DID YOU KNOW?
- Osteoarthritis (OA) is the most common type of arthritis; it affects one in 10 Canadian adults.
- It affects women and men equally (past 60).
- Anyone can get OA, but it is more common as we age.
There is no cure for OA, but when you are diagnosed early and start the right treatment, you can take control of your disease and may delay or even avoid severe damage to your joints.
Most people with OA can lead active and productive lives with the help of the right medication, surgery (in some cases), exercise, rest and joint protection techniques.
WHAT IS OSTEOARTHRITIS?
The word arthritis means inflammation of the joint ("arthr" meaning joint and "itis" meaning inflammation). Inflammation is a medical term describing pain, stiffness, redness and swelling.
There are more than 100 types of arthritis. Arthritis is among the leading causes of disability in Canada, affecting nearly 4.5 million people of every age, physical condition and ethnic background.
Osteoarthritis (OA) is the most prevalent kind of arthritis, affecting more than three million Canadians. It occurs when cartilage (the tough elastic material that covers and protects the ends of bones) begins to wear away. Cartilage is an essential part of the joint; not only does it act as a shock absorber, it also enables the joint to move smoothly. With OA, the cartilage erodes, eventually resulting in pain, stiffness, swelling and bone-on-bone movement in the affected joint.
OA will usually cause the affected joints to become stiff in the morning, but the stiffness usually lasts about 15-20 minutes. As the day progresses and joints are used, the pain and discomfort can get worse. Resting the joints tends to provide relief. The joint may become inflamed with pain, warmth and swelling. The pain and stiffness causes the joints to be used less often and the muscles surrounding the joint weaken.
As the cartilage wears down over time, the joints may slowly become bigger (boney) as the body tries to heal itself. With severe OA, the cartilage may wear away entirely and the bones may rub together ("bone-on-bone"). When this happens, the joints become more painful.
There is also a rare type of osteoarthritis called Inflammatory OA. This is a more severe, rapidly progressive, multiple joint OA that is associated with more stiffness in the morning and swelling in the joints with warmth and redness. This type of OA is more difficult to diagnose because it is often confused with rheumatoid arthritis (RA). A rheumatologist can help make the correct diagnosis and suggest treatment for Inflammatory OA.
WHAT ARE THE WARNING SIGNS OF OA?
OA usually progresses slowly over a period of months to years:
- You start to feel the gradual onset of pain in joints typically affected by OA.
- Early on, the pain is triggered by high impact activities only.
- Later, with mild disease, the pain is triggered by ordinary activities, relieved by rest and may be associated with symptoms, such as locking of the joint.
- This pain is usually worse after you use the joint and improves as you rest it. The joint may be stiff after you rest it or when you wake in the morning. This stiffness is usually short-lived, lasting only 15-20 minutes.
- The pain can be with you (to some degree) most of the day, even causing discomfort while you try to sleep at night.
- You may notice some swelling in the joints and a loss of flexibility or strength. The joints may have a "creaking" sound when you move them.
HOW DOES THE DOCTOR DIAGNOSE OA?
There is no single test for OA. If you have signs and symptoms of osteoarthritis, your doctor will likely discuss your symptoms, examine your joints and perform X-rays to help with the diagnosis.
WHAT DO YOU DO IF YOUR FAMILY DOCTOR THINKS YOU HAVE OA?
If your family doctor believes you have OA, it is important to educate yourself about the disease. Your family doctor may ask you to see other health professionals, such as physiotherapists, occupational therapists and dietitians to provide you with tools to better manage your OA. In some cases, if your family doctor is unsure about the diagnosis or some aspects of the management, a referral to a rheumatologist may be made. A rheumatologist is a doctor who is an expert in arthritis. If your arthritis gets to the point where your family doctor feels surgery is needed, then you will be referred to an orthopedic surgeon.
WHY IS TREATMENT FOR OA SO IMPORTANT?
OA tends to get worse over time as the cartilage wears away. Although there is no cure, with the right treatment you can take control of your disease and keep your joints as healthy as possible for as long as possible. The main goals of treatment include:
- Controlling your pain.
- Improving your ability to function.
WHY DO PEOPLE GET OA?
There are two types of osteoarthritis:
- Primary Osteoarthritis - Primary Osteoarthritis occurs when there is no obvious reason for the arthritis, although you may have some of the risk factors. Generally, primary osteoarthritis occurs in many joints, such as the fingers, base of the thumbs, spine and big toes.
- Secondary Osteoarthritis - Secondary osteoarthritis occurs when there is a likely cause for OA. The most common cause of secondary OA is prior injury to the joint, although there still may be other risk factors. Secondary OA is very common in professional athletes (football and hockey players), but can occur in anyone.
