Understanding osteoarthritis: Insights and advice

In his latest online article, Dr Ziad Farah gives us his insights into osteoarthritis. He talks about what it is, the symptoms, causes, diagnosis, treatment, research findings and prevention.

What is osteoarthritis?

Osteoarthritis stands out as the most prevalent form of arthritis observed in my clinical practice. Essentially, it involves the gradual wearing away of the normal cartilage covering the bones within the joints. This natural process over time can result in pain and discomfort, as the joint's surface loses its smoothness. It's important to note that this is largely a mechanical process, driven by complex pathophysiological processes.

Numerous factors contribute to the onset of osteoarthritis. In many cases, damage to the cartilage prompts the formation of new bone, which may possess sharp and jagged edges. This, in turn, intensifies the pain experienced by the patient.

What are the symptoms of osteoarthritis?

The typical symptoms of osteoarthritis are pain and stiffness. Generally, the affected joint tends to be painful, especially during exertion or strenuous activities involving that particular joint. Another common symptom is the occurrence of clicking or cracking sounds in the joint, particularly noticeable during physical activity.

Complications associated with osteoarthritis often stem from the new bone formation. This excessive bone growth can lead to the compression of neighbouring structures. For instance, it may impact nerve roots in the spine or result in injury to nearby structures like the meniscus or ligament in the knee, leading to issues such as locking and clicking.

While individuals with osteoarthritis may occasionally experience symptom flares characterised by severe pain, swelling, and redness, such occurrences are relatively uncommon in this condition.

What are the causes?

Osteoarthritis has various contributing factors. Primarily, aging plays a significant role as joint-related injuries accumulate over time, leading to cartilage damage and the onset of osteoarthritis. Additionally, there is a notable genetic predisposition, with osteoarthritis showing a tendency to cluster within certain families. Several other risk factors increase the likelihood of osteoarthritis development. Past injuries, such as fractures during youth, can heighten the susceptibility to osteoarthritis later in life. Lifestyle-related elements, including obesity and smoking, are also associated with an increased risk. Lastly, being female and hormonal factors, especially around menopausal stages, pose additional risks for the development of osteoarthritis.

How is it diagnosed?

The initial and primary diagnosis of osteoarthritis involves a comprehensive assessment through history-taking and examination. Key features in the patient's history, such as pain and stiffness exacerbated by activity, are indicative of mechanical and degenerative joint disease. Following the history and examination, the next diagnostic step involves considering imaging. X-rays are particularly informative, offering insights into joint architecture and the presence of sharp bone growth associated with osteoarthritis. If additional details are required, ultrasound and MRI can provide valuable information. It's important to note that blood testing doesn't play a significant role in osteoarthritis diagnosis, as imaging and patient history contribute the majority of diagnostic information.

How is it treated?

Osteoarthritis is addressed through various treatment approaches, with an initial emphasis on lifestyle modification. Ensuring regular exercise, muscle conditioning, weight management for those overweight, and avoiding exacerbating factors like smoking are crucial steps. Following these, the focus of treatment primarily centres on managing pain, often involving the use of painkillers. Injectable options are also available.

In cases where symptoms are severe, especially when complications or compression arise from osteoarthritis, surgical interventions may become necessary. These interventions can involve joint repair or, in more extensive cases, complete joint replacement, such as knee or hip replacement procedures.

What are some of the latest research findings on osteoarthritis?

Currently, there is extensive research focused on osteoarthritis, making it a prominent and critical area of study due to its widespread prevalence and the significant number of individuals affected. The ongoing research primarily centres on understanding the causes of osteoarthritis. This involves exploring genetic factors to decipher why certain individuals are more susceptible to the condition. Another avenue of causality under investigation is the impact of hormonal factors, especially around menopausal stages.

Apart from understanding the causes and mechanisms, research is actively delving into potential treatments. Efforts are directed towards identifying new targets for pain management and innovating surgical approaches, with a particular emphasis on minimally invasive methods and strategies to prolong joint preservation. The extensive research in these domains aims to enhance our long-term capability in effectively treating osteoarthritis.

What can I do to prevent the osteoarthritis?

It's crucial for patients to acknowledge the existence of both modifiable and non-modifiable risk factors. As previously mentioned, factors like genetics and age fall into the non-modifiable category. On the other hand, lifestyle factors offer opportunities for modification, such as engaging in regular exercise to strengthen muscles and alleviate joint stress. Weight management is pivotal, considering the known association between obesity and the exacerbation of osteoarthritis. Additionally, focusing on improving posture and utilising suitable workstations and equipment in daily activities is essential in preventing the progression of this disease.

Dr Ziad Farah is an esteemed rheumatologist. You can schedule an appointment with Dr Farah on his Top Doctors profile.