Osteoarthritis : Symptoms & Medical treatments

The most commonly affected joints are the knee, hip, and spine. However, other joints, such as the shoulder, ankle, and wrist, can also be affected. Osteoarthritis of the fingers (digital osteoarthritis) is also very common, especially in women.

Note . Osteoarthritis of the knee is also called gonarthrosis and osteoarthritis of the hip, coxarthrosis .

 Prevalence

According to Statistics Canada, osteoarthritis affects 10% of the Canadian population, both men and women. After the age of 55, however, women are more affected. The prevalence of osteoarthritis increases with age. By age 70, the majority of people have osteoarthritis in one or more joints.

 Causes

There are many causes of osteoarthritis . Mechanical factors are in the foreground, associated with genetic factors, inflammation process , etc. Osteoarthritis is a disease resulting in abnormal degeneration of the cartilages. Indeed, the wear and tear of a joint with age should not cause osteoarthritis. The repetitive movements and the strain repeated a hinge may, however, cause excessive wear leading to osteoarthritis. Being overweight and not being physically active are two other important factors.

What happens when osteoarthritis appears?

In cases of osteoarthritis, the cartilage gradually wears down and loses its original qualities, that is to say its flexibility and elasticity. However, we now know that the entire joint is affected in cases of osteoarthritis: in addition to the cartilage, ligaments, bone, muscles and synovial fluid are altered. Thus, there is a loss of quality of the synovial fluid, a clear and thick fluid similar to egg white which normally lubricates the joint (see diagram above). 

Osteoarthritis is thought to be the result of an imbalance in the continual mechanisms of cartilage degradation and reconstruction. At the onset of the disease, there is no sign of inflammation. Over time, inflammation can appear. Inflammation is seen more rarely in osteoarthritis than in other forms of arthritis

 Types of osteoarthritis

Primary osteoarthritis. When the person with osteoarthritis has no obvious predisposition, osteoarthritis is called “primary”.

Secondary osteoarthritis. Diseases that affect the joints , such as inflammatory diseases (rheumatoid arthritis, gout, lupus, etc.) and metabolic diseases (diabetes, hemochromatosis ) predispose to osteoarthritis. The same is true of joint injuries and surgeries. When there is predisposition by one or the other of these situations, it is secondary osteoarthritis.

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Symptoms of osteoarthritis

The osteoarthritis , reaches each individual differently. The joints affected and the intensity of the pain vary from person to person:

  • pain in the joint when it is mobilized mainly achieved (e.g. knee pain down stairs);
  • sensitivity of the joint when applying a slight pressure;
  • stiffness of the joint, especially on waking or after a period of immobility. Morning stiffness lasts less than 30 minutes;
  • A gradual loss of flexibility in the joint;
  • A feeling of discomfort in the joint as a result of temperature changes ;
  • “Creaks”, especially in cases of osteoarthritis of the knee;
  • The gradual appearance of small bone growths (osteophytes) at the joint;
  • More rarely, inflammation (redness, pain and swelling of the joint).

People and risk factors for osteoarthritis

People at risk

  • People whose joints are on the wrong axis . This is the case, for example, of people who have their knees turned inward or outward ( genu valgum or varum );
  • People with a hereditary predisposition .

Risk factors

  • Age;
  • Obesity;
  • The movements repetitive caused by work or sport, which cause over time to joint damage
  • Intensive practice of certain sports (rugby, soccer, tennis, etc.);
  • The trauma joints (sprains, fractures, dislocations);
  • A lack of physical activity, which decreases muscle tone, reduces blood supply to the muscles and therefore leads to poor oxygenation of the cartilage;
  • Wearing high heels (for osteoarthritis of the knee).

Prevention of osteoarthritis

Basic preventive measures
 Maintain a healthy weight

In case of excess weight, it is strongly recommended to lose weight and maintain a healthy weight. The causal link between obesity and osteoarthritis of the knee has been well demonstrated. The excess weight exerts a very strong mechanical stress on the joint, which wears it out prematurely. It was determined that every 8 kg excess weight during the health score increases by 70% the risk of suffering later osteoarthritis of the knee 2 . Obesity also increases the risk of osteoarthritis of the fingers, but the mechanisms involved are not yet fully explained.
The healthy weight is determined by the body mass index (BMI), which gives the scale of ideal weight, based on the size of a person. 

