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Osteoarthritis

Published by Bupa's health information team, November 2009.

This factsheet is for people with osteoarthritis, or who would like information about it.

Osteoarthritis is the most common type of arthritis, affecting 8.5 million people in the UK. It develops gradually over time, causing joints to become stiff and painful. It can affect any joint but commonly affects the hands, knees, hips, feet and spine.

• About osteoarthritis
• Symptoms of osteoarthritis
• Causes of osteoarthritis
• Diagnosis of osteoarthritis
• Treatment of osteoarthritis
• Questions and answers
• Video
• Related topics
• Related Bupa products and services
• Further information
• Sources

About osteoarthritis

Osteoarthritis is more common among women and people aged over 40. It's a major cause of disability and reduction in quality of life in the UK. Many people think that osteoarthritis keeps on getting worse, causing increasing permanent pain and disability, but this often isn't the case. Instead, it's likely that your osteoarthritis will settle down over time as your body repairs itself. However, sometimes the damage is too severe to repair and leads to stiffness and pain, especially in the hip and the knee.

Although there isn't a cure, there are many treatments and self-help measures that can ease your symptoms.

You can think of osteoarthritis as a 'wear and tear' disease. It causes the cartilage on the end of your bones to get rougher and thinner. The bone underneath makes up for this by thickening and growing outwards, creating outgrowths (osteophytes) that can make your joint appear knobbly. The capsule around the joint also thickens and becomes inflamed.

How the knee is affected by osteoarthritis

Symptoms of osteoarthritis

If you have osteoarthritis, your joints will be stiff and painful, and may be swollen. The pain may be worse after exercise. You may find you can't move the joint as much or as easily as before. It may make creaking sounds called crepitations. As osteoarthritis progresses your joints may become misshapen and look knobbly. They may also be unstable.

You will probably notice that there are times when your symptoms are worse. There may be no particular cause, although they may be affected by changes in the weather or how active you are.

Sometimes pain and stiffness can be more severe in the early stages, especially in women who develop osteoarthritis around the time of the menopause. It tends to settle down over the next few years.

If you have severe or advanced osteoarthritis, it's possible that you will feel pain all the time, even at night and when you're resting.

More specific symptoms for different joints include the following.

• Hand - the base of your thumb and the joints at the end of your fingers are affected, resulting in firm, knobbly swellings on the back of these joints known as Heberden's nodes.
• Neck and back (spondylosis) - the discs of cartilage between the bones in your back (vertebrae) become thinner, causing the spaces to narrow. Outgrowths form at the edges of your vertebrae and joints, causing pain and numbness to travel down your arm.
• Feet - osteoarthritis generally affects the joint at the base of your big toe making it stiff - leading to difficulty walking - or bent, which may cause painful bunions.
• Knee - you will probably have pain at the front and sides of your knee. If your osteoarthritis is severe, your knees may become bent and bowed.
• Hip - you're likely to have pain mainly in the front of your groin, but sometimes around the side and front of your thigh, buttock or down to your knee. If it's severe, your affected leg may become shorter.

Causes of osteoarthritis

The exact reasons why you develop osteoarthritis aren't fully understood. However, certain things that may increase your risk include:

• being over 40
• being a woman
• being overweight or obese
• someone else in your family having the condition
• playing sport professionally and injuring your joints
• having an injury or an operation on a joint for any other reason
• having rheumatoid arthritis - you may develop secondary osteoarthritis

Diagnosis of osteoarthritis

There's no single test that can check for osteoarthritis, so your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. Your GP will look for bony outgrowths, swelling, creaking, instability and reduced movement of your joint, and ask if the joint is stiff for longer than half an hour in the morning.

Treatment of osteoarthritis

Self-help

Although you may not feel like it, it's very important to take regular exercise to strengthen your muscles around the affected joint and give it more support. Your GP is likely to advise you to take regular aerobic exercise, such as walking or swimming, and do strengthening exercises whatever your age or disability.

Regular exercise combined with a healthy, balanced diet will also help you to lose any excess weight. This will reduce the strain on your knee joints. It's a good idea to exercise little and often. Stop doing exercise or activities that cause you pain because you will continue to damage the joint.

A physiotherapist or occupational therapist can give you specific exercises for the affected joint.

Other self-help treatments include:

• wearing shock-absorbent shoes such as trainers with thick, soft soles
• using a walking stick
• wearing a knee brace or an insole, or a support for your thumb
• electrotherapy, for example TENS (transcutaneous electrical nerve stimulation)
• manipulation and stretching of your hip
• hot and cold packs

If your osteoarthritis stops you from carrying out daily activities, such as turning on taps, your GP may refer you to an occupational therapist.

