Managing joint and bone pains
I’m sure we all know someone who has been diagnosed with “arthritis”. In most instances, the condition that individual has is osteoarthritis (OA). This is a progressive disorder of the joints that leads to deterioration of the cartilage and new bone formation at the surface and margins of the joints.
OA can be distinguished from other forms of arthritis such as rheumatoid arthritis, owing to the lack of inflammation and no involvement of parts of the body other than the joints.
OA is the most common form of arthritis, and the prevalence of it increases with age –– more than 50 per cent of adults over 65 years of age will have OA. It is present equally in males and females up to age 55, but subsequently becomes more frequent in females. Any joint can be affected, but the most common ones are in the knees, hands, feet, hips and the spine (neck and lower back). OA is associated with significant pain, loss of function and disability.
There are many possible causes of OA; but, in most cases, there is no underlying cause other than aging. This is usually referred to as primary or idiopathic OA. Conditions which may lead to secondary OA include:
Acute or chronic trauma.
Abnormal joint alignment (bow-legged or knock-kneed posture).
Abnormal joint formation from childhood.
Joint disorders in childhood.
Crystals deposited into the joint such as in gout.
Episodes of bleeding into the joint such as in haemophilia.
OA has also been found to be associated with some genetic factors; so a family history may increase your risk of developing it.
Symptoms of OA include joint pain, swelling, difficulty moving the joint and impaired function. Affected persons may also notice stiffness that improves with movement, as well as crepitus (creaking or cracking) when moving the affected joint.
Your doctor may notice swelling around your joint, tenderness with palpation of the joint and crepitus. The joint may also be seen to be enlarged as a result of new abnormal bone growth at the joint margins.
The severity and pattern of your symptoms, as well as findings on X-rays of the affected joint will allow your doctor to figure out the severity of your osteoarthritis. OA is usually graded as mild, moderate or severe. This is important to know, as it will dictate the treatment you should be offered and the likely response to treatment.
The rehabilitation specialist plays an important role in managing a person with joint pain. The first and most crucial step is to determine whether the pain is originating from the joint or soft tissues surrounding the joint (tendons, ligaments or bursae).
This is important because the treatment required may be quite different. Depending on the most likely diagnosis, appropriate imaging may be ordered or performed. This may be an X-ray, ultrasound or MRI.
In a person who is confirmed to have OA, the severity determines the initial treatment offered by the rehabilitation specialist. Possible treatments include prescription of pain medications, prescription of braces or use of shoe orthotics. Use of a mobility aid such as a cane may also be recommended.
Physical or occupational therapy should be a part of management of any person with OA as it is crucial to build strength in the muscles surrounding the affected joint. In a person who has a lot of swelling owing to OA, aspiration of the fluid (removal using a needle and syringe) may lead to improved function, and this is usually followed by a steroid injection into the joint.
Another type of injection that has been used in recent times is hyaluronic acid. This medication is injected into the knee joint to provide lubrication and reduce pain. In a person with severe OA or someone who has a poor response to conservative treatments, referral to an orthopaedic surgeon for surgery will be necessary.
If you suspect you have OA, a proper medical evaluation is the first start to reducing your pain and optimizing your physical function.