Osteoarthritis
1. Introduction
Osteoarthritis is a common condition of joint pain accompanied by varying degrees of functional limitation and reduced quality of life (4). Osteoarthritis is not only the most common type of arthritis in the UK (1) but is also the leading causes of pain and disability worldwide (4). Osteoarthritis is estimated to affect 10% of men and 18% of women over 60 years of age worldwide (2). It is estimated that 8.75 million people aged over 45 years in the UK have sought treatment for osteoarthritis (5).
Osteoarthritis refers to symptoms that may be consistent with the normal, ageing process of our musculoskeletal joints. Where two bones meet, they form a joint. Some joints are designed like a hinge (such as the knee joint) and others are shaped like a ball and socket (such as the hip joint). Over many years, the protective lining of these bones (known as cartilage) can gradually thin, causing increased load to the bony tissue underneath.
This is a normal and a natural part of the ageing process and does not automatically lead to pain or loss of function. However, for some individuals, the changes that occur can lead to joint pain, stiffness and loss of function. This is then classed as osteoarthritis of the affected joint (1, 2, 4).
Frequently Asked Questions
- Osteoarthritis is the broad term given to pain, stiffness and loss of a function of a joint due to changes associated with the ageing process.
- Common.
- It is the most common form of arthritis in the UK (1).
- It is the most cause of joint pain and disease worldwide (4).
- It affects an estimated 10% of men and 18% of women over 60 years of age worldwide (2).
- No.
- Osteoarthritis can be painful and have an impact on your life, but it is not a sign of more serious medical condition.
- Many people with osteoarthritis can manage their symptoms well with conservative management and do not need surgery.
- The risk of developing osteoarthritis increases with age and is seen most often in people aged over-60.
- Osteoarthritis is known to affect more females than males.
- Younger people can develop osteoarthritis, but this is far less common as it usually follows a significant joint injury (2).
- Joint tenderness (such as the knee or hip joints).
- Pain and stiffness after periods of inactivity, or first thing in the morning.
- Joints appearing slightly larger or swollen.
- Limited range of movement.
- Weakness and muscle wasting (loss of muscle size) (3).
There are many things you can do to help reduce the impact of osteoarthritis on your quality of life:
- Maintain a healthy weight by eating sensibly and participating in physical exercise.
- Resistance exercises that help develop and maintain muscle strength can have a significant impact on your joint pain.
- Use appropriate pain relief when required as per your doctor’s instructions.
- Applying hot and cold therapy (such as an ice pack or hot water bottle) can be soothing for some people (3).
- Unfortunately, there is currently no cure or medical way to reverse osteoarthritic changes to a joint.
- However, recent research continues to highlight that the changes observed on x-ray have little to no value in predicting future pain levels (2).
- For most patients, symptoms and changes observed on imaging do not progress significantly over time.
- Playing an active role in managing your symptoms can help delay or slow the progression of the disease and enable you to continue to lead an active and fulfilling life.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
Some of the most frequently reported symptoms of osteoarthritis are reported below:
- Joint pain – pain around the affected joint or region, such as the knee or hip joints.
- Changes in joint appearance – the affected joint(s) may appear slightly swollen or larger than others.
- Limited range of movement in the affected joint(s) – stiffness or an inability to move the joint in the way(s) you need it to.
- Weakness and loss of muscle – this can develop secondary to the pain itself but might also occur because of decreasing activity levels due to pain.
3. Causes
It used to be reported that osteoarthritis affected everyone and was just something to be expected as we grow and age (4). However, this is a rather simple way of looking at the issue and has been shown to be incorrect in numerous, high quality research studies (5, 7).
The ageing process affects us all in different ways, and some people are more or less likely to develop symptoms than others. It is now appreciated the changes we see on an x-ray (for example a loss of joint space or thinning of the cartilage) are poorly associated with pain. This means that we may see significant changes on an x-ray in one and yet the person is managing perfectly well but minimal changes on x-ray in another person who is having a lot of pain (7). It is likely that osteoarthritis is influenced by several biological (e.g., muscle strength, fitness levels, body fat percentage) social (such as family support and assistance at work) and psychological factors (such as beliefs about pain or injury). Therefore, it is not a simple case of explaining that pain is due to the ageing process or what we see on an image.
It is also important to note that osteoarthritis does not develop due to exercise. It was previously assumed that exercise (such as running) increased the load on joints and accelerated the degenerative process. However, more recent research has shown exercise appears to have a more protective effect on joints, by keeping them supple and strong (8). Exercise is one of the best ways to manage osteoarthritis (3) although it is important to take advice from a trained medical professional.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing symptomatic osteoarthritis. It does not mean everyone with these risk factors will develop symptoms:
- Advancing age – older patients are more like to develop symptomatic osteoarthritis, peaking at 75–84 years of age.
- Being female – osteoarthritis is more common in females than males.
- Genetics – in some cases, having a parent or relative with osteoarthritis may increase the risk of developing symptoms yourself.
