Osteoarthritis

Osteoarthritis is by far the most common form of arthritis. Unlike rheumatoid arthritis which is caused by inflammation, osteoarthritis is caused by long-term wear-and-tear in the joints. After years of use, the cartilage that cushions the joints can break down, until bone rubs against bone. Osteoarthritis is rarely as crippling as rheumatoid arthritis, but it can have a big impact on a person's life. It can make it hard to do every day activities like getting dressed and walking up the stairs. It most commonly affects the knees, hands, hips and spine. It does not affect both sides equally and symmetrically as commonly as rheumatoid arthritis. Osteoarthritis is the cause of knee pain in over half of people over 55. It is not to be confused with osteoporosis which is “brittle bone disease” and not related to osteoarthritis.

 Who is affected?

Osteoarthritis is the number one reason for joint-replacement surgery.  It can take decades for enough cartilage to wear down to cause osteoarthritis. It occurs mostly in men after the age of 50 and in women after the age of 40. After menopause, women are twice as likely as men of the same age to develop the condition. Being overweight and a family history of arthritis makes you more prone to the condition. However, it has less of a tendency to run in families than rheumatoid arthritis. Playing a lot of high impact sport (eg. Gaelic football and rugby) and having an injury or an operation on a joint can make you more likely to have problems later on.

Symptoms

The main symptoms of osteoarthritis are pain and stiffness of the joints. The joints may also become swollen although this is less common than in rheumatoid arthritis. Unlike rheumatoid arthritis, where pain and stiffness tends to be worse in the morning, the pain of osteoarthritis tends to get worse throughout the day. The joints may not be able to move as easily as before. There may be a crunching feeling in the joints. Joints may make creaking sounds called crepitations. Joints may become misshapen and knobbly, and they may become unstable (but generally not as severe as with rheumatoid arthritis).

Diagnosis             

Unlike other forms of arthritis, there is no single test that can check for osteoarthritis. Outgrowths, swelling, creaking, instability and reduced movement of the joint can be signs. X-rays only give limited information and in the early stages of osteoarthritis, joints may look normal.

Treatment

Certain actions can prevent and reduce the symptoms of osteoarthritis including losing any excess weight, wearing shock-absorbent shoes, using a walking stick and wearing a knee brace. Taking regular exercise is important as it keeps weight down and strengthens muscles which support the joints.

Medicines

There is no cure for osteoarthritis however certain medication will relieve symptoms.

Paracetamol- Over-the-counter painkillers such as paracetamol can help. Paracetamol is safe for most patients once taken within the recommended dosage limits.

NSAIDs- If the pain is more severe, the doctor may prescribe anti-inflammatory medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation. These are helpful in reducing pain, swelling and stiffness. Examples include diclofenic (Difene^®, Diclac^®), naproxen (Naprosyn^®) or etoricoxib (Arcoxia^®). Ibuprofen is an NSAID available over the counter in pharmacies. NSAIDs should be avoided or used in caution with asthma and heart problems and can cause stomach ulcers if over used.

Topical preparations- Many NSAIDs are available in topical forms such as creams or gels which can be rubbed on to give a local effect (eg) Difene Gel^®, Fastum Gel^®. These topical forms have fewer side effects than NSAIDs taken orally. However they are likely to be less effective as less of the drug is absorbed.

Opioid Analgesics- Opioid analgesics such as tramadol are prescription only painkiller which may be considered in cases where NSAIDs are not tolerated or ineffective. However, opioids can become additive. Side effects include drowsiness, nausea and constipation.

Steroid Injections- Steroid injections into the affected joints may be a treatment option. It should only be considered where there is inflammation in the joint. However, the effects of steroid injections only last up to four weeks (often only a week) so it is not a long term solution.

Surgery

Surgery should only be considered when all other options have been tried. Surgical options available have advanced recently. Some options such as realignment and hip resurfacing are available even if you have only mild osteoarthritis. Hip resurfacing is an alternate to hip replacement and is more often used in younger patients.

It involves replacing the socket where the top of leg attaches to the pelvis with a “metal socket”. The advantages of this compared to hip replacement is that it is very durable for young and active patients. It allows the patient to maintain full mobility and even return to active sports in many cases. Some research shows that there is less pain and stiffness after hip resurfacing compared to hip replacement. However more research is needed to confirm this. Patients normally can resume normal daily activities a few weeks after hip resurfacing. Hip resurfacing lasts for 10 to 15 years on average.

If you have a particularly painful joint you may need an operation to replace it. This is most commonly done for the hip and knee joints and both of these have high rates of success in improving mobility and reducing pain. With proper selection of patients, 95% of hip and knee replacements have excellent results with 95% of replacement joints lasting 15 years. 85% of hip and knee replacements are due to osteoarthritis.

Whelehan’s physiotherapy service

Whelehans physiotherapy service is available on Wednesdays and on Saturday mornings. Book a physiotherapist appointment by calling Sinead at 083 1722171.

 Osteoarthritis information event

Whelehans Pharmacy in conjunction with the Westmeath Branch of the Arthritis Ireland are hosting an Osteoarthritis Information evening on Wednesday November 20^th in the Annebrook Hotel, Mullingar at 7:30pm. The guest speaker for the evening is orthopaedic surgeon from Midland Hospital Tullamore, Eoin C Sheehan, MD FRCS (Ortho). Book your free place by calling Whelehans at 044 93 34591.

 This article is shortened to fit within this Health Blog. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie