Osteoarthritis generally effects the hands, feet, knees, hips, shoulders and lumbar/cervical spine. OA is a non-inflammatory degenerative condition affecting the synovial joints resulting in the loss of hyaline cartilage around load-bearing points, degeneration of collagen and agrecan, and altering the configuration of the underlying bone. Generally OA presents as pain in the joints and a reduced range of movement and/or stiffness. OA may occur spontaneously, or it may occur secondary to an underlying condition, or as a result of surgery, injury or repetitive strain; being overweight can also increase the risk of osteoarthritis occurring.
Pain associated with OA is generally a dull, throbbing, localised pain; stiffness after a period of inactivity generally lasts for around 15 minutes. Muscle wastage can sometimes accompany OA as activity is reduced. This may be accompanied by crepitus, joint-line or periarticular tenderness when palpated, or pain on moving the joint. Deformity may be visible if there is bony swelling. Osteoarthritis of the spine is often referred to as spondylosis and is not normally associated with neurological complications.
Diagnosis of OA is generally through x-ray, history and examination, however other diagnoses may need to be ruled out first.
Osteoarthritis is managed through controlling pain, reducing stiffness, and where possible improving or at least maintaining joint mobility. Aids to consider are orthotics, splints or braces depending on the site of the arthritis. Walking aids may also be considered, although this has an impact on body image, and therefore needs to be thoroughly considered. Exercise is important in the management of osteoarthritis and can help to improve or maintain joint mobility, boost fitness and therefore health, and strengthen supporting muscles, as well as enabling weight loss where required. Exercise needs to be carefully considered and tailored to the patient to avoid injury and complications. Heat/cool therapy may be effective in relieving pain and discomfort.
Mild osteoarthritic pain is generally treated first line with paracetamol, with or without codeine. If appropriate for the patient, this can then be augmented with oral NSAIDs. If NSAIDs are taken frequently, a proton pump inhibitory is also advisable. Corticosteroid injections may be useful for short-term pain relief.