- Obesity – due to increased load through the joints but also metabolic changes in the body leading to potentially more pain. (6)
5. Prevalence
Osteoarthritis is the most common cause of musculoskeletal pain and disability worldwide (1, 2). It affects an estimated 10% of men and 18% of women over 60 years of age globally (2). The prevalence of osteoarthritis is very closely linked to the risk factors associated with the condition. It has been shown that the prevalence of symptomatic osteoarthritis, as confirmed by x-ray, is higher in women than men, especially after the age of 50 years (2).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified health care professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent re-assessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.
An x-ray may be ordered to confirm the diagnosis, but the findings will be placed in context together with your physical assessment and symptoms. It is worth repeating here that x-rays are not always necessary. Whilst useful for confirming the diagnosis, they have little predictive value with pain or levels of function, merely as an indicator of the degree of joint change (4).
7. Self-Management
There are many things you can do to help manage your symptoms and lead an active and fulfilling life (4).
- Maintain a healthy weight – to modify and reduce the amount of stress placed on your joints.
- Stay physically active – keeping active helps to keep the muscles strong and joints flexible, try forms of exercise such as walking, swimming, yoga or Pilates as a good way to keep fit and healthy.
- Perform strengthening exercises around the joint – to help build muscle mass and support the affected joints.
- Relaxation techniques – such as meditation or deep breathing exercises can help manage your pain and promote wellbeing.
- Take pain relief if necessary and always follow the advice of your doctor or pharmacist.
8. Rehabilitation
Exercise is very important in the management of osteoarthritis (4). The positive effects of exercise in the long-term management of osteoarthritis are well known and are documented in specific guidelines for healthcare professionals (4). Exercise prescribed by your physiotherapist will include both local muscle strengthening exercises and general aerobic (cardiovascular) fitness exercises.
Exercise such as swimming, walking, Pilates and yoga are a useful starting point and can be progressed as you develop fitness and confidence. Your physiotherapist may also recommend other treatment options such as manual therapy (hands on treatment applied to the joints and/or muscles). Education and advice on how to manage your condition long term is also very important (7).
For further rehabilitation advice on specific joints, please refer to the self-help tool and select the joint that is affected.
9. Osteoarthritis
Rehabilitation Plans
ctivity and exercise modifications should be discussed with a physiotherapist and advice will be individually tailored to the joint(s) affected and your daily routine, occupation, recreational and sport interests.
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
In more advanced or severe cases, or where there has been no consistent improvement, further treatment may be recommended. This may include a corticosteroid injection (a mixture of an anti-inflammatory substance and anaesthetic) into the affected joint for pain relief. In cases where there has been a clear and progressive increase in pain and loss of function, surgery may be required to replace the joint (such as the hip or knee). However, this is now, understandably, reserved for the most severe forms of osteoarthritis.
12. Links for Further Reading
25 locations and counting across the UK
References
- NHS conditions – Osteoarthritis. [online] Available at: https://www.nhs.uk/conditions/osteoarthritis/ [Accessed 19 February 2021]
- National Institute for Health and Care Excellence (2023) Osteoarthritis: how common is it? [online] Available at: https://cks.nice.org.uk/topics/osteoarthritis/background-information/prevalence/ [Accessed 19 February 2021]
- Arthritis Action (2021) Osteoarthritis – Arthritis Action. [online] Available at: https://www.arthritisaction.org.uk/living-with-arthritis/what-is-arthritis/osteoarthritis/ [Accessed 19 February 2021]
- NICE (2022) Osteoarthritis in over 16s: diagnosis and management (NICE guideline). Clinical guideline 177. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng226
- Arthritis Research UK (2013) Osteoarthritis in general practice. Arthritis Research UK.
- Caneiro J, O’Sullivan PB, Roos EM, et al. (2020). Three steps to changing the narrative about knee osteoarthritis care: a call to action. British Journal of Sports Medicine.
- Lo GH, Driban JB, Kriska AM, et al. (2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) doi:10.1002/acr.22939
Other Conditions in
Long Term Conditions, Orthopaedics
Thumb Osteoarthritis
Thumb osteoarthritis (OA) is degeneration of the cartilage that covers the ends of the bones that form the joint, which creates pain and stiffness.
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Shoulder Osteoarthritis (OA)
Age and activity related changes to the joints of the shoulder which can lead to pain and stiffness.
Polymyalgia Rheumatica (PMR)
A rare inflammatory condition affecting joints and surrounding muscles, usually affecting hips and shoulders.
Pelvic Girdle Pain
Typically seen in pregnancy causing pain, instability and limitation of mobility and functioning of the pelvic joints.
Pelvic Floor Dysfunction
The inability to effectively control the muscles of your pelvic floor, leading to issues with continence and pain.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Long Covid
A term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness.
Knee Replacement Surgery
Replacement of the knee hinge joint, typically as a result of severe osteoarthritis or trauma.
Knee Osteoarthritis
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Hip Replacement Surgery
Replacement of the hip ball and socket joint, typically as a result of severe osteoarthritis or trauma.
Hip Osteoarthritis
Common age-related changes to the structure of the hip joint may be associated with pain, stiffness and loss of function.
Fibromyalgia
A persistent pain disorder that is characterised by pain affecting multiple areas of the body.
Complex Regional Pain Syndrome
A rare condition where a person experiences persistent, severe and debilitating pain, often with a complex cause.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.
Adult Acquired Flatfoot
The main arch of the foot loses its height giving the appearance that the foot sits flat on the floor.