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Osteoarthritis When Your Joints Hurt
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A common ailment in the elderly, osteoarthritis or degenerative joint disease is the most prevalent form of arthritis. Affecting the joint cartilage, it causes stiffness and pain, worsening as the level of activity progresses through the day.

It also typically affects overweight people; the excess weight increases stress on weight-bearing joints such as the knees, hips and lower back. It doesn’t mean that osteoarthritis is exclusive to the elderly and overweight though; there are also variants such as primary or generalised osteoarthritis that are familial and start in the hand joints. In these patients, weight loading does not seem to be a major factor.

Osteoarthritis can be described as a disorder of cartilage metabolism, where patients are more prone to cartilage degradation. This is accelerated if they have previous joint injury, joint inflammation or increased weight loading if they are obese. In advanced cases, one can think of the condition as “joint failure” as in any other organ failure.

How is it diagnosed?

There are no definitive tests to diagnose osteoarthritis. It usually begins with a physical examination and medical history, after which the following tests may be ordered to confirm the initial diagnosis:

X-Ray/MRI: Both methods will be able to show the extent of damage to the cartilage, with the latter being able to point out early abnormalities.

Joint aspiration: Fluids are drawn from the affected areas, and tested for signs of joint degeneration. This helps to rule out other forms of arthritis.

How can osteoarthritis be prevented?

Weight management: This is important when weight-bearing joints are affected. If the patient gains 1kg of body weight, weight loading can increase by as much as 5kg. The converse is also true. Many patients are able to even discontinue painkillers if they can lose as little as 3kg.

Exercise: While exertion triggers pain in osteoarthritis, simple exercises can alleviate the symptoms. Light activities such as stretching help to maintain and improve joint flexibility. It strengthens the muscles around the affected joints, and are very useful in improving joint function.

Use of appropriate footwear and walking aids when exercising can also make a difference.

 

How can it be treated?

Where pharmacological therapy is concerned, there are three groups of treatments:

Painkillers

The most appropriate medication for pain relief in a patient with osteoarthritis is paracetamol.

Viscosupplementation

This involves direct injection of hyaluronic acid compounds to increase the viscosity of the cartilage. This works better in patients with milder osteoarthritis, and there is symptom relief for up to a year. It is best reserved for patients who need daily symptom relieving drugs. These patients may do well with other measures too, such as weight management and exercise.

More severely affected patients (such as those with badly swollen joints that significantly affect movement) may require surgery.

Supplements

There are many on the market which claim to help osteoarthritis. Many of these claims are not backed by clinical trials. Some compounds, such as ginger extract, combinations of Indian herbs and soy extracts, have the benefit of clinical trials which show mild symptom relief. For glucosamine hydrochloride and chondroitin sulphate, the effects may vary.

The current status of treatment options in osteoarthritis is far from ideal. In those who are severely affected, joint realignment or replacement surgery can improve the quality of life tremendously.

The best outcome is achieved only with a combination of pharmacological therapy combined with physiotherapy, weight control and surgery where indicated.

 
 
 
A/PROF LEONG KENG HONG

MBBS (Singapore) 1983
Master of Medicine (Singapore) 1989
Doctor of Medicine 2005
Member of the Royal College of Physicians (UK) 1989
Fellow of the Academy of Medicine, (Singapore) 1992
Fellow of the Royal College of Physicians (Edinburgh) 1997

Leong Keng Hong Arthritis and Medical Clinic
6 Napier Road #04-18
Gleneagles Medical Centre

Singapore 258499
Tel : (65) 6472 4337
Fax : (65) 6472 0691
Email : info@leongkenghong.com
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