Arthritis is a general term for disorders that affect the joints, and other connective tissues. It is a common condition in the UK, affecting more than ten million people.
What is osteoarthritis?
The most common form of arthritis is osteoarthritis. This type of arthritis is a long-lasting, and usually slowly worsening condition. Osteoarthritis causes joint pain and stiffness. One cause might be the wear and tear on the joint over years of use. However, there might be other important factors.
We are learning more about the causes of arthritis now because we have better detection methods. These methods confirm that inflammation has a big role to play in osteoarthritis. This shouldn't really be a surprise because osteoarthritis literally means bone-joint inflammation. But it is not a typical inflammatory disease. Not all the usual signs of inflammation are visible. For instance, there is often pain and swelling in osteoarthritis. But other signs of inflammation such as heat and redness are usually absent.
However, these new studies are suggesting that inflammation may be an underlying factor after all. And, at least one possible source of inflammation may be the gut.
See The role of ageing in gut health and osteoarthritis
Which joints are affected?
Osteoarthritis mainly affects the weight-bearing joints such as the hips and especially the knees. But, it is also the case that the body's smallest joints can be arthritic. The highly movable joints such as the fingers and thumbs are common sites of the pain and stiffness. The resulting problems include less range of movement and less grip strength.
Cartilage damage and arthritis
Joint surfaces have a thin layer of cartilage that provides a smooth slippery surface. This allows almost frictionless movement between the bones of the joints. Damage to the cartilage is an early stage of arthritis. If there is a low capacity for self-repair, the cartilage can be worn away. Until eventually the joint is left with bone painfully grating on bone.
An osteoarthritic joint can also develop bone spurs. These are small bony growths at the margins of the joints. Pressure from these bony growths pressing on nerves can also cause pain. The pain is sometimes felt at some distance from the joint. For example, bony spurs on the spine can press on the sciatic nerve. A condition called sciatica. This typically causes pain that can radiate down through the buttock, the back of the leg and into the foot.
What are the early symptoms of osteoarthritis?
The early signs of osteoarthritis can be subtle and gradual. If you have early osteoarthritis you might feel some mild symptoms such as brief early morning joint stiffness. Or perhaps some joint stiffness after periods of rest. You may have a dull ache in a single joint, which might be made worse by activity. Stairs are usually an issue for osteoarthritis of the knees, especially walking downstairs.
Moving a joint with osteoarthritis can produce a variety of sounds. Crepitus or crackling, clicking, creaking or grating sounds in the joint are not uncommon.
There could also be some muscle loss or weakness in muscles surrounding an arthritic joint. This is common when pain prevents a joint from being used regularly.
What are the causes of osteoarthritis?
Some factors greatly increase the risk of developing osteoarthritis. Especially anything that causes excess physical stress to the joints. For instance, being heavier often affects the weight-bearing joints. While extreme sports or occupations involving repetitive movements can stress joints and result in arthritic changes. Previous joint injury, infection or trauma certainly predispose to osteoarthritis later in life. And, factors such as having less than ideal joint alignment, joint hypermobility or instability also make osteoarthritis more likely.
Anything that increases the destruction of cartilage or retards its repair can tip the balance towards arthritis, including:
- frequent use of prescription drugs like non-steroidal anti-inflammatory drugs (NSAIDs)
- increased age
- genetics
- bacterial endotoxins from the gut
Which joints are affected by osteoarthritis?
Osteoarthritis mainly affects the weight-bearing joints, the hips, knees, ankles, and bones of the spine. Yet, smaller joints like the thumbs are commonly affected. This is often the case following damage to the joint, such as a broken wrist that affects the thumb. Other joints of the hand, especially the fingers can often be arthritic in older people. Arthritic bony swellings on the fingers, the Heberden's nodes are also common in later life.
How is osteoarthritis diagnosed?
The National Institute for Health and Care Excellence (NICE) set the criteria for the diagnosis of osteoarthritis:
- age over 45
- pain with activity
- morning joint pain and stiffness, lasting up to 30 minutes
X-rays of the painful joint might show a number of changes:
- narrowed joint spaces
- swelling
- cysts
- hardening
- higher bone density close to the joint
- bony spurs
Yet, the amount of pain that someone feels does not always correlate with x-ray findings. For instance, someone in excruciating pain may have minimal changes on x-ray. While someone with substantial joint destruction may have very little pain.
How is osteoarthritis treated?
Current conventional medicine for osteoarthritis involves symptom relief. But this but does nothing to stop the degenerative process. So the condition gradually gets worse.
Another problem is that some people find that their prescription medication does not take away their pain.
See Is your pain medication working for your chronic pain?
Even worse, we now know that certain medicines can accelerate cartilage loss. They can also sometimes cause dangerous side effects.
See Why NSAIDs are not the best solution for your osteoarthritis
See Is a daily low dose aspirin a good idea?
Chronic pain and complementary therapies
Chronic pain is a major reason that people may turn to complementary therapies. I often hear from patients that they would like to avoid having to take prescription medications if possible. And, in fact, there is evidence that complementary therapies can help in many cases of chronic pain.
See Which therapies for chronic pain?
Alternative medicines have a long tradition of use in musculoskeletal problems. These include certain herbal remedies for osteoarthritis. In fact, research shows that some are as effective for pain relief as modern medicines, but with fewer side effects.
See 8 natural alternatives to NSAIDs
Similarly, topical use of the herbal remedy black cumin seed oil may offer some benefit. In studies, it provides better pain relief than paracetamol for knee osteoarthritis.
See Nigella sativa and osteoarthritis of the knee
Food and osteoarthritis
We know there is a link between obesity and the risk of developing osteoarthritis. So, weight loss may provide one way to reduce symptoms. There is also some evidence that sticking to a Mediterranean diet may result in a lower prevalence of osteoarthritis. Along with a better quality of life and decreased pain and disability.
