Osteoarthritis

Osteoarthritis is the gradual wear and tear of your joints, which causes pain and stiffness. Normally the surfaces of your joints are surrounded by a tissue called cartilage, which prevents your bones from rubbing against each other. Over time cartilage can wear away, causing joint pain and stiffness, spinal stenosis, as well as swelling. 

The most common osteoarthritis symptoms are pain and stiffness in your joints. It's also common to notice knee pain or hip pain but it can affect any joint, including your neck, back, hands and feet. This can make it hard to move your affected joints, which may affect your ability to carry out everyday activities. 

Symptoms usually only affect one or a few joints at any one time. Stiffness is usually worse in the mornings and eases after about 30 minutes. 

Osteoarthritis of the knee

This usually affects both knees over time unless one of your knees is more vulnerable due to a past injury or another condition. Knee pain is often worse when walking, especially up or down hills and stairs. Your knees may give way or you may struggle to straighten your legs. When you move your affected knee joints, you may hear a soft, grating sound. 

Osteoarthritis of the hip

This makes moving your hip joints difficult eg you may struggle to put your shoes on or get in and out of a car. Pain usually affects the outer side of your hip and your groin area and worsens when you move your hip joints. However, you may also have hip pain when resting or sleeping. 

Osteoarthritis of the hand

This usually affects the: 

• Base of your thumb
• Joints nearest to your fingertips
• Middle joints of your fingers

In addition to painful, stiff and swollen fingers, you may develop: 

• A bump at the base of your thumb where it joins your wrist — this can cause pain and make it difficult to perform certain tasks eg opening jars, turning keys, writing
• A slight sideways bending of your fingers at affected joints
• Bumps on your finger joints
• Painful cysts (fluid-filled lumps) on the backs of your fingers

Over time, your pain may decrease and eventually stop, however, any bumps and swelling of your fingers may remain. 

Osteoarthritis of the foot

Your foot has 33 joints, including your ankle, which connects the two long bones of your lower leg to the rest of your foot. Osteoarthritis commonly affects the big toe.

Osteoarthritis can cause other foot problems: 

• Bunions
• Corns and calluses
• Hallux rigidus

It is important to take good care of your feet if you have osteoarthritis. This includes: 

• Moisturising daily
• Using insoles in your shoes
• Washing and drying your feet daily
• Wearing supportive footwear

Other symptoms of osteoarthritis

• Crepitus — a grinding or creaking feeling in the joints
• Ganglion cyst
• Muscle wasting and weakness
• Pain — this includes joint pain such as back pain, foot pain and/or shoulder pain 
• Restricted movement
• Swollen joints such as a swollen knee — this is caused by inflammation, however, the swelling is not severe and joints are not red or warm to touch; if your joint suddenly becomes hot, red or swollen, see your GP as these symptoms are more common in other types of arthritis

Pain and stiffness may worsen if you haven't moved your joints in a while. Your joints may also appear more knobbly or slightly larger than usual. Less commonly, you may develop joint deformities. 

Some people find that their symptoms are worse at night, in cold and/or damp weather. Symptoms can come and go, varying in severity according to your activity levels and the weather. In severe cases of osteoarthritis, symptoms can be continuous.

Some people may have no symptoms despite an X-ray showing osteoarthritis. The reverse can also occur ie you may have severe symptoms but only minor changes showing on your X-ray.

You should see your GP if you have persistent problems with your joints, particularly if they are:

• Affecting your overall mood and positive wellbeing
• Affecting your sleep
• Preventing you from getting on with your everyday life

Your GP can give you a diagnosis from a simple examination of your affected joints, factoring in your age and symptoms. See your GP or use the consultant finder below to book an appointment with a specialist at your nearest Spire hospital.

It's important that you get an accurate diagnosis for osteoarthritis as it can be confused with other forms of arthritis, such as rheumatoid arthritis. In some cases, you may need further tests such as an X-ray or blood test to rule out other causes.

Healthy joints are constantly repairing themselves due to wear and tear from daily activities. However, this repair process can become faulty or fail to keep up with severe wear and tear. 

In osteoarthritis — often referred to as a 'wear and tear' disease — the cartilage surrounding the joints is damaged and worn down. The joint bones, which they cover, can then become damaged and develop growths at their edges (spurs). Connective tissues that hold the joints together and connect bones to muscle can also deteriorate. Additionally, inflammation of the joint linings develops. 

