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, and the most common form is osteoarthritis.
What is osteoarthritis ?
Osteoarthritis is a long-lasting, usually slowly worsening condition that affects the joints, causing pain and stiffness. It is often described as a degenerative disease, caused by wear and tear over the years. However, this view is changing because we now have better detection methods. Scientists now believe that inflammation has a big role to play in osteoarthritis.
Osteoarthritis literally means bone-joint inflammation, but previously osteoarthritis was not thought of as a typical inflammatory disease, since not all the signs of inflammation are visible. For instance, though there is often pain and swelling, other signs such as heat and redness are typically absent. However, newer studies are suggesting that inflammation may be an underlying factor after all. And, at least one possible source of inflammation may be the gut. More on this later…
Though osteoarthritis mainly affects the weight bearing joints such as the hips and especially the knees, often the highly movable joints such as the fingers and thumbs are affected.
Initially there is damage to the thin layer of cartilage at the joint surface where bones meet. Cartilage provides a slippery smooth surface that allows almost frictionless movement between the bones of the joints. In osteoarthritis the cartilage degrades, and if there is a limited capacity for self-repair it can be worn away, until the joint is bone painfully grating on bone.
Thickening of the ends of the bones can result in formation of bony spurs at the margins of an osteoarthritic joint. Pressure from these bony growths impinging on nerves can also cause pain, sometimes at some distance from the joint. For example, bony spurs on the spine can press on the sciatic nerve and typically causes pain that can radiate down through the buttock, the back of the leg and into the foot, this is a condition called sciatica.
What are the 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 early morning joint stiffness, lasting up to 30 minutes. Or perhaps some joint stiffness after periods of rest. A dull ache in a single joint, which might be exacerbated by activity, such as walking down stairs or by carrying heavy objects.
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.
Osteoarthritis can cause swelling of joints, but other signs such as heat or redness around the joint suggest that the problem is more inflammatory in nature, such as seen in rheumatoid arthritis or gout.
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. The weight bearing joints are particularly affected in overweight or obese people. But, extreme sports or occupations that involve repetitive movements can cause excess physical stress to certain joints that result in arthritic changes. Previous joint injury, infection or trauma certainly predispose to osteoarthritis in the affected joint later in life. Other factors such as having less than ideal joint alignment, joint hyper mobility or instability also make osteoarthritis more likely.
Any factor that increases the destruction of cartilage or retards cartilage repair can tip the balance towards osteoarthritis. This could include frequent use of prescription drugs like non-steroidal anti-inflammatory drugs (NSAIDs), increased age, genetics and even bacterial endotoxins from the gut.
Which joints are affected by osteoarthritis ?
It is mainly the weight bearing joints, the hips, knees, ankles, and bones of the spine that are affected. Joints like the thumbs are commonly affected, sometimes following trauma such as a broken wrist that affects the thumb. Other joints of the hand, especially the fingers can be affected, and arthritic bony swellings on the fingers are common in later life.
How is osteoarthritis diagnosed ?
The National Institute for Health and Care Excellence (NICE) suggests that osteoarthritis can be diagnosed if a person is over the age of 45, has activity-related joint pain and has morning joint pain stiffness lasting 0 to 30 minutes.
X-rays of an affected joint might show narrowed joint spaces, swelling, cysts, hardening and increased of bone density close to the joint and bony spurs. Yet, the amount of pain that someone feels often does not correlate with findings on x-ray. Someone in excruciating pain may have minimal changes on x-ray. Similarly, someone with substantial joint destruction may have very little pain.
How is osteoarthritis treated ?
Current conventional medicine for osteoarthritis involves symptomatic pain relief, but does nothing to arrest the process of degeneration, so the condition gradually gets worse. What’s more, some people find that their prescription medication is inadequate.
Even worse, we now know that certain medications can accelerate the loss of cartilage, as well as having dangerous side effects in some cases.
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.
Of course, some alternative medicines such as certain herbal remedies, have a long tradition of use in musculoskeletal problems such as osteoarthritis. Now research evidence shows that some may have similar efficacy for pain relief in osteoarthritis as modern medicines, but with fewer side effects.
In fact in one study, the herbal remedy black cumin seed oil, applied topically was found to provide better pain relief than paracetamol for knee osteoarthritis.
Food and osteoarthritis
As obesity is linked to an increased risk of developing osteoarthritis, weight loss is often suggested as one way to reduce symptoms. There is also some evidence that adhering to a Mediterranean diet is associated with a lower prevalence of osteoarthritis, with better quality of life and decreased pain and disability.