Engage in regular physical activity

The practice of physical activity regularly helps maintain overall good health, ensure good oxygenation of the joints and strengthen muscles. Strong muscles protect the joints, especially the knee, and therefore limit the risk of osteoarthritis and symptoms.
 
Take care of your joints

Protect your joints when practicing a sport or a job that puts you at risk of injury.If possible, avoid making excessive repetitive movements or putting too much stress on a joint. However, the link between acute trauma and osteoarthritis is more certain than with chronic or repetitive strain injuries. 

Treat joint diseases

In the event of a disease that may contribute to the development of osteoarthritis (such as gout or rheumatoid arthritis), those affected should ensure that their condition is controlled as much as possible through medical monitoring and appropriate treatment.

Medical treatments for osteoarthritis

There is no cure for the moment. In addition, there is no known treatment that can delay the destruction of cartilage . However, there are drug and non-drug solutions that aim to relieve pain and stiffness in affected joints. They vary according to the intensity of the symptoms.

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 Non-drug treatments

The latest international recommendations 5 stress the importance of non-pharmacological measures to treat osteoarthritis, especially when it affects the knee or hip.

  • Regular physical exercise , 15 to 30 minutes, at least 3 times a week: walking, swimming, aerobic, adapted muscle strengthening, etc. The intensity of the exercises can be adapted to variations in the intensity of the pain;
  • Weight loss in case of obesity or overweight. Losing 5% to 10% of your weight can sometimes eliminate pain in cases of osteoarthritis of the knee, by reducing the load on the joint;
  • Physiotherapy if necessary;
  • Adaptation of the professional environment if the work causes articular trauma causing osteoarthritis.

When they are not enough, these measures can be supplemented by taking medication to relieve pain. In more serious cases, the doctor sometimes suggests surgery. See the Arthritis fact sheet for other pain relief methods.

Analgesic drugs

Acetaminophen . Acetaminophen (Tylenol®, Tempra®) is the first recommended painkiller for osteoarthritis. This medication is very effective, especially if the osteoarthritis is mild. It is important to follow the recommended dosage, since large doses can damage the liver.

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Stronger pain relievers may be prescribed if the pain is not relieved by acetaminophen or other medications (see below). Some contain a combination of acetaminophen and codeine. However, they can cause nausea, constipation and drowsiness.

 Anti-inflammatory drugs

Like other pain relievers, these drugs do not affect the course of osteoarthritis, but its symptoms. Because of their potential side effects, it is only used when the highest dose acetaminophen (4 g / day) fails to relieve pain.

Classic nonsteroidal anti-inflammatory drugs (NSAIDs). Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation . The NSAID family includes ibuprofen (eg, Advil® and Motrin®), ketoprofen (eg, Actron® and Orudis®), and naproxen (eg, Anaprox® and Naproxen®). Some are obtained over the counter and others, more potent, are prescribed by a doctor. As they can cause potentially serious digestive effects, they are sometimes combined with drugs that protect the stomach wall. They are used for the shortest possible time, as needed only. Alcohol consumption is not recommended during treatment.
Common side effects: gastrointestinal discomfort, such as heartburn, ulcers or sometimes severe digestive bleeding.

Nonsteroidal anti-inflammatory drugs selective Cox-2 inhibitors (or coxibs). This generation of anti-inflammatory drugs, selective inhibitors of cyclooxygenase-2 (Cox-2) or coxibs, works by inhibiting an enzyme, Cox-2, involved in the inflammatory process. They are less damaging to the stomach than conventional anti-inflammatory drugs. Celecoxib (Celebrex®) is one of them. Its use is generally reserved for people whose risk of gastrointestinal complications is considered high and whose risk of cardiovascular disease is low. Meloxicam (Mobicox®) also has an inhibitory effect on Cox-2, but weaker than that of celecoxib. For their part, rofecoxib (Vioxx®), valdecoxib (Bextra®) and lumiracoxib (Prexige®) were in turn withdrawn from the market by Health Canada between the years 2004 and 2007, due to the risk of side effects. serious that they included , 7 .