Risk Factors For Developing OA
Age - As we get older, so do our chances of developing osteoarthritis. If we live long enough, many of us will experience OA. Age alone, however, doesn't mean the disease is inevitable.
Family History - It is becoming clear that genetics plays a role in the development of osteoarthritis. This seems to be more of a factor with arthritis affecting the small joints in the hands (nodal OA). Researchers are not sure how genetics plays a role, but it may be due to the shape of your bones and the way they fit together or your ability to make and repair cartilage.
Excess Weight - If you weigh too much, your feet, knees and hips have to carry more weight than they should. The good news is that losing weight, even just 10 pounds (4.5 kilograms), can help reduce strain on your knees. Even if you have OA in your knees, losing weight can make you feel better and delay or may be even prevent the need for surgery in the future. Less body weight means less stress on your joints and often less pain.
Joint Injury - Osteoarthritis can occur in joints that have been "damaged" by a previous injury. The initial injury may have damaged the cartilage or affected the way the joint moves, resulting in secondary OA.
Complications of Other Types of Arthritis - Osteoarthritis can occur in joints that have been "damaged" by other types of arthritis. For example, people with rheumatoid arthritis or gout can develop secondary osteoarthritis in those joints in which the inflammation has caused damage.
Wear and Tear - Wear and tear on the joints alone does not lead to OA. For example, some people with similar jobs and lifestyles develop OA in the small joints of the hands and others do not. Research now shows that normal wear does not actually cause the joints to degenerate. Normal activity and exercise is good rather than bad for joints and does not cause osteoarthritis.
HOW Do I MANAGE OA?
Once your diagnosis is confirmed, there are many treatments that can help decrease your pain and increase your movement. Non-medication therapies, such as physiotherapy, occupational therapy, education, physical activity, healthy eating and relaxation techniques, are a very important part of the treatment of OA. While you can perform them on your own, it's best that you first ask a health-care professional for guidance.
Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by
arthritis. A properly designed program of physical activity reduces pain and fatigue, improves mobility and overall fitness, and alleviates depression. Physical activity allows
someone with arthritis to have a more productive, enjoyable life. There are different types of exercises you can do to lessen your pain and stiffness:
- Range of motion exercises reduce pain and stiffness and keep your joints moving. To achieve the most benefit, these exercises should be done daily.
- Strengthening exercises maintain or increase muscle tone and protect your joints.
- Moderate stretching exercises help to relieve the pain and keep the muscles and tendons around an affected joint flexible.
- Endurance exercises strengthen your heart, give you energy, control your weight and help you feel better overall. These exercises include things like walking, swimming and cycling. It is best to avoid high-impact exercises like step aerobics, jogging or kickboxing.
For more information, refer to The Arthritis Society's Physical Activity & Arthritis Guide [PDF] and Top 10 Exercises [PDF].
Heat and Cold
Heat: Taking a warm shower and using warm packs are great ways to help reduce pain and stiffness. Always use a protective barrier, such as a towel, between the warm pack and the skin. Heat is ideal for:
- Relieving pain.
- Relieving muscle spasms and tightness.
- Enhancing range of motion.
To avoid making symptoms worse, heat should not be applied to an already inflamed joint.
Cold: Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful. Always use a protective barrier, such as a towel, between the cold pack and the skin. Cold is ideal for:
- Decreasing swelling.
- Decreasing pain.
- Constricting blood flow to an inflamed joint.
For further details on using heat and cold to manage your arthritis, speak with your health-care team.
Protecting Your Joints
You should always use your joints in ways that avoid excess stress. This allows you to experience less pain, perform tasks more easily and protect your joints from damage. Techniques to protect your joints include:
- Pacing by alternating heavy or repeated tasks with lighter tasks. Taking a break reduces the stress on painful joints and conserves energy by allowing weakened muscles to rest.
- Positioning joints wisely promotes proper alignment and decreases excess stress. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs.
- Using assistive devices conserves energy and makes daily tasks easier. Raise seat levels to decrease stress on hip and knee joints. Use a reacher to pick up items from the ground. Use a cane to decrease stress on hip and knee joints. Enlarge grips on utensils, such as spoons or peelers, to decrease stress on delicate hand joints. Other devices to consider include carts for carrying objects and jar/tap openers.
- Talk to your doctor about seeing an occupational therapist or physiotherapist, who may prescribe splints, braces or orthotics (shoe inserts) to help align and support your joints.
