Osteoarthritis is the leading cause of physical disability in people over the age of 65. Sufferers find that everyday tasks become challenging or impossible, and many of the activities they used to enjoy gradually drift away from them. How does this happen, and what can be done to help them?

There are many factors which contribute to the development of osteoarthritis, and these can be summarized by two main disease pathways: either abnormal mechanical stresses damage what was a previously healthy joint; or an abnormal, unhealthy joint will be injured by normal mechanical forces. The end result of both is that there is structural failure of the cartilage, ligaments and bones of the joint and damage is sustained to the joint housing, the ‘synovial capsule’. It is usually the hip, knee and hand joints which suffer the greatest disability in osteoarthritis.

The first symptom to be noticed is usually pain in the joint. This pain appears gradually and may be intermittent at first. It will be aching in character and is initially provoked by movement of the joint and relieved by rest. As the disease progresses bouts of pain will become more prolonged and the individual may start waking at night because of it. Morning stiffness or stiffness after inactivity is transient and will only last a few minutes. Because of the pain and disability, anxiety and depression are not uncommon in arthritics and this can amplify pain, leading to a vicious circle which can be very difficult to escape from.

Sometimes arthritic individuals don’t experience very much pain. In which case, they present to their doctor because of functional impairment. Restriction of movement can be caused by fibrosis of the joint capsule or development of bony outgrowths which get in the way of the joint, blocking its movement. Deformity of the joint is common, particularly in the hands, and causes significant functional limitation. Muscle weakness and wasting mean gripping or walking become very difficult.

Osteoarthritis treatment is predominantly directed at relieving symptoms, maintaining and improving joint function and minimizing the disability. The non-pharmacological measures which can be taken are dependent on the sites of the arthritis, i.e. knee braces or special footwear. Most people with osteoarthritis will benefit from physiotherapy or other muscle-strengthening activities. Pharmacological treatment begins with pain-killers and continues with other drugs such as steroid injections to help halt disease progression. The last resort for patients with hip or knee arthritis that is not responding to treatment is joint replacement surgery.