There are many factors that may increase your risk of osteoarthritis; often it is a mixture of the following:

• Activity — active hobbies, sports and jobs that place excessive strain on your joints can contribute to wear and tear
• Age — osteoarthritis usually begins from your late 40s onward
• Family history — if your parents or grandparents have or had osteoarthritis, you may be at a higher risk  
• Gender — osteoarthritis is more common in women than men
• Meniscus tear
• Obesity — being overweight places greater strain on your joints, especially on your hips and knees, which increases your risk of osteoarthritis in these joints

Previous injuries also affect your risk of osteoarthritis later in life, such as fractures, dislocated joints and ligament injuries. Even having an operation can increase your risk.

Certain medical conditions can increase your risk too, specifically metabolic diseases, including: 

• Diabetes 
• Haemochromatosis — an inherited condition that causes iron to build up over time

Who gets osteoarthritis?

Around 8.5 million people in the UK have joint pain due to osteoarthritis. There are two types of osteoarthritis: 

• • Primary osteoarthritis — this develops in healthy joints of people usually aged 50 or over; half of people aged 65 have osteoarthritis in one or more joints; it is usually mild but it causes major disability in one in 10 people aged over 65, usually because it affects both knees or hips
  • Secondary osteoarthritis — this develops in joints that were or are affected by damage, deformity or injury; this can occur in younger people

Osteoarthritis can't be cured, however, it often doesn’t worsen over time. There are treatments that can help and things you can do yourself to manage it. Simple things such as exercise, over-the-counter painkillers, supportive therapies and weight loss can make everyday activities easier. 

Osteoarthritis treatment aims to:

• Help you to understand how to manage your condition
• Maintain or improve the mobility of your affected joint(s)
• Limit disability due to your condition
• Limit joint damage
• Limit side effects from any medications
• Reduce your pain and stiffness

Although osteoarthritis is more common in older people, you don’t need to simply accept it as a part of growing older — treatments are available so you don't have to live with disability or pain. 

Treatments that can help with osteoarthritis vary depending on the severity of your condition and the affected joints, but they include:

Exercise

This is an important part of osteoarthritis treatment, whatever your age or fitness level. Exercises should include those that improve your general fitness and strengthen your muscles. Regular exercise will build up your muscles and consequently strengthen your joints, which will improve your symptoms. Exercise also helps with weight loss, improves posture and reduces stress, which can all help ease your symptoms. 

Your GP or a physiotherapist can put together an exercise programme for you and explain its benefits. Try to follow the recommended exercise programme as it is easy to overdo it or perform exercises that worsen your symptoms. Swimming is a good exercise if you have osteoarthritis as it doesn’t put too much strain on your joints. Going for regular walks can also help.

Weight loss

Excess weight puts your joints under greater strain and therefore makes osteoarthritis worse. Regular exercise and eating a healthy diet can help you lose weight. Speak to your GP or physiotherapist before you start on your exercise programme or change your diet. 

Painkillers

A variety of different painkillers can be taken to manage your pain. Your doctor will recommend which are most appropriate in your case, depending on the severity of your pain and factors such as other medical conditions you have.

Paracetamol

Take it at regular intervals, rather than waiting for your pain to become severe, but do not exceed the recommended daily allowance. 

Non-steroidal anti-inflammatory drugs (NSAIDs)

These reduce inflammation and therefore also reduce pain and swelling. They're available as creams applied directly to your affected joints (topical NSAIDs) and as tablets. 

Topical NSAIDs are particularly effective for treating osteoarthritis in your hands or knees. If they are not effective and paracetamol is not enough to ease your pain, your doctor may recommend NSAID tablets. However, NSAID tablets are not suitable for everyone eg if you have: 

• A stomach ulcer
• Angina
• Asthma
• Have had a heart attack or stroke

If taking NSAID tablets, your doctor will usually also recommend a proton pump inhibitor (PPI) — these are tablets that protect your stomach from excess acid, which is a potential side effect of NSAID tablets. 

Opioids

Opioids eg codeine are strong painkillers but can cause side effects, including constipation, drowsiness and nausea. Opioids can be combined with paracetamol in medicines such as co-codamol.

Capsaicin cream

This is applied directly onto affected joints and blocks pain signals from nerves in the area. You may have to use it for up to two weeks before you start to feel your pain ease and it may take a month for the full effect. 

