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What is osteoarthritis?
Osteoarthritis (OA) is the most common form of arthritis, especially among older adults, and it is a significant concern for many. It begins with the slow deterioration of cartilage, the tough but flexible tissue that cushions the ends of bones in your joints. This process gradually transforms the smooth cartilage into a rougher, thinner form, causing uncomfortable friction and pain during joint movements.
This condition affects various joints, with a particular inclination towards those that endure considerable stress and strain throughout life. These include the knees, hips, neck, lower back, and hands, which are particularly vulnerable to OA due to their heavy usage and critical role in daily activities. Osteoarthritis can occur in the following joints:
- Knees: the knees are one of the most common sites for OA. Knee arthritis can severely hamper basic movements like walking, climbing stairs, and sitting down.
- Hips: hip osteoarthritis can lead to discomfort and pain in the groin, thigh, or buttocks, significantly impacting a person’s ability to move around.
- Neck and lower back: spinal osteoarthritis can cause stiffness and pain in the neck or lower back areas, sometimes even causing pain that radiates to the arms or legs if the nerves are involved.
- Hands: the hands are another common site for OA. Hand arthritis is characterised by pain, swelling, and stiffness and can significantly affect the fingers and thumbs, making it challenging to grasp or hold objects.
What causes osteoarthritis?
Osteoarthritis is a wear-and-tear disease. It involves the gradual deterioration of the cartilage, which acts as a cushion or shock absorber at the ends of bones. Cartilage is usually slippery and firm, allowing for smooth and pain-free joint movement as we carry out daily activities.
However, this thick cartilage can wear down over time, leading to bone rubbing on bone. This causes pain with every movement, significantly affecting one’s quality of life. Osteoarthritis can also affect the bone and cause the deterioration of connective tissues, anchoring muscles to bone. These combinations of effects lead to painful joint movement.
What are the symptoms of osteoarthritis?
The progression of osteoarthritis symptoms can significantly affect one’s quality of life. Here’s a closer look at the symptoms of osteoarthritis:
- Pain and stiffness: joint pain that worsens after activity or at the end of the day and stiffness after periods of inactivity are hallmark symptoms.
- Reduced flexibility: individuals might find it difficult to move the affected joint through its full range of motion.
- Tenderness: pressing on or around the joint can feel tender.
- Grating sensation: a sensation or sound of bone rubbing against bone when the joint is used.
- Swelling: joint swelling may occur due to inflammation of the joint area.
- Bone spurs: bone spurs are extra bits of bone which feel like hard lumps and may form around the joint.
Who is at risk of osteoarthritis in Singapore?
Some individuals are more susceptible to developing osteoarthritis. Risk factors for developing osteoarthritis include:
- Age: the risk of osteoarthritis increases with age, making it more common in older adults.
- Gender: women are more likely than men to develop osteoarthritis, particularly post-menopause, due to hormonal changes.
- Obesity: higher body weight increases joint stress, thus elevating OA risk.
- Individuals with joint injuries: a history of joint injuries raises the likelihood of osteoarthritis in those joints. This condition is known as post-traumatic osteoarthritis.
- Genetic factors: some individuals have a genetic predisposition to osteoarthritis, meaning a family history of osteoarthritis can increase one’s risk.
How is osteoarthritis diagnosed?
Diagnosing osteoarthritis involves several steps to rule out other causes and confirm the extent of joint damage:
- Medical history: your pain specialist will inquire about your symptoms, medical history, and risk factors.
- Physical examination: a physical exam involves assessing symptom patterns, joint tenderness, and range of motion.
- Imaging tests: imaging tests, such as X-rays, can show joint space narrowing and bone changes, while magnetic resonance imaging (MRI) provides detailed images of cartilage and soft tissue.
- Laboratory tests: additional tests such as blood tests help exclude other conditions that mimic osteoarthritis.
- Diagnostic criteria: the American College of Rheumatology (ACR) provides diagnostic criteria for osteoarthritis, which include the presence of joint symptoms (such as pain, stiffness, and functional impairment) and characteristic radiographic findings consistent with osteoarthritis.
What are the treatment options for osteoarthritis in Singapore?
The treatment of osteoarthritis aims to alleviate symptoms, improve joint function, and slow disease progression. Treatment plans are tailored to individual needs and may include a combination of non-pharmacological interventions, medications, therapies, and surgical procedures. Here are the primary treatment options for osteoarthritis:
- Lifestyle modifications: weight loss, joint protection (avoiding activities that exacerbate pain and discomfort), and exercise are all effective at alleviating the symptoms of osteoarthritis.
- Medications: medications such as pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving pain and reducing inflammation.
- Intra-articular injections: corticosteroid or hyaluronic injections may be utilised to ease joint pain by reducing inflammation and lubricating joints.
- Radiofrequency ablation: RF treatment for specific nerves innervating a joint (shoulder, knee, hip, etc) will be a useful modality for more sustained pain alleviation.
Frequently asked questions
The best treatment approach for osteoarthritis involves a combination of methods tailored to an individual’s symptoms, lifestyle, and health condition. Key components include engaging in physical activity and exercise to maintain mobility and relieve pain, managing weight to reduce stress on joints, using over-the-counter or prescription medications for pain relief, physical therapy, healthy lifestyle changes, and possibly topical or injectable medications may also play crucial roles in managing symptoms.
Osteoarthritis is primarily caused by the breakdown of cartilage in the joints, which can result from ageing, normal wear and tear, joint injuries, and other factors like obesity, certain health conditions, and genetic predisposition. While the exact cause can vary, these factors collectively contribute to the development of osteoarthritis by damaging the joint’s cartilage and leading to inflammation and pain.
When managing osteoarthritis, avoid activities that overstrain your joints, such as repetitive or high-impact exercises that can exacerbate pain and stiffness; use supportive devices or orthotics if prescribed, as they can help relieve pressure on your joints. Additionally, excessive weight can increase stress on weight-bearing joints, so maintaining a healthy weight is crucial. It is essential to consult with your pain specialist to tailor treatment and lifestyle adjustments to your specific needs and conditions.
Total Pain Specialist