Osteoarthritis: Time For Us All to Shift the Needle

A Summary of the Journal of Rhematology Article

The Journal of Rheumatology published an excellent article in (April 2018) summarising the best current medical and scientific understanding of the condition we call osteoarthritis. Here is the WrinkleWell summary of the summary.

Osteoarthritis (OA) is a common condition that affects the joints of 1 in every 11 Australians. Of those who develop OA, two thirds are female (Aust Institute of Health and Welfare). The most widely recognised risk factors for the development of OA are:

• Age,

• Genetics,

• Obesity, and

• Joint injury.

With the average age of our population increasing, and with many people also dealing with obesity and a sedentary lifestyle, the number of people affected by OA and the disability it causes is also increasing. Fortunately, so has our understanding of this condition. So, what exactly is OA? Previously considered to be a degenerative disease of the cartilage inside our joints, OA is now understood to affect all parts of the joint, including the surrounding ligaments, the bones, and the synovial lining tissues. The role of chronic inflammation has been shown to be very significant in the way OA progresses (click here for more information on inflammation).

The actual damage caused by OA to the joint can vary from mild to severe, but interestingly, research has shown that there is very little correlation between the amount of damage (shown on X-rays, for example) and the amount of pain that is felt. Across the spectrum of people dealing with OA there is the full range of damage/pain combinations, including patients with minimal X-ray evidence of damage who have severe pain, through to patients with extreme levels of OA damage who have little or no pain. This apparent contradiction starts to make more sense as we understand the complex nature of pain, which is affected by many different factors (click here for more information on pain).

Treatment for OA should therefore not be based just on what scans have shown about the degree of damage. OA should be treated holistically, based on the patient’s symptoms, limitations, interests, goals, and life stage.

Studies have shown that many health practitioners and patients are failing to take advantage of the most effective, proven treatments for OA - lifestyle modification strategies including weight loss and exercise. Instead, time and money are being poured into passive or “hands-on” treatment options that may offer short-term pain relief, but are largely no better than placebo. Education, self-management and exercise should be key components in the care of OA.  Surgery may be appropriate for some people, but only when symptoms are severe and lasting, and when active lifestyle strategies have been employed (click here for more information on joint surgeries).