Joint Pain & Arthritis: Understanding Osteoarthritis, Symptoms & Treatment

 Key takeaways:

• Joint pain is a common symptom affecting the elderly population.
• Osteoarthritis (osteo-bone, arth-joint, -itis –inflammation) is the most commonly diagnosed cause of joint pain in aging populations. It is a chronic, degenerative, non-inflammatory joint disease.
• The diagnosis of osteoarthritis entails taking a detailed history of the patient’s symptoms and doing lab tests and imaging studies. 
• There is currently no cure for osteoarthritis. However, treatment options exist that are aimed at managing symptoms and preventing the development of joint deformity.

Joint pain is prevalently encountered in older age groups by doctors in the geriatric outpatient department. The most common cause of this symptom among the elderly population is a condition called osteoarthritis.

The World Health Organization estimates there are over 500 million people worldwide currently living with arthritis—a joint condition characterized by swelling of the joints—with the majority of that population consisting of women.

While there are more than 100 types of arthritis in existence (each with its own unique pattern of presentation), osteoarthritis has the greatest disease prevalence. Its far-reaching effects impact not just the joints but overall quality of life. 

 What is osteoarthritis?

Osteoarthritis (OA) is a longstanding joint disease characterized by progressive breakdown of the joint tissue. The name “osteoarthritis” (osteo-bone, arth-joint, -itis –inflammation) is a misnomer as this is a non-inflammatory condition, though in some people, research shows it may take on an inflammatory pattern.

The joint consists of bone, cartilage, ligaments, tendons, synovial fluid, and synovial membrane. Normally, the joint cartilage acts as a natural shock absorber, reducing friction and allowing for adequate weight-bearing and smooth movement.

However, in osteoarthritis, the cartilage is gradually eroded by several physical stressors. For this reason, osteoarthritis is alternatively referred to as “wear and tear” arthritis.

As cartilage erodes, the chondrocytes (cartilage cells) attempt to build new cartilage to keep up with the rate of breakdown. With enough cartilage breakdown, the underlying bone is exposed, causing increased friction at the joint level. This leads to bone hardening as the cells try to adapt to the new stress without the protection of cartilage.

There is also the formation of “osteophytes” or “bone spurs,” which are bony projections at the margins of the affected joints. Along with these, structural changes contribute to the symptoms seen in osteoarthritis and the eventual development of joint deformity. 

 Causes of osteoarthritis

Osteoarthritis is caused by factors associated with the genes and lifestyle or environmental problems. The exact mechanism by which it develops is not entirely understood. 

The following risk factors are linked to the development of osteoarthritis:

• Age: More common in older age populations
• Sex: More common in menopausal women
• Occupation: Seen more in farmers, sports players, construction workers, cleaners, or any professions that require loading of joints
• Nutrition: Seen more in people with low vitamin D
• Obesity
• Pre-existing joint disease
• Family history of osteoarthritis
• Metabolic disease, e.g., diabetes mellitus
• Systemic disease, e.g., Neuropathies (conditions that affect the nerves) and Hemoglobinopathies (genetic disorders affecting hemoglobin, which is the protein in red blood cells responsible for carrying oxygen)

 Signs and symptoms of osteoarthritis

In the early stages, osteoarthritis may be without symptoms, though tests may show the presence of the disease. 

Osteoarthritis typically affects one or a few joints, with symptoms progressing over time. Some of the more common symptoms include:

• Joint pain: Typically in one or a few of the weight-bearing joints. It may come and go, with people finding relief on resting.
• Night pain: Pain around the joint that is worse during the night-time. This may lead to difficulty with sleeping and poor sleep quality.
• Morning stiffness: Inability to move affected joints freely. This usually lasts less than 30 minutes on waking.
• Swelling around the joint.
• Weak grip.
• Muscle weakness.

Joints that are most affected include:

• Hips
• Knees
• Waist
• Hands(arms, wrists and fingers)
• Feet
• Spine

 Diagnosis

A detailed history of the patient’s symptoms, lab tests, and imaging studies are needed to make a diagnosis of osteoarthritis.

