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Arthritis, osteoarthritis

 


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Condition
Arthritis, osteoarthritis
Class
Musculoskeletal system
Description
The word ‘arthritis’ means inflammation of the joints. Arthritis is one of the commonest causes of disability in the UK, over 200 different kinds of arthritis have been identified. The most common form of arthritis is osteoarthritis, which usually affects the knees, hips, spine, hands and finger joints.

Osteoarthritis tends to develop gradually usually starting in people in their 40s, 50s or 60s. It is uncommon for osteoarthritis to develop in people before the age of 40, but it does happen. Women are more likely to be affected than men. An estimated 8 million people in the UK will have symptoms of osteoarthritis, of which approximately 1 million require treatment.

For other forms of arthritis, please see separate articles: Rheumatoid arthritis and Gout.
Causes
The fact that osteoarthritis usually first affects people aged between 40 and 60 and gets more common as people age, suggests that osteoarthritis may be related to wear and tear on the joints, and the joints losing the ability to repair themselves. Excessive weight on load-bearing joints and previous damage to the joint through injury or surgery appears to contribute to the problem. There may also be a genetic link.

To understand how osteoarthritis develops, it is necessary to understand the structure and function of joints.

Joints permit movement. Without them, the bones that make up the skeleton would be fixed in a rigid position. Each joint is surrounded by a capsule, within which there is a layer called the synovial membrane that produces a fluid called synovial fluid. At the end of each bone, there is a protective layer made of a tissue called cartilage.

The synovial fluid has viscoelastic properties, able to act like a hydraulic shock-absorber, dissipating and absorbing energy caused by impact, for example when jumping up and down. The synovial fluid also helps feed and lubricate the cartilage keeping it in a healthy state to protect the bones from damage.

As people age, the viscoelastic properties of the synovial fluid decline so that it becomes less effective as a shock-absorber. The cartilage also starts to break down, becoming pitted, rough and thinner and eventually wearing away. As the cartilage deteriorates, the bones may rub together as they move. Where the bone has been damaged, it develops knobbly spurs called osteophytes. These distort the joint, further decreasing its ability to allow movement. The synovial membrane and joint capsule thicken, limiting the space within the joint. Secretion of synovial fluid increases but it is more watery and less viscous than normal secretions. The joint swells, becomes stiff and it becomes painful to move.
Symptoms
Common symptoms of osteoarthritis include discomfort, aches and pains, swelling and inflammation, stiffness and fatigue. The symptoms can vary greatly from one person to another and can be short-lived or long-term. Pain and discomfort tend to be restricted to the affected joint area, and tend to get worse during the day as the joints are used more. Pain and stiffness usually wear off after resting, but the joint may not move as freely or as far as normal, and may issue an audible creaking or cracking sound when moved. People with osteoarthritis may develop disabilities such as loss of strength and grip, while long-standing and severe osteoarthritis can eventually lead to deformity of the joint and permanent loss of movement.
Treatment
Osteoarthritis is generally manageable with simple measures such as weight loss and pain relief. Drug treatment focuses on relieving the symptoms through the use of anti-inflammatories and painkillers.

Injections into the joints (intra-articular injections) of corticosteroids provide a way of reducing inflammation and pain.

Intra-articular injections of hyaluronans provide a way of restoring the viscoelastic properties of the synovial fluid.

In severe cases, a knee or hip replacement may be necessary.
When to see your pharmacist
If you are experiencing pain and stiffness in your joints there are a number of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen that can be bought from the pharmacy to relieve pain and inflammation. They come in preparations that can either be taken by mouth or rubbed into the skin at the affected area.

It is important always to ask your pharmacist which medicines are safe to take, especially if you are already taking other prescribed or over the counter medicines, or have a history of allergies or stomach complaints.

If you have poor grip strength and find it difficult to open medicine bottles, tell your pharmacist. When dispensing your medicines your pharmacist will fit special caps on the bottles that will make them easier to open.
When to see your doctor
See a doctor if you suspect you have arthritis but have not yet been diagnosed. A physical examination and questions about your family’s medical history and your lifestyle will help establish a diagnosis.

If your symptoms do not improve and/or worsen while on medication, or you develop side effects such as an upset stomach, go back to your doctor for a review.
Living with osteoarthritis
Young or old, it is wise to look after your joints to reduce the risk of osteoarthritis developing in later life. Keep your weight under control. Excess body weight exerts a heavy toll on load-bearing joints such as the knees and hips. Eat a balanced diet, rich in fresh fruit and vegetables. Limit your consumption of fatty foods and increase the amount of oily fish (mackerel, herring, sardines) in your diet.

Stay active. Regular exercise strengthens muscles that will help support joints. If you like running, get yourself a pair of good trainers with cushioned soles that will help reduce impact on the knees. If you enjoy walking, kit yourself with quality walking boots that provide support to the feet and ankles. A ski-pole or walking stick will also help ease the load on the hips and knees. If you participate in contact sports, try to protect those joints that are likely to get injured. Use knee, elbow and back braces if necessary. Swimming is a great way to keep the heart and circulation in good order without putting too great a strain on joints.

If you do develop osteoarthritis, although it cannot be cured, there is a lot that you can do to delay its progression and ease symptoms. Maintain an upright posture when sitting, standing or moving around to keep joints in alignment. Avoid repetitive tasks and if your joints start to ache, rest for a while. Organise your work area, to make things accessible. If you spend long times in front of a computer, make sure that your screen and chair are appropriately adjusted to avoid strain to the neck, back, hips and knees. If you require treatment, talk to your doctor about the options available. In some cases a referral to a physiotherapist or an occupational therapist will help. The therapists can give you special exercises to help overcome mobility problems and avoid joint strain, and show techniques that will help you relax.

If you do need medicines, talk to your doctor or pharmacist about the types available. Tell them if the medicines lose their effect and report any side effects.
Useful Tips
  • If you are overweight, try losing a few pounds
  • Keep active to strengthen muscles, but make sure you don’t put too much strain on your joints; non-weight bearing exercise such as swimming is ideal
  • Very swollen joints should be rested
  • During a bad attack take painkillers and wear warm clothing over the joints
  • Trainer shoes may help ease the pressure on large joints and even help back and neck pains. Try special cushioning innersoles for shoes
  • Ice and heat packs may ease the pain
  • Supplements of glucosamine and chondroitin, constituents of cartilage, and supplements of omega 3 fish oils may provide some relief
  • Certain foods such as ginger and cider vinegar may help
Further information
Arthritis Care  - Arthritis Care is the UK's largest charity working with and for all people who have arthritis. The website provides useful information about the various forms of arthritis and makes available a series of guides that contain practical advice to help you take control of your symptoms and to live and work with the condition.

Arthritis Care
18 Stephenson Way
London NW1 2HD
Helpline: 0808 800 4050
www.arthritiscare.org.uk

Arthritis Research UK - Arthritis Research UK is the charity leading the fight against arthritis by funding high class research, providing information and campaigning.

Arthritis Research Campaign
Copeman House
St Mary's Court
St Mary's Gate
Chesterfield
Derbyshire
S41 7TD
Helpline 0870 850 5000
www.arc.org.uk


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