilage will culminate in sharp pain, sometimes of sudden onset, accompanied by stiffness or swelling in the hip, knee, neck, hand or back joints.
Unfortunately, once exposed to natural wear and tear, the cartilage can no longer ensure the proper functioning of the joints concerned. Similarly, it is incapable of renewal.
As this is a major cause of disability, osteoarthritis must be diagnosed as soon as possible and treated effectively. Medicinal treatments and appropriate rehabilitation are essential.
What are the risk factors in osteoarthritis?
Osteoarthritis affects women more than men, particularly during the menopause because of the reduction in oestrogen levels which have protected the cartilage cell function thus far.
The causes of osteoarthritis can vary depending on the individual. Two of the most common causes are:
Age: osteoarthritis affects nearly 90% of people over 75 years of age.
Excess weight: the link between obesity and osteoarthritis of the weight-bearing and non-weight-bearing joints has now been confirmed. The Body Mass Index (BMI) should therefore be monitored. It should be below 25 (otherwise the individual is considered to be overweight) and, in any case, below 29 (otherwise the individual is considered to be obese).
Factors other than age-related risks and excess weight are involved in the development of osteoarthritis. These primarily include:
Certain mechanical factors, such as excessive loads
Some genetic factors
Inflammation (in arthritis in particular)
Bone and joint diseases such as osteoporosis
Repeated microtrauma to a joint, fractures and bone damage
A lack of physical activity and immobility lead to osteoarthritis. Conversely, excessive sporting activities can also result in osteoarthritis.
Fractures, dislocations and sprains cause joint trauma, which in turn can lead to joint wear and tear and trigger the onset of the symptoms of osteoarthritis.
Any individual with joint disease likely to promote the onset of osteoarthritis should receive preventive medical treatment to avoid disease onset. This type of treatment is available and should be discussed with your doctor.
Caution and moderation are therefore essential. Above all, it is important to take care of your joints. Protect yourself from the risk of injury or major trauma.
In fact, while immobility and a lack of exercise promote the onset of osteoarthritis, excessive physical activities involving sudden movements, the movement of excessively heavy loads, or standing upright for prolonged periods can also trigger osteoarthritis.
Can the risk of osteoarthritis be prevented or reduced?
Various preventive measures help prevent the onset of osteoarthritis.
The benefits of exercise
Regular exercise or sport is now known to play a key role in preventing osteoarthritis. Indeed, during exercise or sporting activities, the muscles are strengthened and an optimal oxygen supply is delivered to the joints. Consequently, walking and Nordic walking on flat ground in particular, swimming and cycling are excellent ways of preventing osteoarthritis. These activities should be carried out three times a week.
In fact, strong muscles afford better joint protection. The latter are then less prone to osteoarthritis. However, beware of over-exercising as mentioned earlier. Although beneficial in moderation, sports such as rugby, football or tennis may damage the joints if taken to excess.
Overweight individuals should monitor their food intake and may need to go on a diet to regain an ideal healthy weight.
A Body Mass Index (BMI) below 25 is recommended. A BMI ranging from 25 to 29 indicates that the individual is overweight whilst a BMI over 29 is indicative of obesity. There is medical evidence to show that excess weight can trigger osteoarthritis of the knee in particular.
Note: every additional eight kilos (over the recommended weight) increases the future risk of osteoarthritis by 70%.
Avoid repetitive movements and poor posture.
Some studies have shown that individuals who bend their knees too far forward and women who constantly wear high heels are predisposed to osteoarthritis in the knee.
Unfortunately, no cure has been found for this disease to date. Furthermore, since the symptoms of osteoarthritis are extremely heterogeneous, treatments have to be adapted for each individual and adjusted in line with disease progression.
What treatments are available for osteoarthritis?
Because it is a major debilitating condition, osteoarthritis should be diagnosed as soon as possible and treated effectively. Medicinal treatments and appropriate rehabilitation are essential.
As osteoarthritis is a chronic disease that advances slowly, the cartilage will gradually deteriorate without the patient necessarily feeling any specific pain. The pain comes later with disease progression. It then becomes persistent and various medicinal treatments, injections, physiotherapy and surgery may be required.
Only analgesics can provide pain relief. Rehabilitation is also very beneficial, but in cases of long-term, severe osteoarthritis, only a prosthesis will allow the individual in question to maintain a certain degree of independence. This procedure is usually performed 7 years after "coxarthrosis" (osteoarthritis of the hip) is diagnosed following an initial X-ray , and ten to twelve years following the onset of "gonarthrosis" (osteoarthritis of the knee).
Medicinal treatments for osteoarthritis
Although there is no known treatment to prevent the destruction of cartilage, various medicinal treatments have been developed to slow down disease progression and to alleviate the inevitable pain. These treatments are also administered in an attempt to reduce joint stiffness due to osteoarthritis.
Medicinal treatments differ depending on the clinical course of the disease and the severity of the symptoms. Local treatments are generally preferred by doctors due to the lower side effect profile.
As osteoarthritis advances slowly, the body will have to learn to tolerate long-term treatment.
Several types of medication are used to treat osteoarthritis:
Analgesics: acetaminophen (Tylenol®, Tempra®) alone or in combination with codeine. These medicinal products should be used in moderation since they may trigger side effects such as nausea and drowsiness, etc.
Non-steroidal anti-inflammatory drugs such as ibuprofen, ketoprofen or naproxen are prescribed to combat intense pain.
It should be noted that these medicinal products may trigger side effects including gastrointestinal problems.
Non-steroidal anti-inflammatory drugs (or coxibs) or topical anti-inflammatories applied directly to the osteoarthritic joint.
Glucosamine sulphate, diacerein, chondroitin sulphates and avocado and soybean unsaponifiable matter. Successful outcomes have recently been documented with these treatments.
Apart from their efficacy, these medicinal products cause considerably fewer side effects and may slow down disease progression.
Two types of injections are also used. Corticosteroids are injected directly into the affected joint or hyaluronic acid is injected to lubricate the painful joint.
A new treatment: capsaicin
This substance is extracted from the red pepper, capsicum, used mainly by the South American Indians. It attacks pain by binding to a receptor, namely the vanilloid receptor, and triggers a biphasic mechanism to desensitise these pain receptors.
You should discuss with your GP which osteoarthritis treatment is the most suitable depending on the type of pain experienced.
Non-medicinal solutions to alleviate osteoarthritis
The following are strongly recommended in order to relieve the pain of osteoarthritis:
Exercise three times a week. Typical activities include swimming or walking, such as Nordic walking on flat ground.
Maintain a healthy weight: BMI under 25.
Attend physiotherapy sessions.
Avoid microtraumas such as carrying excessively heavy loads or over-exerting the joints.
Follow medical orthopaedic therapy to reduce pressure on the joints.
Attend joint rehabilitation sessions.
Use orthotic devices as required.
Try spa therapy for osteoarthritis.
Surgical procedures to relieve osteoarthritis.
When medication is no longer sufficient to relieve the pain, doctors recommend surgical procedures such as arthroscopy to clean out the joint, or operations to remove the bony growths formed by osteoarthritis.
Prosthetic devices are still very common. In the case of osteoarthritis of the hip, corrective procedures are generally performed seven years after the condition is initially detected by X-ray. This prevents any disability due to the total disappearance of the cartilage as movement is extremely difficult at this stage. Total loss of cartilage is anticipated some 10 to 12 years post-diagnosis. The affected individual will often have to use a walking stick to move around. A knee prosthesis will be feasible in 10% of cases.
The implants are expected to last about 15 to 20 years. Follow-up X-rays should be performed every two years.
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