Osteoarthritis

Osteoarthritis is sometimes described as ‘wear and tear’ of your joints. But it’s more like ‘wear and repair’ as the joints in your body are constantly adapting to the various stresses on them – from an injury or overuse or if you’re overweight. Osteoarthritis most commonly affects your knees, hips, spinal joints and hands. When severely affected, the joint space is narrowed and osteophytes form (little bony spikes) with some bone changes so that generates pain as the main bones rub together.

People usually start to suffer from osteoarthritis between the ages of 45 and 55 years and most people over 75 years old, will have some degree of osteoarthritis in various joints. The knee joint is the commonest site and osteoarthritis of the hip is less common.

Usually osteoarthritis is diagnosed by how someone describes the pain or swelling of their joint(s) and how swollen the joint looks and feels, rather than the extent of structural changes a doctor might detect on an Xray of the joint(s). Sometimes diagnosing osteoarthritis is confused by other musculoskeletal disorders a person might have too - like gout or fibromyalgia.

There are a variety of treatments for osteoarthritis. The simplest is for a person to self care. So that would be weight reduction if they’re overweight, muscle strengthening exercises, walking aids, taping the patellar joint of their knee to provide more support, and adding insoles to their footwear. Just wearing supporting cushioned trainers may make an enormous difference to daily walking if you have osteoarthritis in your feet.

Someone who needs pain relief for their osteoarthritis should try paracetamol or rub in anti-inflammatory cream that they’ve bought over the counter or has been prescribed by their doctor. Anti-inflammatory tablets like ibuprofen should only be used if someone’s symptoms are not controlled by other means or during acute flare-up, and risks of them taking them are low (as they can cause severe bleeding or clash with other prescribed drugs). Then once their joint has calmed down they should step off these tablets if possible.

It’s possible for a doctor to inject a joint that’s not settling after a really painful flare-up with a corticosteroid injection; and that can make a real difference. Surgery is the end of the line of treatment options for osteoarthritis. Someone would need to be in constant pain, when they’re at rest or at night, to justify joint replacement eg of a knee or hip.

Q1. My father is in his 80s and a keen gardener. But he lives on a steep hill and he’s finding it difficult to manage the steps and kneel down to weed because bending his knees is really painful. What treatment do you suggest? 

A. You’re best getting a therapist’s advice on what tools he could use to grip better and stand steadily. It’ll be better to sit on a low portable chair to do the weeding than kneel down. Setting up rails to help him up and down the steps is really important so he doesn’t fall and stays active.