Osteoarthritis / degenerative spondylitis & Surgery
Symptoms of osteoarthritis / degenerative spondylitis
The main symptoms of osteoarthritis are joint pain and stiffness, and problems moving the joint. Some people also have symptoms such as: - swelling - tenderness - grating or crackling sound when moving the affected joints
The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints.
For some people, the symptoms can be mild and may come and go. Other people can experience more continuous and severe problems which make it difficult to carry out everyday activities.
Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips and small joints of the hands.
You should see your GP if you have persistent symptoms of osteoarthritis so they can confirm the diagnosis and prescribe any necessary treatment.
Read more about the symptoms of osteoarthritis.
Causes of osteoarthritis
As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs the damage itself and you do not experience any symptoms.
But in osteoarthritis, the protective cartilage on the ends of your bones breaks down, causing pain, swelling and problems moving the joint. Bony growths can develop, and the area can become red and swollen.
The exact cause is not known, but several things are thought to increase your risk of developing osteoarthritis, including:
joint injury – overusing your joint when it has not had enough time to heal after an injury or operation
age – your risk of developing the condition increases as you get older.
family history – osteoarthritis may run in families, although studies have not identified a single gene responsible
obesity – being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips
being a woman – osteoarthristis is more common in women than men.
To help determine whether you have osteoarthritis, a GP will first ask you about your symptoms and examine your joints.
A GP may suspect osteoarthritis if:
you're aged 45 or older
you have joint pain that gets worse the more you use your joints
the stiffness in your joints is not there in the mornings, or lasts less than 30 minutes
If your symptoms are slightly different, this may indicate another joint condition. For example, prolonged joint stiffness in the morning can be a sign of rheumatoid arthritis.
Osteoarthritis is a long-term condition and cannot be cured, but it doesn't necessarily get any worse over time and it can sometimes gradually improve. A number of treatments are also available to reduce the symptoms.
Mild symptoms can sometimes be managed with simple measures including:
Regular slow yoga type exercises - 10 - 20 times each
2 hours - Outdoor activity daily - walking, cycling, gardening, social work
1 hour sunlight exposure daily
Losing weight if you're overweight, by eating more salads - raw and less cooked food
standard BMI should be between 20 - 24
wearing suitable Footwear
Using brace, sticks, walkers during your everyday activities
Pain Killers, Application of Body oils + Brugel, Voveron gels
Hot / Cold Bag regularly
Target injections or surgery
If your symptoms are more severe, you may need additional treatments such as painkillers and a structured exercise plan with a physiotherapist, yoga teacher or trainer.
In a small number of cases, where these treatments haven't helped or the damage to the joints is particularly severe, target injections or surgery may be done to repair, strengthen or replace a damaged joint.
Pain relief medicines
Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control your pain.
The type of painkiller a GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are below.
If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. You can buy this at supermarkets or pharmacies. It's best to take it regularly rather than waiting until your pain becomes unbearable.
When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.
Find out more about paracetamol.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of osteoarthritis, a GP may prescribe a non-steroidal anti-inflammatory drug (NSAID).
NSAIDs are painkillers that work by reducing inflammation.
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.
Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.
NSAID tablets may be needed if paracetamol and topical NSAIDs are not easing the pain. They may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or if you have had a heart attack or stroke. If you're taking low-dose aspirin, ask your GP whether you should use a NSAID.
If your GP recommends or prescribes an NSAID to be taken by mouth, they'll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.
Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.
Codeine is combined with paracetamol in common medicines such as co-codamol.
If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.
Capsaicin cream / Pain-relieving gels like Brugel, Voveron etc
A GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain.
Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it's likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.
Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.
Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked.
The injection will be made directly into the affected area. You may be given a local anaesthetic first to numb the area and reduce the pain.
Steroid injections work quickly and can ease pain for several weeks or months.
In addition to lifestyle changes and medicines, you may benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) uses a machine that sends electrical impulses through sticky patches, called electrodes, attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.
Treatment with TENS is usually arranged by a physiotherapist or doctor, who can advise you on the strength of the pulses and how long your treatment should last.
Hot or cold packs
Applying hot or cold packs to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.
Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.
If osteoarthritis is causing mobility problems or making it difficult to do everyday tasks, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes.
Footwear with shock-absorbing soles can help relieve some of the pressure on the joints in your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.
If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.
A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace.
Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a technique to stretch, mobilise and massage the body tissues to joints flexible.
Find out more about physiotherapy.
Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where one of your joints is severely damaged.
If you need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life.
However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness from your condition.
There are several different types of surgery for osteoarthritis.
Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints.
During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years, although it may eventually need to be replaced.
There's also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.
If joint replacement is not suitable for you, your surgeon may suggest an operation to fuse your joint in a permanent position, known as an arthrodesis.