Lots of claims are made about certain foods affecting osteoarthritis but there is little evidence to support them. The only certainty is that if you're overweight, eating a balanced diet that is low in sugar and fat will help you to lose excess weight and ease your symptoms.

Glucosamine sulphate and chondroitin supplements may provide you with some pain relief, although there is limited evidence that they are effective. Glucosamine usually comes from shellfish so don't take it if you have a shellfish allergy. However, vegetarian versions are available and these may be suitable if you're allergic to shellfish.

There is only limited evidence that cod liver oil is helpful if you have osteoarthritis.

Medicines

Medicines can't cure osteoarthritis but they can relieve your symptoms. Pain may be relieved by over-the-counter painkillers such as paracetamol, ibuprofen or aspirin. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may wish to use non-steroidal anti-inflammatory drugs (NSAIDs) in the form of creams and gels that you rub into your affected joints. These are less likely to have side-effects than NSAIDs taken as tablets, but this means you may notice only limited benefit as less of the medicine gets to the affected area. If these don't help, your GP may prescribe NSAIDs to take as tablets to reduce the inflammation, pain, and stiffness, but it's important to balance any benefits these may offer with possible negative side-effects.

Your GP will only prescribe stronger painkillers if your pain is severe. He or she may also suggest steroid injections given directly into the affected area.

Non-surgical treatments

You may be prescribed capsaicin cream or gel, made from an extract of chilli peppers, to help relieve pain. Your GP may prescribe it as an additional treatment for osteoarthritis of the hand or knee.

Surgery

If you have severe osteoarthritis, there are a number of different types of surgery that you may be able to have. These include the following.

• Microfracture surgery uses a drill or pick to make holes in the bone surfaces to encourage new cartilage to grow.
• If your knee locks or gives way, a knee arthroscopy can clear away debris in it that causes this. The operation is done using keyhole surgery.
• Hip resurfacing replaces the damaged surfaces in your hip joint with artificial ones.
• Hip or knee replacements have high rates of success in improving mobility and reducing pain.
• Realignment or osteotomy changes the position of the bones in your knee joint.
• Trapeziectomy is thumb surgery to remove a small bone and create more space so the bone surfaces don't rub together.
• Foot surgery can correct the positions of these joints.
• Wrist surgery includes stiffening or fusion, and less commonly joint replacement.
• Chondrocyte or cartilage transplants involve growing new, healthy cartilage cells and transplanting them into people who have osteoarthritis. However, this technique is only in the early stages of being developed.

Complementary therapies

There is good evidence to suggest that acupuncture is effective in relieving symptoms of osteoarthritis.

There is little evidence for other therapies although you may find they make you feel more relaxed, which helps you better manage your osteoarthritis. Speak to your GP before trying complementary therapy or herbal remedies.

Related topics

• Acupuncture
• Healthy eating
• Herbal remedies
• Hip replacement
• Knee arthroscopy
• Knee replacement
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Rheumatoid arthritis
• Shoulder replacement

Further information

Arthritis Care
0808 800 4050
www.arthritiscare.org.uk

Arthritis Research Campaign
0870 850 5000
www.arc.org.uk

Sources

• Osteoarthritis. Arthritis Care. www.arthritiscare.org.uk, accessed 16 June 2009
• Brouwer RW, van Raaij TM, Jakma TTSC, et al. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2005, Issue 1. doi:10.1002/14651858.CD004020.pub2
• An exercise in knee pain self management. Arthritis Research Campaign. www.arc.org.uk, accessed 16 June 2009
• Osteoarthritis - management. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 16 June 2009
• Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2008, Issue 4. doi:10.1002/14651858.CD002946.pub2
• Common food allergens. The Anaphylaxis Campaign. www.anaphylaxis.org.uk, accessed 16 June 2009
• Lützner J, Kasten P, Günther KP, et al. Surgical options for patients with osteoarthritis of the knee. Nat Rev Rheumatol 2009; 5: 309-16. doi:10.1038/nrrheum.2009.88
• Brouwer RW, Jakma TSC, Bierma-Zeinstra SMA, et al. Osteotomy for treating knee osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 2. doi:10.1002/14651858.CD004019.pub3
• Fortin PR, Lew RA, Liang MH, et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995; 48(11):1379-90

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2009