Osteoarthritis: Understanding and treating the pain

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Osteoarthritis (OA) is one of the most common types of arthritis, affecting millions of people around the world. 

It’s a condition where the joints gradually break down over time.

“OA can also affect the whole joint. It may start with cartilage loss, but the tissues around the joint like the tendons, muscles, even the underlying bone can be involved,” says Dr Stella Botha, a specialist physician with a sub-specialty in rheumatology at the Institute of Orthopaedics and Rheumatology at Mediclinic Winelands Orthopaedic Hospital. 

Osteoarthritis most often affects the knees, hips, spine (including the neck and lower back), big toe, base of the thumb, and the finger joints closest to the fingertips.

Who gets osteoarthritis?

Osteoarthritis is more common as you get older, explains Dr Botha. Being overweight can also cause osteoarthritis due to the pressure on weight-bearing joints like the knees. Women tend to be more affected by OA than men, especially in their hands.

Osteoarthritis has two main types: primary and secondary. Knowing which type you have matters because it helps doctors treat the root cause of the problem.

Primary osteoarthritis is the most common form. Secondary osteoarthritis happens when something else damages your joints first. This could be:

• An injury or trauma, such as breaking a bone or damaging a joint in an accident.
• Other forms of arthritis, such as rheumatoid arthritis, which causes inflammation that can lead to osteoarthritis later.

Symptoms of osteoarthritis

Osteoarthritis symptoms often develop slowly and worsen over time. The most common symptoms include pain, swelling, and stiffness in the affected joint. This can make it difficult to move freely.

Joint stiffness from osteoarthritis usually doesn't last long – typically about half an hour in the morning or after sitting still for a while.

Swelling is normally mild and not as severe as in patients with rheumatoid arthritis or gout, which is a type of inflammatory arthritis.

How osteoarthritis is diagnosed

Rheumatologists like Dr Botha are specialists who can diagnose and treat all rheumatic diseases. These chronic conditions affect your musculoskeletal system, including joints, muscles, and bones, and sometimes internal organs.

Your GP will be able to help you manage your condition. Osteoarthritis is not always referred to a specialist unless:

• An orthopaedic surgeon needs to advise on surgery
• A rheumatologist needs to confirm the diagnosis of osteoarthritis if there is a possibility of secondary osteoarthritis, such as an underlying inflammatory form of arthritis.

Your doctor can diagnose osteoarthritis by looking at your medical history and examining your joints. “We often see swelling on the finger joints, called Heberden’s nodules, caused by bony outgrowths called osteophytes,” says Dr Botha. “The diagnosis of osteoarthritis can be confirmed with an X-ray, which may also show joint space narrowing. This is a result of the loss of the cartilage layer.”

In early osteoarthritis, you can still have significant pain, even when X-rays show only small changes like tiny bone spurs and slightly narrowed spaces between bones.

Dr Botha explains that doctors sometimes use MRI scans to diagnose osteoarthritis. Specialists often request these scans to distinguish osteoarthritis from other problems involving the meniscus or tendons.

Treatment for osteoarthritis

There is no cure for osteoarthritis, but there are many ways to improve your symptoms and maintain joint function.

Dr Botha says making healthy lifestyle changes can help significantly with treatment. Patients should have a say in choosing their treatment and learn to manage their condition themselves, since osteoarthritis is a condition that they’ll live with over the long term.

“You need to understand basic information about the disease and how to self-manage the condition by protecting and strengthening the joint,” he adds. “This is where exercise is important. It usually focuses on strengthening the muscles around the joint, especially the knee. Working with a physiotherapist on an exercise routine can help you lose weight and keep it off. For osteoarthritis in the hip and the back, strengthening your core muscles is very important.”

Eating a Mediterranean diet with fish rich in Omega-3 and taking Omega-3 supplements is also advisable. Your doctor will create an exercise and weight-loss plan that suits you. “Losing weight can also reduce body inflammation, which may ease osteoarthritis pain,” says Dr Botha.

Your doctor may also prescribe pain relief, like paracetamol. Anti-inflammatory tablets and gels can help but only in the short term and in small doses because of side-effects.

Sometimes the pain is not from the joint itself, but from the surrounding tissue. For example, osteoarthritis in the knee can be accompanied by mild joint inflammation or bursitis (soft tissue inflammation) near the joint. This can be treated with a steroid injection directly into the joint or surrounding fluid sacs.

“However, if you have particularly severe ongoing symptoms or limitations, they must be referred for orthopaedic surgical review,” says Dr Botha. “Arthroplasty (joint replacement) can be very successful in patients with severe osteoarthritis.”

Future treatments for osteoarthritis

Scientists are working to find new osteoarthritis medicines that could slow down or stop the disease from getting worse.

Dr Botha says that in future, patients may benefit from exciting new treatments that help the body repair itself, plus injections into joints that reduce swelling and help joints heal. Among these are anti-nerve growth factor (NGF) medications that reduce pain by blocking pain-signalling pathways. Doctors are also testing injections made from the patient’s own blood (called PRP) to see if they can help regenerate cartilage and reduce inflammation. These treatments and others are still being tested in medical studies, so they’re not available as standard treatment yet.

If you're experiencing joint pain or stiffness, don't suffer in silence – see your doctor to get a proper diagnosis and discuss your treatment options.