Osteoarthritis

Osteoarthritis, often called OA, is a common condition that affects the whole joint. Cartilage, the smooth tissue covering the ends of bones, can become thinner or damaged. Changes can also occur in the nearby bone, joint lining, ligaments and muscles. Together, these changes may cause pain, stiffness and difficulty moving.

Osteoarthritis most often affects the knees, hips and hands. It can also affect joints in the feet and spine. It becomes more common with age, but younger adults can develop it too, particularly after a joint injury.

Osteoarthritis does not always get steadily worse. Symptoms can vary from day to day, and many people remain active with the right combination of exercise, practical adjustments and pain relief.

What are the symptoms?

Symptoms depend on which joint is affected. Common ones include:

• Pain during or after activity
• Stiffness after resting or on waking, usually easing within about 30 minutes
• Difficulty bending or moving the joint fully
• A grinding or crackling sensation when moving
• Mild swelling or changes in the shape of the joint
• Difficulty with activities such as climbing stairs, getting out of a chair, walking or opening jars

Knee osteoarthritis may make stairs or standing up uncomfortable. Hip osteoarthritis can cause pain in the groin, thigh or sometimes the knee. Hand osteoarthritis may affect finger joints or the base of the thumb, making gripping and pinching difficult.

The amount of pain does not always match what an X-ray shows. Someone with noticeable changes on an X-ray may have little pain, while someone with significant pain may have relatively modest X-ray changes.

Why does osteoarthritis happen?

There is rarely one single cause. Factors that can increase the chance of osteoarthritis include:

• Increasing age
• A previous injury to the joint
• Repeated heavy strain on a joint over many years
• Excess body weight, particularly for knee osteoarthritis
• The shape or alignment of a joint
• A family history of osteoarthritis

Having one or more of these factors does not mean osteoarthritis is inevitable. Nor does a diagnosis mean you must stop using the affected joint.

How is osteoarthritis diagnosed?

Your clinician will ask about your pain, stiffness and daily activities, then examine the joint. In many people, symptoms and an examination are enough to make the diagnosis.

An X-ray is not always needed. It may be useful if the diagnosis is uncertain, symptoms are unusual, or surgery is being considered. Blood tests are not used to confirm osteoarthritis, but they may help check for another cause of joint symptoms.

Tell your clinician if a joint suddenly becomes very swollen, red or hot, or if you have fever or prolonged morning stiffness. These features may suggest a condition other than osteoarthritis.

What can I do to feel better?

Keep moving

Regular exercise is one of the most effective treatments for osteoarthritis. It can strengthen the muscles supporting your joints, improve movement and make everyday activities easier. Both strengthening exercises and activities that raise your heart rate can help.

Walking, cycling, swimming and exercise in water are options. The best activity is one you can do regularly and adjust to your abilities. If you have been inactive, start with a manageable amount and build up gradually. A physiotherapist can help you choose exercises for the joints that trouble you.

It is possible to feel some discomfort when beginning an exercise programme. This does not necessarily mean you are damaging the joint. If pain becomes much worse, remains worse afterward, or causes you to limp or change how you move, reduce the intensity and ask for advice.

Balance activity and rest

On a particularly painful day, it is reasonable to slow down and take short breaks. Avoid prolonged rest, which can weaken muscles and increase stiffness. Break demanding tasks into smaller parts, change position regularly and return to your usual activities as the pain settles.

Manage your weight if needed

If you have excess body weight, gradual weight loss can reduce pain and improve movement, especially when the knees or hips are affected. You do not need to reach a particular weight before you can benefit. A clinician or dietitian can help you make a realistic plan.

Try heat or cold

A warm shower or heat pack may ease stiffness. A cold pack may help when a joint feels swollen or particularly painful. Wrap either pack in a towel to protect your skin, and use it for short periods. Avoid sleeping with a heating pad on.

Consider helpful devices

A walking stick can make walking more comfortable for some people with hip or knee osteoarthritis. A hand therapist may suggest ways to protect a painful thumb joint or make gripping tasks easier. Braces, splints and shoe inserts help in some situations, but they are not needed by everyone. Ask a clinician or therapist which device, if any, suits your joint and symptoms.

Which medicines can help?

Medicines can reduce pain so that you can move, exercise and manage daily activities. They work best alongside exercise and other practical measures. The right choice depends on which joint is affected and your other health conditions.

• Anti-inflammatory gels: A topical non-steroidal anti-inflammatory drug, or NSAID, may help, particularly for knee osteoarthritis. It can also be considered for some other joints. Follow the directions for applying it.
• Anti-inflammatory tablets: An oral NSAID may help if a gel is unsuitable or does not provide enough relief. These medicines can cause stomach bleeding and affect the kidneys or heart in some people. Tell your clinician if you have kidney disease, a stomach ulcer, heart disease, high blood pressure, or take blood thinners or other regular medicines. Use the lowest effective dose for the shortest suitable time.
• Paracetamol: This does not help osteoarthritis pain very much for many people and is not usually the main treatment. Your clinician can advise whether occasional use is appropriate for you.

Do not take several anti-inflammatory medicines together unless your clinician specifically advises it. If you regularly need pain medicine or it is no longer helping, arrange a review rather than repeatedly increasing the dose yourself.

Do joint injections help?

A steroid injection into a joint can provide short-term pain relief for some people. It may be considered when other treatments are unsuitable or insufficient, or when pain is preventing you from exercising. Its effect usually wears off, so it is not a substitute for a longer-term plan.

You may also hear about hyaluronic acid or “gel” injections. These are not routinely recommended for osteoarthritis because reliable benefit has not been shown. Discuss the likely benefits, limitations and costs of any proposed injection before deciding.

Can supplements rebuild cartilage?

No supplement has been shown to rebuild cartilage. Glucosamine and chondroitin are commonly marketed for osteoarthritis, but evidence of meaningful benefit is not strong enough to recommend them as routine treatment.

Supplements can have side effects or interact with medicines. Tell your clinician what you take, including products bought without a prescription.

Will I need surgery?

Most people with osteoarthritis do not need surgery. Joint replacement may be considered if pain, stiffness or loss of function continues to have a substantial effect on your life despite an appropriate treatment plan.

Knee and hip replacement are established options. An orthopaedic surgeon can explain the likely benefits, recovery, risks and alternatives in your situation. The decision depends on how the condition affects you, not only on how severe an X-ray looks.

What should I expect over time?

Osteoarthritis is usually a long-term condition, but its course varies. Symptoms may stay similar for years, fluctuate, or become more troublesome. Treatment focuses on helping you remain active, reducing pain and preserving the activities that matter to you.

Your plan may need adjustment over time. Tell your clinician which tasks you find difficult and what you hope to return to doing. This makes it easier to choose useful exercises, medicines, devices or a surgical assessment when appropriate.

When should I seek medical advice?

Arrange a review if:

• Pain is regularly disrupting sleep or daily activities.
• You are becoming less able to walk, use your hands or manage usual tasks.
• Your current treatment is not helping enough.
• A joint becomes repeatedly swollen or your symptoms change substantially.
• You are taking pain medicines often or are concerned about side effects.

Seek prompt medical assessment for a suddenly very painful, hot or markedly swollen joint, especially if you have a fever or feel unwell. Do not assume that a new symptom is caused by osteoarthritis.

This is general patient information. Your treatment should be tailored to your symptoms, other health conditions and preferences.