Living with
Osteoarthritis

What is osteoarthritis?

If you have osteoarthritis it means that the cartilage that cushions the ends of your bones has become worn down over time. Osteoarthritis is a degenerative or “wear-and-tear” form of arthritis.

This is also the most common form of arthritis, affecting millions of mostly middle-aged to elderly people worldwide. However, young people can also get osteoarthritis, primarily through injuries to their joints.

Although you cannot reverse the damage to your joints in osteoarthritis, you can largely manage the symptoms and slow the progression of the disease through lifestyle changes, such as maintaining a healthy weight and staying active.

What happens during osteoarthritic disease?

If you have osteoarthritis:

• There is breakdown of the cartilage that cushions the ends of the bones between joints. Cartilage is a firm but slippery tissue that enables frictionless joint motion, and if it wears down, bone can rub on bone.
• There are associated bony changes of the joints, with the growth of hard bony osteophytes or bone spurs.
• There is associated deterioration of tendons and ligaments.
• There is variable inflammation of the lining of the joints (the lining is called the synovium) with swelling caused by excess synovial fluid production.

How do you know you have osteoarthritis?

Symptoms of osteoarthritis develop gradually, worsening over time. Osteoarthritis most commonly affects the large weight-bearing joints like the knees and hips; however, the hands, feet and spine can also be affected, while, the elbows, wrists and ankles are generally spared.

The most common symptoms are:

• Pain: Joint pain is usually worse during exercise or movement, or at the end of the day.
• Stiffness: The stiffness in your joints will usually occur after rest. It might take a while for the affected joint to be fully mobile when it has been inactive for long, and even then, mobility might be limited with little flexibility and “creaking” or “cracking” sounds (medically known as crepitus) heard during movement. Otherwise, a grating sensation might be felt or heard when you move the joint.
• Tenderness: When you apply pressure, the joint might feel tender.
• Bone spurs/osteophytes: These are extra bits of bone around the affected joint. To the touch, they feel like hard lumps.
• Swelling: There might be inflammation of the muscle, tendons or ligaments around the joint. The affected joint(s) may also appear red.

When to see your doctor:
If your joints are often or continuously painful or stiff, see your doctor.

What is the difference between osteoarthritis and rheumatoid arthritis?

There are several types of arthritis, of which osteoarthritis and rheumatoid arthritis are the most common.

Osteoarthritis is a result of the wear-and-tear on your joints. Hence, symptoms of osteoarthritis usually take several years to develop and worsen, often only affecting a single joint at a time, or only some joints in a certain area. Rheumatoid arthritis, however, is an autoimmune disease where the immune system attacks and damages the lining (synovium) around the joints, usually affecting several joints at the same time. Rheumatoid arthritis can affect small joints, for example joints in the digits (fingers and toes); while osteoarthritis usually affects the larger weight-bearing joints like the hips and knees.

If you are not sure which type of arthritis you have, speak to your doctor or healthcare provider.

What causes osteoarthritis?

Osteoarthritis is the most common musculoskeletal disease worldwide. While knee osteoarthritis is more common than hip osteoarthritis, Disability Info South Africa reported in 2010 that these two types of osteoarthritis together affect an estimated 3,8 % of the general population.

Additionally, these types of arthritis are a major cause of disability and disease in older people, affecting 10-20 % of people aged over 65 years, according to the Arthritis Foundation of South Africa; this is equivalent to about 10 % of males and 18 % of females over 60 years.

While data on the overall prevalence of osteoarthritis in South Africa is lacking, a study of the literature in 2015, found that the prevalence of all types of osteoarthritis in South Africa is between 55 % and 82 % for people over 65 years of age.

Factors that can increase your risk of osteoarthritis include:

• Older age: Osteoarthritis is uncommon before 40 years of age, and the risk of developing osteoarthritis increases as you get older.
• Sex: Women are more likely to develop osteoarthritis, especially in the knees and hands, and are more likely to have severe disease, although it is not yet clear exactly why this is. Additionally, if you are female and your mother has nodal arthritis with knobbly fingers, then you have about a 30-50 % chance of developing arthritis according to the Arthritis Foundation of South Africa.
• Overweight and obesity: Increased weight adds stress to weight-bearing joints, particularly the knees and hips. Furthermore, adipose tissue (fat tissue) produces inflammatory proteins that are known to cause damage to joints. Being overweight will also make your symptoms more severe once you have osteoarthritis.
• Previous joint injury or joint surgery: A major injury or operation on a joint may lead to osteoarthritis at that site later in life.
• Repeated stress on the joint: Normal activity and exercise are good for joints; however, very hard, repetitive activity can injure joints over time. This is why some professional sportsmen develop osteoarthritis.
• Genetics: As already mentioned, some forms of osteoarthritis, such as nodal arthritis, can be inherited if you have someone in your close family with the condition.
• Bone deformities: Some people are born with malformed joints, such as Pethers’ disease of the hips, or develop them as children, such as with osteochondritis dissecans. Some people may also be born with defective cartilage, such as in the condition osteochondrodysplasia. These conditions increase your risk of developing osteoarthritis.
• Certain metabolic diseases: Certain conditions like diabetes and a condition in which your body has too much iron (haemochromatosis), among others, can also increase your risk of developing osteoarthritis.