Relaxation & Coping Skills
Developing good relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain. There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation tapes. Imagine or visualize a pleasant activity, such as lying on a beach.
The most important link between your diet and arthritis is your weight. Did you know that 90 per cent of knee replacement and 80 per cent of hip replacement patients are either overweight or obese? Being overweight puts an extra burden on your weightbearing joints (back, hips, knees, ankles and feet). Maintaining an appropriate weight will help you more than any food supplements. If you are overweight and have arthritis, consider a balanced diet as a way to help you achieve and maintain a healthy weight. For others, healthy eating may give you the energy to complete your daily activities. Proper nutrition is vital to controlling body weight and managing arthritis symptoms.
For more information, read The Arthritis Society's Nutrition & Arthritis Guide [PDF] and watch the Nutrition and Arthritis video.
WHAT MEDICATIONS ARE USED FOR OA?
Medications for OA are designed to control the pain, stiffness and swelling of your joints, with the goal of improving your function. Painkillers (analgesics) and anti-inflammatory medications (Non-Steroidal Anti- Inflammatory Drugs, for example) fall into this category. Although they may make you feel better, they do not affect the course of OA and will not prevent the damage to bones and joints that can occur with this disease.
Unfortunately, there is no medication that has been shown to consistently slow down the progression of OA.
Please discuss the use of any arthritis medication with your doctor.
For more detailed information on arthritis medications see Arthritis Medications: A Consumer's Guide [PDF].
Acetaminophen is a very safe and effective medication for pain relief that can be used for both short- and long-term pain control. If you have pain from osteoarthritis that is present most of the time, your doctor may recommend that you take acetaminophen regularly. When the pain is there all of the time, there is no point in waiting for it to become unbearable before taking your medication. Then, you have to wait for the effects of the acetaminophen to "catch up" to the pain.
Ibuprofen and Acetylsalicylic Acid Acetylsalicylic Acid and ibuprofen are Non-Steroidal
Anti-Inflammatory Drugs (NSAIDs) that can be purchased over the counter. You must be careful to avoid taking ibuprofen with other NSAIDs your doctor may prescribe, as it increases your risk of developing stomach problems.
There are a number of over-the-counter creams and rubs available to help with the symptoms of osteoarthritis. Some of these products contain salicylate as the active
ingredient, whereas others contain capsaicin or menthol. Salicylates work by decreasing pain and inflammation. Capsaicin is found naturally in hot peppers. Capsaicin works by blocking the transmission of a pain-relaying substance called Substance P to the brain. Camphor, eucalyptus oil and menthol are found in a variety of agents. These substances are able to relieve pain by tricking the body to feel the coolness or heat of these agents.
Living with a chronic disease like arthritis can be very frustrating, especially if the medications prescribed by your doctor don't seem to have the desired effect. In these instances, it can be tempting to exhaust all possible solutions for bringing your pain under control. A popular option for many people with arthritis is complementary and alternative therapies, which are treatments that fall outside the scope of traditional medicine. Examples include naturopathic medicine, special herbs, acupuncture and meditation.
Before you try any of these treatments, always inform your health-care provider of any complementary and alternative therapies you are taking, receiving or would like to try. Your health-care provider can offer valuable advice about these treatments.
For further information, refer to The Arthritis Society's Complementary and Alternative Therapies Guide [PDF].
When osteoarthritis becomes severe and medical therapies are not working, surgery may be considered. The most common surgical procedures for OA include hip and knee replacements. However, other surgical treatments are available. Surgery can be performed at any age, but is usually reserved for patients with advanced arthritis to maximize the life of the joint. The decision to undergo surgery really depends on the amount of pain and disability your arthritis is causing, as well as the risks and benefits of surgery. This should be discussed further with your doctor.
WHAT QUESTIONS SHOULD I ASK MY DOCTOR?
Patients who learn about their treatment program and talk to their doctor about it tend to report fewer symptoms, including less pain and greater mobility. You can really help yourself by getting involved in managing your OA. The more you learn about the disease, your treatment options and what steps you can take to get your disease under control, the better off you will be now and in the future. It's important to get all the information you need to make an informed decision about the right treatment for you.
To help you get started, here are some common questions you may want to ask your doctor about OA treatment:
- What local resources are available so I can better educate myself about OA?
- Should I be referred to a rheumatologist, physiotherapist, occupational therapist or orthopedic surgeon?
In regards to my medications:
- What are the possible side effects and how often do they occur?
- What should I do to minimize the chances of side effects?
- How will I know if the drug is working and how long will this take?
- Who do I contact if I have concerns about the medication?
- Are there medications I should stop taking now that I am beginning this new treatment?