Osteoarthritis (OA)

What is it?

Osteoarthritis (OA) is a degenerative arthritis that can affect any joint in the body, most commonly the hips, knees, spine, hands and feet. OA is a disease that degrades the joint cartilage (Cartilage is like Teflon material that covers and protects the ends of bone) resulting in pain, stiffness, grinding, mobility limitations and disability. OA is the most common cause of chronic disability (Institute of Clinical and Evaluative Sciences, 2004).

How common is it?

Affects 1 in 10 Canadians. Peak onset of the disease may appear at 45 years but can occur at any age. OA is most common in men before the age of 50 and most common in women after 50.(Oliveria, 1995)

Stages:

  • Breakdown of cartilage-the smooth coating gets rough and worn away = narrowing of joint space.
  • Synovial irritation (fluid in knee).
  • Remodeling: osteophytes (bony spurs) form at ends of bones
  • Eburnation of bone
    • Bones rub together (bone on bone)
  • Disorganization-over time, the joint loses its shape and does not work properly = joint stiffness, instability (feeling of giving away), muscle weakness.

Warning Signs of OA:

  • Pain with activity which eases with rest
  • Soreness and stiffness
  • Loss of full motion
  • Loss of muscle strength
  • May have joint effusion (swelling)
  • Joint crepitus (cracking and grinding)
  • Joint malalignment (in knees – bow legged usually).

Treatment: No cure!

Depending on the severity of your arthritis, you have a few options. The Advanced Practice Physiotherapist (APP) will educate you on the best pathways to better your current condition. Recommendations are dependent on the individual’s needs and severity, here are some examples:

Process

Outcome / Result

Education

  • Understanding disease
  • Decrease joint stress and prevent overuse
  • Modification of lifestyle
  • Understand importance of proper exercise
  • Use of mobility aid if necessary (cane, poles, walkers)
  • Resources - Arthritis Society (1-800-321-1433)

Weight Loss

Medicine

  • Simple analgesics (acetaminophen)
  • NSAIDS (anti-inflammatory)
    • Over-the-counter NSAIDS: (ie: non-steroidal ant inflammatory (ex: Ibuprofen, Aleve))
    • Prescription from your doctor
  • Topical Creams
    • NSAIDs
    • Capsaicin

Natural Supplements

  • Glucosamine
  • Chrondroitin

Pain/Swelling modification

  • Ice or heat packs X 15 minutes, 2-3 times per day
  • Bracing, soft sleeve

Physiotherapy Assessment
and Treatment

  • Education
  • Well designed, supervised programs
  • Modalities: IFC, Ultrasound

Exercises

  • Specific Exercises: as prescribed by a Registered Physiotherapist to improve joint lubrication, improve dynamic (muscle) stability and to correct any muscle imbalances to decrease stress at knee.
  • General Exercises: once cleared by family physician and discussed with physiotherapist.
  • Walking
  • Swimming/aquatics
  • Stationary bicycle

Other Options
Footwear

  • Orthotics – wedge insole
  • Bracing - ie. unloader for knee OA

Injections

  • Corticosteroids (steroid)
  • Viscosupplementation (ie: Synvisc, Durolane)

Surgery

  • Surgical intervention required - Excruciating pain and failure to respond to conservative treatment:
    • Arthoscopy
    • Osteotomy
    • Total Joint Replacement

Relevant Links

Managing Arthritis 

Arthritis Society

Eat Right Ontario

Dietitians of Canada