Osteoarthritis

Osteoarthritis is common as age advances. Individuals above the age of 60 have significant wear and tear in their joints, leading to the development of osteoarthritis. The following symptoms are commonly seen with osteoarthritis:

Knee Osteoarthritis

• Chronic pain, tenderness, and swelling in the knee joint
• Reduced range of motion and stiffness in the knee joint
• Crepitus or abnormal grinding sounds heard during joint movement
• Bone spurs, which are extra bits of bone that feel like hard lumps, can form around the affected joint
• Bone deformity

Hip Osteoarthritis

• Chronic pain, tenderness, and swelling in the hip joint
• Reduced range of motion and stiffness in the hip joint
• Crepitus or abnormal grinding sounds heard during joint movement
• Joint deformity

Cervical Spondylosis (Osteoarthritis)

• Pain and stiffness of the neck
• Radiating or sharp shooting pain in the upper limbs
• Tingling and/or numbness in the upper limbs
• Dizziness
• Vertigo
• Grinding noise in the neck when turned sideways

Lumbar Spondylosis (Osteoarthritis)

• Pain and stiffness of the lower back
• Radiating or sharp shooting pain in the lower limbs and buttocks
• Tingling and/or numbness in the lower limbs
• Inability to stand or walk for prolonged durations
• Balance problems

A lot of factors are responsible for osteoarthritis, such as:

• Age-related degenerative changes: With increasing age, there is normal wear and tear of the joints, cartilages, ligaments, and other soft tissues in the body. These degenerative changes occur in various joints, making them stiff. Degeneration of the joints also leads to the formation of osteophytes, which are extra bony protrusions characteristic of osteoarthritic joints. These can lead to immense pain and stiffness. In advanced stages, joint deformities occur that can severely impact function and mobility.
• Heredity: Genetic factors likely influence the formation of osteophytes and degeneration of joints. This is likely attributed to polymorphism in genes regulating inflammatory pathways. For example, Ehlers-Danlos syndrome, characterized by joint hypermobility, can contribute to osteoarthritis.
• Environmental factors: Poor posture, lack of exercise, obesity, and occupational hazards, such as lifting heavy weights, along with previous trauma to the joints, cause faster wear and tear of the joints, leading to osteoarthritis.
• Post-menopause: Decreased estrogen levels experienced by post-menopausal women increase the risk of knee osteoarthritis, as estrogen is protective of bone health, specifically reducing oxidative stress to the cartilage.

• Age more than 50 years
• Obesity/overweight
• Diabetes
• Elevated cholesterol levels
• Hypothyroidism
• Hyperparathyroidism
• Acromegaly
• Paget’s disease
• Wilson disease
• History of trauma to the joints
• Faulty alignment of the joints
• Occupational overuse of a joint, e.g., athletes or people using hand drills
• Improper weight-bearing
• History of heavy weight lifting
• Poor posture
• Lack of exercise

The following evaluations are performed by the doctor to confirm the diagnosis of osteoarthritis:

History and Physical Examination

• The doctor will take a detailed history of the onset of symptoms.
• A thorough physical examination will be performed, checking for joint stiffness, muscle spasms, muscle strength, and conducting a neurological examination to evaluate the affected joints.

Imaging Studies

• X-Ray Both Knee Standing AP & Lateral Views - to study the bony changes in the knee joints.
• MRI Both Knee Joints - to evaluate soft tissue changes around the knee joint.
• X-Ray Hip Joint AP View - to study the bony changes in the hip joints.
• MRI Both Hip Joint - to evaluate soft tissue changes around the hip joint.
• X-Ray Cervical Spine AP & Lateral - to study the bony changes in the neck.
• X-Ray Lumbar Spine AP & Lateral - to study the bony changes in the lower back.
• MRI Screening of Whole Spine - to evaluate in detail the soft tissue and bony changes of the entire spine, such as disc desiccation, disc protrusion, ligament thickening, etc.
• Bone Densitometry Whole Body - to check for concomitant osteoporosis, a condition where the bones lack calcium and become brittle and weak.

Other Tests

• Serum Calcium - advised to check for calcium deficiency that plays an important role in bone and joint pains.
• Vitamin D (25 - OH) - to check for calcium deficiency that is essential for absorbing calcium in the body.
• Although there's no blood test for osteoarthritis, certain tests can help rule out other causes of joint pain, such as rheumatoid arthritis.
• Joint Fluid Analysis - a test in which your doctor might use a needle to draw fluid from an affected joint. The fluid is then tested for inflammation and to determine whether your pain is caused by gout or an infection other than osteoarthritis.

