“An old lady is struggling to stand up. Even after standing, her grimace of pain says it all. She has unbearable knee joint soreness. The lady is fidgety with a walking stick. Her fingers are swollen over the joints, making it difficult to firmly grip the handle. Her legs are bowed at the knees – what we call ‘bow legs’ is evident even from a distance.”
So what is the underlying cause of knee pain? And what affects the hands and other joints simultaneously to create generalized joint pain? And how does the body strangely select certain joints, damage them and spare some of the most weight bearing joints like the ankles from getting harmed?
This is a condition called osteoarthritis, the commonest type of arthritis out of nearly a hundred different types of diseases affecting the joints. We believe that osteoarthritis is the key joint disease among Sri Lankans, although nationwide surveys have never been done. Osteoarthritis is quite a common occurrence at our joint clinics. This is also known as wear and tear arthritis, although research has shown lately that it’s not just that.
So who gets osteoarthritis?
Osteoarthritis is more likely found in the following categories of patients: Women, people aged 40 or above, those who have had fractures or injuries in the joints, a familial tendency to have osteoarthritis, overweight people, people who do an occupation that puts additional burden on any joint and if there is another joint disease like rheumatoid arthritis.
What are the symptoms of osteoarthritis?
This is important to know, as not all patients might feel severe pain from within the joint. Pain is still the commonest complaint. Especially pain felt immediately after prolonged periods of rest; after being in a seated position for half an hour and pain that is worse at the end of the day. It could become so severe that it could even prevent patients from falling asleep.
Another symptom might be stiffness, which again is felt after periods of rest. Stiffness might prevent you from properly moving your joints. Some patients recall instances where they had to put in an additional effort to move that particular joint.
Swelling is also a common occurrence. There are several different types of swellings that we observe. Certain joints get swollen when joint fluid collects inside a small space called the joint cavity. This fluid swelling increases the pressure within the joint and as a result, the skin bulges outwards. There’s also a bony swelling which occurs because of bone fragments called osteophytes. Unlike fluid swelling, this is felt if you press hard.
The crackling sensation or bone grinding feeling is called crepitus. Crepitus is also felt by patients in most instances. This happens when you move your joint. Do note that even healthy individuals might feel a bit of crepitus. Crepitus alone doesn’t mean you have osteoarthritis.
How is osteoarthritis evaluated?
The rheumatologists will first test how severe the osteoarthritis is, especially in the weight-bearing joints like hips, knees and ankles. The evaluation includes a detailed history, a complete examination of not just the joints that are affected but the healthy ones as well. During an examination, you might be asked to perform certain joint movements or the specialist might do them passively.
Sometimes the consultant might order certain blood tests to see whether there is a bit of inflammation coming from within the joint. Inflammation is swelling related to increased blood supply to a certain part of your body. They might also order X-rays to see how well preserved the bone structure is. Joint ultrasound scans are very useful as well.
Rarely do we have special imaging methods like CT scans and MRI scans to have a more clear view of the joint damage not visible though conventional images.
What can be done for osteoarthritis?
Whenever I tell a person who has osteoarthritis that fifty percent of the cure is achieved by the patients themselves, they shake their head in disbelief. Here in Sri Lanka, patients rely on their rheumatologists for a one hundred percent cure. Whereas in the developed world, “self-help” plays a major role in “controlling” the arthritis.
Many proven treatment strategies are patient-based ones and rheumatologists are there just for guidance. It is a well-known fact that joint protection strategies and exercise can ease off the pain completely.
There are several different types of medication that help patients control the symptoms of osteoarthritis. Out of these, painkillers play a major role. Starting from ointments, paracetamol and non-steroidanti-inflammatory drugs, we might even prescribe opioid analgesics for severe pain. Certain drugs which relax the muscles also help.
Joint injections consist of a mixture of steroids and pain-relieving medication. Injections are very useful to rapidly bring down the swelling and provide great relief.
Some of the newer methods of controlling symptoms
There are more than ten different and novel ways of treating osteoarthritis. As I said, joint protection strategies are useful in preventing further damage.
We use braces/guards/splints that are worn over joints to control unwanted movement. Again, these come in various types and sizes. We also recommend supports to be worn with your footwear.
Muscle strengthening if properly done, protects the joints that lie beneath. There is proven evidence that this might even halt the joint from getting deformed. Aerobic exercises, cycling and swimming are very useful in treating osteoarthritis. Even T’ai Chi which is all about gradual limb movements while maintaining body balance was studied and proven to alleviate joint pain.
An electrical impulse to be applied over the affected joints called TENS therapy is also very popular in the west. Guided physiotherapy is also useful to diminish symptoms in osteoarthritis.
Certain nutritional supplements like glucosamine and chondroitin, compounds normally found in joint cartilage, may improve damaged cartilage, according to some studies. Weight reduction is known to improve pain, especially of the weight-bearing joints. Sometimes patients with osteoarthritis need early referral to orthopaedic surgeons for joint operations. There are numerous surgical methods of treating worn-out joints and patients are involved in selecting what suits them best.
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