Arthritis: The thorn in the flesh
Dr Pauline Williams-Green, Contributor
Recently, colleague health columnist Dahlia McDaniel wrote about her challenges with rheumatoid arthritis. This week, I will share with readers information about another type of arthritis which is truly a bane of life - osteoarthritis. This is a chronic disease of our joints, affecting older people but which can also occur in the younger generation, particularly when previous joint injury has occurred. Osteoarthritis is the most common joint disease. As our population ages, it is associated with difficulties with daily living as well as costs incurred by doctor's visits, medication and surgical interventions.
Loss of cartilage
Osteoarthritis is caused by the loss of the cartilage (gristle) which cushions contact between the bones in our joints. The disease also affects the bones covered by the cartilage and the fluid in the joint space. Bone along the periphery of the joint thickens to form spurs, or osteophytes, while bone beneath the denuded cartilage not only thickens but forms cysts. The normal joint contains a viscous fluid which has hyaluronic acid. This fluid acts as a shock absorber and gives elasticity to the joint. As the disease progresses, there is a low concentration of the hyaluronic acid and increased water content.
All ages affected
Osteoarthritis affects the large weight-bearing joints such as the spine, knees, hips and ankles. By age 55, a quarter of adults have osteoarthritis in the knees and hips. Men develop osteoarthritis before age 45 because of a predilection for injury to their joints. However, after age 55, women suffer more from osteoarthritis than men.
Pain is common
Osteoarthritis starts out as an insidious pain which is aching or throbbing in nature. The pain usually worsens with activity of the affected joint and will initially be relieved with rest. As the condition worsens, the pain occurs even while resting. There is usually a brief period of joint stiffness on rising in the mornings. Walking often becomes painful. Joint swelling and weakness occur intermittently.
There is no cure for osteoarthritis but exercise and weight loss (if overweight) are vital to its management. Exercise should focus on strengthening the muscles which cross the affected joint(s). Swimming is a great way of doing aerobic conditioning while strengthening joints. Tai chi is also an effective treatment for osteoarthritis of the knees. Devices such as braces, a cane and hand splints help to reduce pain and facilitate continued activity.
Steroid injections into the painful joint may provide pain relief. Unfortunately, the effect usually lasts no more than several weeks. Injections of hyaluronic acid into the knee joint have been very effective in reducing pain for several months. Oral glucosamine may also provide some relief but diabetics should monitor their blood sugar carefully. Pain control can be also effected by taking over-the-counter analgesics such as acetominophen. Topical analgesics are most effective for the knees and hands.
Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: firstname.lastname@example.org.