Osteoarthritis is an age-related condition that occurs due to unavoidable degenerative changes and wear and tear of the joints. A few strategies that can help prevent the occurrence of serious symptoms of osteoarthritis include:

• Following a healthy diet rich in calcium and other essential minerals
• Ensuring adequate exposure to morning sunlight to maintain sufficient vitamin D levels in the body
• Engaging in regular exercise to maintain strength and mobility in the joints
• Practicing correct ergonomics while lifting weights and exercising
• Avoiding sudden jerky and twisting movements of the joints
• Steering clear of squatting positions and sitting cross-legged

The treatment of osteoarthritis mainly involves medical management and surgical management.

Medical Management

• NSAID Analgesics: These include medicines like Ibuprofen, Diclofenac, and Paracetamol that help relieve pain and inflammation. These medicines must always be consumed with meals, as taking them on an empty stomach can irritate the gastric lining.
• Narcotics: This class of drugs may be required for more severe pain that is not relieved by first-line medications. These tablets must be used only as prescribed by the physician, as they are potentially habit-forming. In 2010, the FDA approved the use of duloxetine (Cymbalta) for chronic musculoskeletal pain, including from OA. This oral drug is also used for other health concerns, such as mood disorders, nerve pain, and fibromyalgia.
• Muscle Relaxants: These drugs help relieve painful spasms and stiffness associated with osteoarthritis of the spine. One of the most commonly used drugs in this category is Cyclobenzaprine.
• Corticosteroids: This class includes medicines like Prednisolone, which may be prescribed for a short duration or as an injection to help relieve pain. Joint injections with corticosteroids (sometimes called cortisone shots) or with a lubricant called hyaluronic acid can provide months of pain relief from OA. These shots may help delay the need for a knee replacement by a few years in some patients.
• Topical Analgesics and Sprays: Topical application of analgesic ointments and sprays can help with symptomatic pain relief.
• Medications for Nerve Pain: These are useful in providing relief from complications of osteoarthritis of the spine, such as radiating pain, tingling, and numbness in the upper and lower limbs.
• Supplements: Many over-the-counter nutritional supplements have been used for osteoarthritis treatment. Most lack strong research data to support their effectiveness and safety. Among the most widely used are calcium, vitamin D, and omega-3 fatty acids. Fish oils are also known for their anti-inflammatory properties; however, their use has been established mainly in rheumatoid arthritis. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements.

Surgical Management and Other Invasive Procedures

• Intra-articular Injections: In cases of severe pain that does not respond to medications, a Hydrocortisone injection may be given in the joint for quick relief. Hyaluronic Acid injections are also provided to help with joint lubrication.
• Alignment Correction Surgery: Corrective surgeries like osteotomy, laminectomy, and spinal fusion are performed for severe joint deformities that cause limitations in function and pain.
• Joint Replacement Surgery: For severely damaged knees and hips, a prosthesis may be fitted, and the worn-out joints are completely replaced by mechanical joints. Though some joint changes are irreversible, most patients will not need joint replacement surgery.
• Transcutaneous Electrical Nerve Stimulation (TENS): This uses a low-voltage electrical current to relieve pain and provides short-term relief for some people with knee and hip osteoarthritis.

At present, there is no treatment that can reverse the damage of OA in the joints. However, research is ongoing to find ways to slow or reverse this joint damage.

Along with the medications, following home care tips can help manage symptoms and lead to the best possible disease outcomes:

• Take a wholesome, balanced diet rich in calcium and other minerals.
• Follow the exercise routine suggested by the doctor or physiotherapist.
• Hot fomentation and application of topical analgesic preparations help relieve pain and stiffness.
• Intermittent hot and cold treatments may provide temporary relief of pain and stiffness. Such treatments include a hot shower or bath and the careful application of heating or cooling pads or packs.
• Gentle massage performed by a massage therapist can provide relaxation and promote pain relief.
• Use joint supports, such as knee caps, cervical collars, and lumbosacral belts to help support the spine.
• Walking aids, such as a cane or walker, may help offload the diseased joints and promote safer walking while offering pain relief.
• Avoid lifting heavy weights, and if done as part of an exercise program, it must be done with extreme caution and correct ergonomic posture.
• Change the mattress and sleeping pillow if they do not provide proper support, and use those that stabilize the spine.
• Properly position and support your neck and back while sitting or sleeping.
• Adjust furniture, such as raising a chair or adjusting your toilet seat, to prevent pressure on the joints.
• Avoid repeated motions of the joint, especially frequent bending.