These drugs do not eliminate the risk of gastrointestinal symptoms and should be subjected to the same moderation as other anti-inflammatory drugs.

Topical anti-inflammatory drugs. This type of anti-inflammatory gel or cream is applied directly to the painful joint (for example, Pennsaid® or Voltaren emulgel®, diclofenac topical solution). They are a good alternative to oral anti-inflammatory drugs, as they do not cause digestive side effects. However, with osteoarthritis of the hip or spine , it is not known whether the drug can penetrate deep enough (up to the joints) to be effective.

Corticosteroid injections. In more severe cases, when the person has difficulty moving and the pain is not relieved by oral pain relievers, the doctor will prescribe corticosteroid injections directly into the affected joint. People who take this treatment should expect relief to come in gradually rather than immediately. Only 2 to 4 injections of corticosteroids can be given each year, to limit side effects, such as loss of minerals from the bones.

Hyaluronic acid injections. In the event of osteoarthritis of the hip or knee, injections of hyaluronic acid can also relieve the pain, but with a slower effect than injections of corticosteroids. This procedure is also called ”  viscosupplementation  ” because hyaluronic acid is a kind of gel that lubricates the joint, relieves pain and provides better mobility. However, studies conducted so far indicate that the beneficial effect of this treatment is relatively small. Several studies have not shown an effect superior to placebo.

Other drugs like glucosamine or chondroitin are effective and frequently prescribed by doctors for osteoarthritis. See the Complementary Approaches section.

 Surgery

Surgery . In case of failure of medical treatment and too great functional discomfort, surgical operations may be suggested. The arthroscopy removes debris of cartilage and bone in the joint. Other procedures allow to correct bone growths and deformities, to weld the joints or to reconstruct part of the joint. As a last resort, replacement surgery will be performed . The affected joint (often the hip) is then replaced by an artificial joint (a metal or plastic prosthesis ).

 Practical advice

Take care of your joints. 

After doing an activity that puts more stress on the joint, give yourself a break. In case of severe pain, avoid straining the joint.

 Moderate your physical efforts. 

Begin exercise or physical exertion quietly and safely to avoid injury. Don’t engage in activities that are beyond your ability.

 Have good posture. 
While standing, stand up straight to protect the joints in your neck, spine, hips, and knees. 

Lift objects carefully. 
To pick up a heavy object, crouch down and bend your knees. As you stand up, keep your back straight while keeping the object as close to your body as possible.

 Avoid staying still for too long. Change your position regularly to decrease the stiffness in your muscles and joints.

 Wear good shoes. If you have osteoarthritis in the knee or hip, wear comfortable shoes with good soles that cushion shock and allow proper weight distribution on the feet. 


Use specialized devices. Supports can help you support your joints and facilitate movement. Consulting a doctor or an occupational therapist helps to choose the appropriate devices: canes, walkers, carts, and other supports.  

Adapt the house as needed.
 For example, a suitable faucet so as not to twist the wrist and fingers, grab bars for moving or standing, suitable covers, etc. An occupational therapist can advise you.

The opinion of our doctor concerning osteoarthritis

Osteoarthritis is a very common problem and simple x-rays can confirm the diagnosis. As it is a chronic disease, we must learn to live with the pain (see our Arthritis sheet, overview).

I strongly recommend the regular practice of exercise adapted to your condition and the achievement or maintenance of an ideal weight, especially effective in cases of osteoarthritis of the knee.
If medication is needed, give acetaminophen a rigorous trial before taking anti-inflammatory drugs (NSAIDs) on a regular basis, which could cause you serious side effects. Using topical gels, especially in the knee area before exercise, can help.


Finally, for patients with significant functional impairment, hip or knee replacement surgery can significantly improve quality of life, even in very elderly patients.