Osteoarthritis

What is it? 

• Osteoarthritis is the most common form of arthritis that can affect any joint in the body. However, it is more likely to affect our weight-bearing joints, such as the hips and knees. It is one of the leading causes of pain and disability. It presents as joint pain and stiffness (and sometimes swelling), with varying degrees of functional limitation, that can negatively affect someone’s quality of life.

• Within a joint, you have a tough slippery tissue called cartilage that covers the surface of the bones. This cartilage is there to protect the bones, help the bones to move against each other freely and to cushion the joint. Over the years, the cartilage gets thinner, and the surface becomes less smooth. This can cause the joint to feel stiff, and you may notice creaking sounds when moving.

• Sometimes the altered joint structure compensates for the changes and does not cause pain. It’s when the natural repair process cannot compensate enough that the joint starts to become painful.

Typical Symptoms/features:

• Stiffness - This is generally worse first thing in the morning or after a period of rest. The stiffness typically eases with movement.

• Reduced range of movement of the knee. 

• Functional restrictions e.g. walking, climbing stairs, standing still. 

• Activity related joint pain - this may be felt on the outside, inside, front or back of the knee. 

Management:

• Activity modification 

• Walking aids.

• Appropriate footwear which provides support.

• Weight loss if overweight or obese (most people will notice an improvement in joint pain and function after losing 5% of their body weight) - Please visit https://feelgoodsuffolk.co.uk/healthy-weight/ to make a self-referral if you would like help with weight management in Suffolk.

• Physiotherapy including range of movement exercises and a graded strengthening programme. 

• Orthopaedic options- In more severe and/or prolonged cases where pain is limiting conservative measures OR where 6 months of conservative management have failed to manage symptoms, then knee replacement surgery may be appropriate. 

Do I need imaging?  

• In line with national guidelines (https://www.nice.org.uk/guidance/ng226/chapter/Recommendations), osteoarthritis should be diagnosed clinically WITHOUT imaging. This means that a healthcare professional should be able to diagnose osteoarthritis by asking you some questions about your pain and doing some tests to the joint in clinic.

• Most people above the age of about 30 will have some age-related changes in their joints that can be seen on imaging. These changes do NOT mean that the joint is painful or not functioning well. 

• There is a poor link between osteoarthritic changes visible on an x-ray and the symptoms felt; minimal changes can be associated with a lot of pain, or modest structural changes to joints can occur with minimal accompanying symptoms. 

• This means that an x-ray result will likely not influence your treatment, and your management plan will be based instead around your pain, level of function and what you have tried so far.