What is Osteoarthritis?
Osteoarthritis is a condition that causes joints to become painful and stiff. It's the most common type of arthritis in the UK.
Inside a healthy joint, moving surfaces are covered by a layer of cartilage which stops two bone surfaces rubbing together and creating friction. Movement of the joint is made smoother still by the synovial fluid, which bathes the cartilage in lubricating molecules.
However, in people with osteoarthritis, the integrity of the joint is compressed.
The cartilage begins to wear thin, sometimes getting worn away completely, while the level of lubricating molecules in the synovial fluid and on the cartilage become depleted.
The degradation inside osteoarthritic joints contributes to inflammation, joint stiffness, reduced mobility and pain upon movement. As the disease progresses, symptoms become more sever and debilitating, with pain sometimes becoming a permanent feature.
What causes osteoarthritis?
Essentially, there are two types of osteoarthritis - Primary or Secondary. The key difference between these two types is down to the underlying cause.
This type of osteoarthritis is associated with ageing, affecting people aged around 55+ and is the result of wear and tear on your joints. The more you age, the more likely you will be affected by osteoarthritis. The joints most commonly affected are knees, hands, the spine, and hips.
This type of osteoarthritis is likely to affect people who are predisposed to the condition through various means such as obesity, genetics, the result of another disease of previous trauma / injury such as fracture or ligament rupture.
What are the symptoms?
Osteoarthritis can affect any joint in the body, but the most common areas affected by pain and stiffness are the knees, hips and small joints in the hands.
The NHS also says that you or your doctor may notice the following symptoms:
- joint tenderness
- increased pain and stiffness when you have not moved your joints for a while
- joints appearing slightly larger or more "knobbly" than usual
- a grating or crackling sound or sensation in your joints
- limited range of movement in your joints
- weakness and muscle wasting (loss of muscle bulk)
Osteoarthritis in the UK
- In the UK, 8.75 million people aged 45 and over have sought treatment for osteoarthritis.
- Approximately 1 in 5 adults over 45 years in England have osteoarthritis of the knee and 1 in 9 adults have osteoarthritis of the hip.
- 97% of initial knee replacement and 91% of hip replacement surgeries are as a result of osteoarthritis.
- Approximately 32.2 million prescriptions were dispensed for Musculoskeletal and joint diseases in England in 2017, costing approximately £195.3 million.
- Musculoskeletal conditions are responsible for over 30 million working days lost each year
- Care for Musculoskeletal conditions accounts for the third largest area of NHS programme spend at £4.7 billion.
It's not possible to prevent osteoarthritis altogether. However, you can minimise your risk of developing the condition by avoiding injury and living a healthy lifestyle.
Being overweight can put excess pressure on the joints, which can make arthritis more severe if you develop it. Weight gain happens when we eat more calories than our body needs so the only way to lose this weight is to eat less calories that our body uses or to use up more calories by being more active. Use the NHS BMI calculator to find out whether you're overweight or obese. If so, you should look to implement a sustainable weight loss programme.
Contrary to popular belief, being active and exercising does not lead to arthritis-in fat, it can strengthen the muscles around the joints and promote a healthy weight which can actually reduce the risk factors that can lead to arthritis.
Doing exercise while you have osteoarthritis won't make it worse either - as long as you're careful and have correct form, exercise can actually improve the symptoms of arthritis and reduce pain because it can help strengthen the muscle around the joint to help you better support yourself. Head to our blog for lots of tips on staying active.
Control blood sugar levels
According to the Arthritis Foundation, "high blood sugar (glucose) levels speed the formation of certain molecules that make cartilage stiffer and more sensitive to mechanical stress. Diabetes can also trigger systematic inflammation that leads to cartilage loss."
If you're concerned about diabetes and/or hyperglycaemia- the medical term for high blood sugar - you should contact your GP who may advise you to change your diet, to exercise more often and to drink plenty of sugar-free fluids.
While there is no cure for osteoarthritis, you can help relieve the symptoms by maintaining a healthy weight and by undertaking regular exercise to keep active, build up muscle and retain joint mobility.
When it comes to managing pain, there are various treatments and physical therapies available. You should always consult your doctor in order to identify what is causing your pain before undertaking any of them.
Depending on the severity of your pain and other conditions or health problems you have, your GP may recommend the use of painkillers. The main medications used are described below.
If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable. However, when taking paracetamol, always follow the dosage your GP recommends and do not exceed the maximum dose stated on the pack.
Despite its popularity, recent study evidence has questioned the usefulness of paracetamol in treating osteoarthritis. Evidence published in the Lancet lead to the conclusion, “we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose”1. __
1 Lancet 2016 Mar 17. pii: S0140-6736(16)30002-2.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are painkillers that work by reducing inflammation. There are two types of NSAID and they work in slightly different ways:
- Traditional NSAIDs – such as ibuprofen, naproxen or diclofenac
- COX-2 inhibitors – often called coxibs – such as celecoxib and etoricoxib
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints and can be available over the counter, without a prescription. Some oral NSAIDs are available without a prescription. 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.
NSAIDs carry numerous warnings and must be taken with caution. They may not be suitable for people with certain conditions, such as asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke. If you are taking low-dose aspirin, ask your GP whether you should use an NSAID.
Similarly NSAIDs can interfere with medications, for example negating the effect of most blood pressure medicines. You should always consult with your GP to see if NSAIDs are suitable for you.
Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol or NSAIDs do not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.
Codeine is found in combination with paracetamol in common preparations such as co-codamol.
Other opioids that may be prescribed for osteoarthritis include tramadol (brand names include Zamadol and Zydol), and dihydrocodeine (brand name DF 118 Forte). Both come in tablet form and as an injection.
Tramadol is not suitable if you have uncontrolled epilepsy, and dihydrocodeine is not recommended for patients with chronic obstructive pulmonary disease (COPD).
If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.
If you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.
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 two weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-sized amount of capsaicin cream to your affected joints up to four times a day, but not more often than every four 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 a molecule found in chilies that causes the burning sensation everyone is familiar with, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours.
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.
If your osteoarthritis is severe, treatment using painkillers may not be enough to control your pain.
In this case, you may be able to have a type of treatment where medicine is injected into the joints affected by osteoarthritis. This is known as intra-articular injection.
If you need intra-articular injections, it is likely that you will have injections of corticosteroid, a medicine that reduces swelling and pain.
If you get a prolonged response to the injection, it may be repeated. Ideally, you should have no more than three corticosteroid injections a year, with at least a three-month gap between injections.
FlexiSEQ gels are specially formulated to help fight against the pain and stiffness associated with joint wear & tear and osteoarthritis.
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Our products are drug-free and can be used long-term and alongside medications without drug interactions or exacerbating pre-existing conditions.
UK's largest UK arthritis charity championing treatments and how best to live and manage with the disease
UK arthritis charity specialising in self-management for those living with arthritis, and in particular osteoarthritis.
The NHS have specific pages dedicated to the symptoms, management and potential treatment of a variety of types of arthritis.
A magazine and social network for young people living with arthritis who celebrate stories of those living with the disease.
Simon Stones has lived with arthritis since he was a child and is an award winning patient advocate.
A website dedicated to the study of how weather impacts the pain of arthritis
Kate Lawson lives with rheumatoid arthritis and has created a host of tips and recipes to eat right when living with arthritis.