Living and managing

Learn about lifestyle changes to manage your symptoms of osteoarthritis and to slow disease progression. Such steps to take include:

• Staying physically active: By strengthening the muscles around your joints, low-impact exercise can make your joints more stable. Try light aerobic activities (like walking, swimming or water aerobics) that minimise the stress placed on joints.
  Do not overdo exercise, such that you feel pain in your joints, and stretch and rest as needed before and during exercise. Try not to do hard repetitive movements or to hyperextend joints while exercising.
  You can read here about how much exercise you should be doing regularly in order to stay healthy.
• Maintaining a healthy weight: Carrying extra weight increases the stress on your weight-bearing joints, the hips and knees. Even minor weight loss can relieve the stress on your joints. Talk to a dietitian about healthy ways to lose weight, including eating a healthy, low-fat diet.
• Eating well for good bone health: While there is no evidence that one specific diet will benefit you if you have osteoarthritis, it is recommended that you eat a healthy, balanced diet to stay generally healthy.
  Be sure to include lots of foods rich in calcium in your diet. Calcium is a mineral found in dairy products, dark green leafy vegetables like spinach and broccoli, the bones of canned oily fish and in soy products like tofu. Calcium is essential for strong, healthy bones. Men and women between the ages of 18-50 years need 1 000 milligrams of calcium per day, while women older than 50 years and men older than 70 years need 1 200 milligrams per day.
  See Cooking from the Heart for healthy recipes and to find out more about how to incorporate more foods that are high in calcium into your diet.
• Quitting smoking: Talk to your doctor about ways to quit smoking, as smoking is bad for your health in general and can increase inflammation and worsen many different types of arthritis.
• Limiting your alcohol consumption: Do not drink more than two alcoholic beverages per day, as any more than this intake can speed up bone loss and reduces your body’s ability to absorb calcium, especially if you drink during a meal.
• Cutting down on caffeine: Caffeine may increase calcium loss in the urine. However, moderate caffeine use (about two cups of coffee a day) is probably not harmful if your diet contains enough calcium.
• Getting plenty of vitamin D: Vitamin D improves your body’s ability to absorb calcium. In South Africa, it is quite possible to get enough vitamin D from sunlight; however, good dietary sources of the vitamin include eggs and fish (salmon and canned tuna, for example).

Additionally, different healthcare professionals may also be involved in helping with your therapy in the following ways:

• Physical therapist: This professional shows you how to do exercises that can be used to strengthen the muscles around your joints, increasing flexibility and reducing pain.
• Occupational therapist: This professional can help teach you about ways to do everyday tasks without putting extra stress on affected joints.

You can also try the following to help manage your symptoms of osteoarthritis:

• Movement therapies: Tai chi and yoga involve gentle exercise and stretching that can keep you fit but they do not place unnecessary stress on joints. Many people also use these therapies to reduce stress, and some research suggests that these types of exercise might be able to reduce the pain associated with osteoarthritis and improve joint mobility.
  Avoid moves that cause pain in your joints, such as hyperextension.
• Apply heat and cold: These can be used to relieve pain and swelling in your joints. Heat can help relax muscles, while cold can relieve muscle aches after exercise and decrease the chance of muscle spasms.
• Braces, shoe inserts and assistive devices: If you have arthritis, then braces, shoe inserts or other devices can be used to help reduce pain when you stand or walk. They help support joints. Assistive devices like walking canes, on the other hand, help relieve stress on some of your joints.
• Transcutaneous electrical nerve stimulation (TENS): TENS uses a low-voltage electrical current for short-term pain relief for people with knee and hip osteoarthritis.

What treatment is available for osteoarthritis?

Medications that can help relieve osteoarthritis symptoms, primarily pain, include:

• Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter/Consumer NSAIDs, such as ibuprofen and meloxicam, taken at recommended doses, can relieve osteoarthritic pain. Courses of corticosteroids, like cortisone, and stronger NSAIDs are available by prescription from your doctor.
  NSAIDs can cause stomach, cardiovascular and bleeding problems, as well as liver and kidney damage – so take care to use these medications correctly and only as indicated.
  NSAID gels (diclofenac, for example) can be applied to the skin over the affected joint, and, in this way, may, produce fewer side-effects and be more effective at relieving pain than some oral NSAIDs.
  You can also ask your doctor about injectable cortisone or anti-inflammatory treatments for an affected joint.
• Paracetamol: This has been shown to help some people who have mild to moderate osteoarthritic pain. Speak to your doctor about the use of paracetamol for your osteoarthritis, as excess use of this compound is associated with liver damage.

If symptoms persist or worsen, even after conventional therapy, you may want to consider procedures such as:

• Realigning bones/osteotomy: For example, this is used when osteoarthritis has damaged one side of your knee more than the other. In a knee osteotomy, a surgeon cuts either above or below the knee, and then removes or adds a wedge of bone, shifting your body weight away from the worn-out part of the joint.
• Joint replacement surgery: In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surface(s) and replaces them with plastic or metal parts (prostheses). Artificial joints can also wear out with time and you may eventually need to replace them.

What are the complications associated with osteoarthritis?

Joint pain and stiffness can become severe enough to make daily tasks difficult for you to perform, resulting in limited movement, reduced function and associated disability.

Depression and sleep disturbances can also result from the pain and disability caused by osteoarthritis.