Osteoarthritis is a disease that progresses with age. If adequate care is not taken during the early stages of osteoarthritis, the following complications can occur:

• A complete loss of mobility and extreme stiffness in the joints, rendering a patient bedridden or causing severe walking issues.
• Chronic debilitating pain that may interfere with sleep and be a source of anxiety or depression.
• Neurological complications, such as paralysis and nerve pain, may occur as a result of advanced spondylosis.

Along with medicines and topical analgesic preparations, various other treatment options help in the management of osteoarthritis:

• Exercise and Yoga: Regular exercises and yoga focused on strengthening the joints and surrounding musculature, as well as improving mobility, are very helpful in managing the pain and stiffness caused by osteoarthritis.
• Massage: A gentle massage improves blood flow in the affected areas, promotes relaxation, and aids in pain relief. Massages should only be performed by a qualified massage therapist.
• Physiotherapy: Physiotherapeutic modalities, such as Interferential Therapy (IFT) and Transcutaneous Electrical Nerve Stimulation (TENS), are effective in providing pain relief, including from nerve pain. Rehabilitation exercises focus on strengthening and correcting weight-bearing of the joint and surrounding muscles, enhancing the overall strength and mobility of the affected joints.
• Acupressure and Acupuncture: Chronic joint pain may respond to acupuncture or acupressure therapy, which involves applying pressure or noxious stimuli on peripheral trigger points.
• Ayurveda: Various Ayurvedic preparations, in the form of oils and liniments, are typically applied locally at the site of pain. These provide significant relief from symptoms and promote joint health.
• Homeopathy: Homeopathic preparations, available as injections or oral drops/pills, such as Rhus Toxicodendron, Arnica Montana, and Solanum Dulcamara, are known to alleviate pain and other troublesome symptoms in patients with osteoarthritis.
• External Orthoses Support: Utilizing knee caps, cervical collars, lumbosacral belts, and walking aids like sticks or walkers offers essential support to degenerative joints and is beneficial in reducing pain associated with osteoarthritis.

Osteoarthritis has a significant impact on an individual’s quality of life. Severe, chronic, and debilitating pain may interfere with basic activities, such as walking, leading to restrictions in movement and travel. Often, chronic pain is a source of anxiety and depression in osteoarthritic patients, causing them to withdraw from society and the community at large. Joining knee care and spine care clubs may help these patients cope with degenerative changes and connect with others experiencing similar pain.

Here are a few lifestyle changes one can incorporate into their routine to ease joint pain, especially during winter:

• Supplement with bone and joint healthy foods:
  • Stock up on dairy products and spend at least 15 minutes in sunlight daily to increase vitamin D intake.
  • Include foods rich in omega-3 fats such as salmon, nuts, and fish oil in your diet, as these help ease inflammation.
  • Incorporate foods rich in vitamin K, such as spinach, fenugreek (methi), cabbage, and kale, for their pain-soothing properties.
  • Add vitamin C-rich foods like juicy oranges, sweet red peppers, tomatoes, and amla to halt cartilage loss associated with arthritis.
• Exercise regularly: Go for a 30-minute walk daily. If cold weather makes it difficult to go out in the mornings, opt for an afternoon walk. Also, stretch your muscles to help maintain mobility.
• Stay hydrated: Drink plenty of water in winter, as dehydration reduces flexibility and increases stiffness.
• Get a massage: Professional massage therapy helps relax the muscles around painful joints, reducing pain and improving mobility.
• Cover up: Keep painful joints covered with a sleeve or wrap. Keeping them warm helps reduce pain and increases mobility. Using a muscle relaxant gel on aching joints before covering them can be very helpful.
• Use hot packs or ice packs: Hot packs, hot baths, or steam can soothe painful joints. Heat stimulates blood flow, bringing healing nutrients to the affected area and inhibiting pain signals to the brain.
• Take medication on time: Do not forget to take your medications as advised by your doctor. If you suffer from chronic joint pain, consult your doctor for painkillers. Avoid self-medication and attend regular doctor consultations, especially if your symptoms recur or worsen.

Looking for some simple yet effective exercises for knee pain? If yes, then watch this video to learn expert-approved exercises and tips.