How to manage joint pain

Osteoarthritis is the most common form of arthritis, affecting millions of people globally. You get it when the cartilage on the ends of your bones in the joints wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine. The disease is irreversible but the symptoms can usually be effectively managed. Eating healthy and exercising, maintaining a
healthy weight and other treatments may slow progression of the disease and help improve pain and joint function. If you have joint pain or stiffness that doesn’t go away, make an appointment with your doctor. Osteoarthritis is a degenerative disease that worsens over time.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

Pain. Your joint may hurt during or after movement.

Tenderness. Your joint may feel pain when you apply light pressure to it.

Stiffness. May be most noticeable when you wake up or after a period of inactivity.

Loss of flexibility. You may not be able to move your joint through its full range of motion.

Grating sensation. You may hear or feel a grating sensation when you use the joint.

Bone spurs. These extra bits of bone, which feel like hard lumps, may form around affected joints.

Causes

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the surface that is normally smooth of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Risk factors include:

Older age. The risk of osteoarthritis increases with age.

Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.

Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight puts added stress on weight-bearing joints, such as your hips and knees.

In addition, fat tissue produces proteins that may cause harmful  inflammation in and around joints.

Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk – even injuries that occurred many years ago and seemingly healed.

Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.

Genetics. Some people inherit a tendency to develop osteoarthritis Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.

Diagnosis

During the physical exam, your doctor will closely examine your affected joint, checking for tenderness, swelling or redness, and for range of motion in the joint. Your doctor may also recommend imaging and lab tests.

Imaging tests

Pictures of the affected joint can be obtained during imaging tests. Examples include:

X-rays. Cartilage doesn’t show up on X-ray images, but cartilage loss is revealed by a narrowing of the space between the bones in
your joint. An X-ray may also show bone spurs around a joint. Some people may have X-ray evidence of osteoarthritis before they experience any symptoms.

Magnetic resonance imaging (MRI). It uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage. An MRI isn’t commonly needed to diagnose osteoarthritis but may provide more information in complex cases.

Lab tests

Analysing your blood or joint fluid can help confirm the diagnosis. Blood tests. Although there is no blood test for osteoarthritis, certain tests may help rule out other causes of joint pain, such as rheumatoid arthritis.

Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid can determine if there’s inflammation and if pain is caused by gout or an infection.

Treatment

Symptoms can usually be effectively managed with lifestyle changes, physical and other therapies, medications, and surgery. Exercising and achieving a healthy weight are generally the most important ways to treat osteoarthritis. Your doctor may also suggest:

Medications

Symptoms, primarily pain, may be helped by certain medications, including: v Paracetamol. It has been shown to be effective for mild to moderate pain. Taking more than the recommended dosage of painamol can cause liver damage.

Over-the-counter nonsteroidal anti-inflammatory drugs, including ibuprofen, indomethacin and naproxen sodium, taken at the recommended doses, typically relieve osteoarthritis pain. v Amitryptiline. Normally used as an antidepressant, it is also approved to treat chronic pain,
including osteoarthritis pain.

Therapy

Physiotherapy. A physiotherapist can work with you to create an individualised exercise programme that will strengthen the muscles around your joint, increase your range of motion and reduce pain. Regular gentle exercise that you do on your own, such as swimming or walking, can be equally effective. v Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint.

Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Research suggests that tai chi and yoga may reduce osteoarthritis pain and improve movement. When led by a knowledgeable instructor, these therapies are generally safe.

Surgical and other procedures

If conservative treatments do not help, you may want to consider procedures such as cortisone injections; lubrication injections; realigning bones; and joint replacement.

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