This means your joint will be stronger and much less painful, although you will no longer be able to move it.
Osteotomies, High tibia Osteotomies....Adding or removing some bone around a joint
If you have osteoarthritis in your knees but you're not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.
This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
Does glucosamine really help joint pain? Ans - NO
With such a massive global market, there's plenty of money being made by big companies - and that's problem number one.
Commercially funded trials of products are a well-known issue in medicine, and in the case of glucosamine studies it seems that those that are commercially funded turn out to be more likely to show a positive result than those done independently.
Even putting aside industry-funded studies, though, there have been a lot of decent trials done on various forms of glucosamine compared with pretty much anything you might consider an alternative - painkillers, exercise, other drugs... and placebo.
In the group that were given exercises to do, 80% reported the same reduction in pain. So, the exercises were much more effective than the supplement Glucosamine.
If you've got sore joints, then, you might as well save yourself some money - about half the time a sugar pill will make you feel better, but if you actually want the best chance of making a difference, then Phil's exercises are the way to go. Nothing beats them in studies - and they're free.
As Phil explains: "A lot of the pain is coming from the tendons and structures around the joint. If you have trouble getting out of a chair, or trouble undoing a jar, you're at risk of joint pain because your muscles are weak."
The exercises strengthen those muscles and take the strain off your joints. No need for glucosamine.
Intra-Articular Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis
A Double-Blind, Randomized Controlled Trial, Nattapol Tammachote, MD, MSc; Supakit Kanitnate, MD; Thanasak Yakumpor, MD; Phonthakorn Panichkul, MD; J Bone Joint Surg Am, 2016 Jun 01; 98 (11): 885 -892
Conclusions: Steroid Triamcinolone acetonide provided better pain control and better knee functional improvement and range of motion compared with Hyaluronic Acid Injection hylan G-F 20 at the 6-month follow-up.
Why ‘new’ knee isn’t the final answer
“Nearly 30-35% of knee replacements conducted in the country are unnecessary. At AIIMS, we have been holding awareness programmes to educate patients about the need to focus more on lifestyle modification than surgeries,” said Dr C S Yadav, professor of orthopaedics, AIIMS.
Physiotherapy help........ if unable to follow correct exercises
Sometimes advice or treatment from a physiotherapist is helpful. For example:
For advice on which exercises to do to strengthen the muscles above the knee (quadriceps) if you have OA of the knee. Strengthening the 'quads' has been shown to improve symptoms caused by OA of the knee.
For advice on how to keep active and fit.
For advice on shoes insoles, knee braces, taping to the knee, and how to use walking aids properly (to make sure you have one of the correct height).
Complementary and alternative therapies
Some people with osteoarthritis try complementary or alternative therapies – such as acupuncture and aromatherapy – and find them helpful.
However, there's a lack of medical evidence to suggest they're effective and they generally are not recommended by the National Institute for Health and Care Excellence (NICE).
A number of nutritional supplements have been used to treat osteoarthritis in the past, including chondroitin and glucosamine.
No longer prescribe chondroitin and glucosamine on the NHS because there’s no strong evidence that they are effective as a treatment.
Generally, supplements can be expensive and NICE recommends that they should not routinely be offered on the NHS.
Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in.
Several rubefacients have been used to treat joint pain caused by osteoarthritis.
However, research has shown that rubefacients have little effect in improving the symptoms of osteoarthritis and NICE therefore does not recommend their use.
Living with osteoarthritis
As osteoarthritis is a long-term condition, it's important you receive support to help you cope with any issues such as reduced mobility, and advice on any necessary financial support.
Some people may find it helpful to talk to their GP or others who are living with osteoarthritis, as there may be questions or worries you want to share.
Find out more about living with osteoarthritis.
It's not possible to prevent osteoarthritis altogether. However, you may be able to minimise your risk of developing the condition by avoiding injury and living a healthy lifestyle.
Avoid exercise that puts strain on your joints and forces them to bear an excessive load, such as running and weight training. Instead, try exercises such as swimming and cycling, where the strain on your joints is more controlled.
Try to do at least 150 minutes of moderate aerobic activity (such as cycling or fast walking) every week, plus strength exercises on 2 or more days each week that work the major muscle groups, to keep yourself generally healthy.
Find out more about health and fitness, including tips on simple exercises you can do at home.
It can also help to maintain good posture at all times and avoid staying in the same position for too long.
If you work at a desk, make sure your chair is at the correct height, and take regular breaks to move around.
Find out more about common posture mistakes and fixes.
Being overweight or obese increases the strain on your joints and your risk of developing osteoarthritis. If you're overweight, losing weight may help lower your chances of developing the condition.
Use the healthy weight calculator to find out whether you're overweight or obese.