The doctor may request blood tests such as:

• Full Blood Count
• Erythrocyte Sedimentation Rate (ESR)
• Rheumatoid Factor Assay (RF)
• Antinuclear antibody (ANA) test
• Imaging studies of affected joints, e.g., X-rays and MRIs 

On imaging, the joint space will appear narrowed. Bone spurs may be present as well as evidence of joint damage and bone regeneration. Fluid may be taken from the joint cavity to detect the presence of infections or diseases such as gout.

 Treatment options for osteoarthritis

Osteoarthritis is an incurable disease, but several treatment options exist to manage its symptoms. These can broadly be categorized as non-pharmacological and pharmacological (drug treatments).

 Drug Treatment

Healthcare providers typically prescribe pain medications and certain injections for treating osteoarthritis.

 1. Pain Management

Several medications may be used to manage arthritic pain, including paracetamol for mild to moderate pain.

A more powerful class of pain relievers called non-steroidal anti-inflammatory drugs (NSAIDs) may be taken orally or massaged into the skin to alleviate moderate pain.

Moderate to severe pain is typically managed with the use of opioids, with people describing varying levels of pain relief with use.

Corticosteroids may be prescribed as short-term therapy for how quickly they reduce swelling (inflammation). However, the use of steroid therapy for osteoarthritis comes with serious side effects, especially in cases of long-term use. 

 2. Intra-articular Injections

Certain agents can be administered into the joints with varying levels of efficacy. Hyaluronic acid, a substance naturally produced by the body, can be injected into the joint, where it acts as a lubricant, reducing friction and symptoms of disease. This is a form of long-term therapy called viscosupplementation, which has been proven to significantly delay surgery.

Corticosteroids, in combination with a local anesthetic, may alternatively be injected directly into the joint for treatment.

 Non-drug Treatment

Aside from medications, there are other treatment options for osteoarthritis, including the following:

 1. Lifestyle modifications

Dieting and exercise are key parts of managing osteoarthritis. Maintaining a decent weight through exercise will help alleviate the stress on joints and boost joint function.

Low-impact aerobic exercises such as swimming, walking, and cycling, as well as strength-training exercises, are great forms to adopt as they promote weight loss and boost muscle mass without the risk of joint injury.

Yoga and Tai Chi are alternate means of exercise that may help improve joint flexibility and decrease morning stiffness.

Foods that reduce inflammation, such as leafy greens, whole grains, antioxidants, and limited processed foods, provide a range of benefits, including a significant reduction in inflammation seen in osteoarthritis.

 2. Physiotherapy

A physical therapist can help evaluate and create an individualized exercise plan, prescribing exercises to strengthen muscle groups and stabilize affected joints to prevent joint deformity.

 3. Occupational therapy

Occupational Therapists (OTs) help make daily working life better through the use of tools and technologies that help with movement. They may also evaluate your daily activities and prescribe alternative means of movement that prevent the worsening of joint disease.

 4. Use of assistive devices

The biggest challenge for many people with joint disease is physical dependency due to limitations in movement. Walking canes, grab bars, reachers, jar openers, and neck pillows are some assistive devices that can be employed to help with this problem.

These assistive devices improve movement and joint function, allowing people undergoing treatment a sense of independence.

 5. Supportive footwear

The right footwear makes a difference. Shock-absorbing footwear can help with proper joint alignment, stability, and balance, preventing the development of secondary injuries to the foot. Moreover, shoes with good arch support afford adequate weight distribution and offer comfort to the joints during movement.

 6. Surgery

Joint-replacement surgery or arthroplasty, is a common surgical intervention sought as a last resort in the management of osteoarthritis. It involves replacing the diseased joint tissue with a prosthesis. This surgery can be offered as a solution in cases of extensive hip joint damage.

 Prevention tips for osteoarthritis

Osteoarthritis can be prevented by keeping a healthy lifestyle and taking proactive approaches toward joint health and preservation. Some ways you can prevent this include:

• Maintaining a healthy weight
• Exercising regularly
• Eating a healthy diet
• Avoiding tobacco products
• Getting regular health checkups

 Conclusion

Joint pain can be a weakening symptom significantly affecting a person’s quality of life, especially in old age. Osteoarthritis is the most common culprit causing joint pain in the aged population. With adequate attention and timely joint care, this condition can be managed, preserving joint function and putting off deformity.