When using capsaicin cream apply a pea-sized amount to your affected joints up to four times a day. Do not apply this cream more often than every four hours. Capsaicin cream is made from chillies so you may feel a burning sensation after applying it. Avoid getting the cream on sensitive areas of your body as this can cause a painful, burning sensation for a few hours. 

Steroid injections

Steroid joint injections contain an artificial version of the natural hormone cortisol. They are given directly into the affected joint. 

Supportive treatments

These can help relieve your symptoms and/or prevent them from worsening. 

Transcutaneous electrical nerve stimulation (TENS)

A TENS machine has sticky patches called electrodes that you attach to your skin. Through these patches, the machine sends electrical impulses to numb nerves that send pain signals and therefore ease your pain.

Hot or cold packs

You can fill a hot-water bottle with either hot or cold water and apply it to the affected joint to reduce your pain. You can also buy hot packs that you can heat up in the microwave and cold packs that you can cool in the freezer. 

Assistive devices

These cover a variety of devices that can help you with everyday activities, including: 

• A splint to rest a painful joint — a piece of rigid material to support a joint or bone 
• A stick or cane to hold on the side opposite your affected joint
• Footwear with shock-absorbing soles to relieve pressure on your leg joints when you walk
• Self-help devices to make hand-operated tasks easier eg easy-grip utensils, jar openers, reachers and tap turners
• Special insoles, leg braces and supports to help spread your weight more evenly

Manual therapy

This is a type of physiotherapy. A physiotherapist will use their hands to massage, mobilise and stretch your tissues to keep your joints flexible and supple. 

Surgery

Surgery is rarely needed and is only performed if other treatments have not been effective or a joint is severely damaged. It may not completely resolve all of your symptoms.

Joint replacement

This is medically known as arthroplasty. The most common types of joint replacement for people with osteoarthritis are knee replacement and hip replacement.

The affected joint will be removed and replaced with a prosthetic joint made of special plastics and metal. A prosthetic joint can last up to 20 years and therefore may need to be replaced.

A newer type of joint replacement surgery called resurfacing only uses metal parts. This may be recommended for younger patients. 

Joint fusing

This is medically called arthrodesis. Your joint pain will be much less after this surgery and your joint will be stronger but you will no longer be able to bend it. 

Osteotomy

Surgery to add or remove a small section of bone either above or below your knee joint. This helps realign the knee joint so that your weight isn't carried by the damaged part of your knee. You may eventually still need knee replacement surgery.

Other surgical procedures 

• Back surgery
• Knee arthroscopy
• Gastric sleeve surgery 
• Orthopaedic surgery

Complementary and alternative therapies

For example acupuncture and aromatherapy. There is no conclusive evidence that these treatments are effective. 

Rubefacients — creams applied to the skin that cause warming and reddening — are available but are not recommended by the National Institute for Health and Care Excellence (NICE). 

Nutritional supplements

Glucosamine and chondroitin supplements have been used to treat osteoarthritis. These chemicals are found in healthy cartilage and therefore are taken as supplements with the aim of helping repair damaged cartilage. However, studies have shown little to no effect of taking these supplements to treat osteoarthritis and NICE does not recommend them as an osteoarthritis treatment. 

Exercising regularly and eating a healthy diet are important for managing your osteoarthritis as they help keep your muscles strong and help maintain a healthy weight.

You should take your medication as prescribed by your doctor, even if your symptoms improve. Make sure you talk to your doctor if you: 

• Are experiencing any side effects from your medication
• Have any concerns about your medication 
• Want to try taking over-the-counter painkillers or nutritional supplements — these may interfere with your current medications

Your doctor may also recommend that you get the annual flu vaccination to protect you from catching the flu. 

Keep up with regular reviews with your healthcare team as the more they know about your condition, the more they can help. You may also want to try talking to others with osteoarthritis, either individually or as part of a support group.

Work and money

Osteoarthritis may affect your ability to work, depending on the type of work you do. You may therefore be entitled to financial support, which includes:

• Attendance Allowance — if you're aged 65 or over and need personal care due to your condition
• Employment and Support Allowance — if you don't have a job and can't work due to your condition
• Personal Independence Payment — if you're aged 64 or under and have trouble walking or need help with personal care
• Statutory Sick Pay from your employer — if you have a job but can't work due to your condition

Osteoarthritis usually doesn't worsen over time or cause disability. In many cases, osteoarthritis is mild and you can remain as active as others your age who don't have osteoarthritis. 

However, in cases where osteoarthritis is severe, one or more joints can be badly affected and your mobility may be significantly reduced for your age.