Family Doctor Books


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Family Doctor Books
Preview of Understanding Arthritis & Rheumatism

Osteoarthritis is very common and affects most of us as we get older. It is the most common form of arthritis in people over the age of 65. Men are more likely to be affected than women before they reach 45, but, in the over-55s, the balance shifts so that more women are affected. Osteo-arthritis is sometimes called ‘wear and tear arthritis’ and ‘degenerative arthritis’, but wear and tear and degeneration are not the whole story. Lots of people who have done heavy work all their lives do not develop osteoarthritis and it is not confined to older people.

Osteoarthritis can run in families and, if your parents had it, you have a slightly greater chance of developing it too. It can also develop early in any joint that has previously been seriously injured. Footballers, for instance, often suffer repeated cartilage injuries and may develop osteoarthritis in their knees. Besides the knee, osteoarthritis is common in the hip, the knuckle joint of the big toe, the joint at the base of the thumb, the spine, especially the lower back, and the neck.

Osteoarthritis is often referred to as wear and tear of the joints.
1. A normal joint has a smooth layer of cartilage overlying bone and is lubricated by synovial fluid 2. First the cartilage wears away and the smooth surface of the joint disappears; small pieces of the cartilage may break off, creating debris in the joint which can interrupt movement
3. Bony protrusions called osteophytes may appear at the edges of joints, again disrupting function and causing pain 4. Eventually the cartilage may wear down so much that the bone is exposed; the joint is stiff and painful and may be swollen with excess synovial fluid

What’s going on?

Osteoarthritis was once seen as a natural and inevitable consequence of ageing, but we now know that the real picture is rather more complex. Doctors now think that osteoarthritis may be a disorder affecting the cells responsible for making cartilage. The cartilage loses its slippery surface, cracks develop and it becomes roughened (see diagram opposite). Over time, the cartilage becomes thinner and the joint may not move as freely as it did. The bone at the edges of the joint may change shape and bony lumps, or osteophytes, may form. In advanced cases, the cartilage may disappear entirely and the bones forming the joint may become deformed.

Women who have a family history of the condition are likely to develop problems in the joints of their fingers and thumbs and in their knees. In some people, joint problems are more widespread, with hands, feet, hips, knees and shoulders all being affected. Sometimes, a single joint such as the knee may be the only one affected, especially if it has been previously injured.

Symptoms

Many people have no symptoms at all and find out that they have osteoarthritis only when an X-ray is taken for some other reason, Most people, however, do have some symptoms (see box below).

COMMON SYMPTOMS IN OSTEOARTHRITIS
  • The joint is painful after exercise and at the end of the day, but the pain gets better with rest.
  • The joint is stiff first thing in the morning or after a daytime rest, but quickly loosens up with exercise.
  • The joint creaks or grinds when you move it – this is known as ‘crepitus’. Crepitus is often not painful and should not prevent you from using the joint.
  • Tender lumps may appear on the small joints at the ends of your fingers and the bases of your thumbs.

Despite their knobbly appearance and the stiffness and pain, arthritic joints can continue to give good service for many years. Occasionally these joints, especially the knees, may suddenly become swollen and very painful, especially after some vigorous activity, such as a day out walking. The inflammation is usually mild and should respond to an anti-inflammatory drug and a short period of rest. Sometimes, the excess fluid in the joint needs to be removed and an injection of steroid given to settle the inflamation.

Arthritis in the neck may cause irritation of a nerve root, leading to numbness, pins and needles and pain in the arms. Headaches can also occur and are the result of tension in the muscles at the back of the neck. Dizziness on looking up may be caused by pressure on some of the blood vessels that supply the brain.

Diagnosis

Usually, your GP will be able to tell whether you have osteoarthritis after taking your history and examining you, as described on pages 7–9. Sometimes an X-ray will be needed. Osteoarthritis does not show up as abnormalities in blood tests.

Treatment

The mainstays of treatment for osteoarthritis are exercise, reducing the strain on the affected joints and pain-killers when necessary.

The right kind of exercise will maintain movement and strengthen the muscles around a joint. This will stabilise the joint and protect it from strain. If you are overweight, then losing some weight will help to take the strain off your lower back, knees, ankles and feet. Pain-killers and sometimes anti-inflammatory drugs can relieve the pain and stiffness and allow you to benefit fully from an exercise programme.

The outlook

The idea that disability caused by osteoarthritis is inevitable as we get older is old-fashioned. Although getting older is, of course, inevitable, disability is most definitely not inevitable. Modern medicine has a lot to offer and there is also a great deal you can do to help yourself. If you learn to use your joints appro-priately, you can remain healthy and active into old age. The way to do this is to avoid straining the joints but take plenty of the right sort of exercise, do not put on too much weight and use pain-killers when necessary.

Sometimes, joints become so damaged, painful and stiff that they can no longer work properly, in spite of regular exercise and pain-killers. The cartilage becomes thin and disappears completely and bone is moving on bone, instead of on cartilage. The joint may be painful all the time, even when it is held still and rested. Surgery to remove the worn-out joint and replace it with an artificial one may then be the answer. Artificial hips and knees have been available for over 20 years and many thousands of these operations are performed every year, with a very high success rate. Indeed, joint replacement surgery is probably the greatest advance ever made in the treatment of arthritis! If you would like to know more, there is a separate book in the Family Doctor Series, Understanding Hip and Knee Arthritis Surgery, which deals with these procedures.
 
KEY POINTS
  • Osteoarthritis affects most of us as we get older
  • You will keep more active by avoiding strain to the joints, taking exercise, keeping your weight down and using pain-killers when you need to