What is arthritis?
There are many different forms of arthritis. Osteoarthritis is the most common and affects all of us as we age, usually starting from our late forties onwards.
The most common joints affected are the knee, hip and thumb.
Normal Joint and Arthritic Joint
In normal joints the bone ends are covered by a thin layer of cartilage which is smooth and shiny. This allows the joint to move smoothly. The joint is lubricated by a liquid called synovial fluid which is produced by the inner layer of the joint capsule (the synovium). This fluid also nourishes the joint cartilage.
In arthritic joints the cartilage becomes rougher and thinner. The bone underneath thickens and can form bony spurs called osteophytes. The synovium can then produce extra fluid which makes the joint swell. The capsule and ligaments thicken and tighten as they try to stabilise the joint as it changes shape. The surrounding muscles often weaken.
Signs and symptoms of Osteoarthritis (O.A)
O.A. tends to creep up on us gradually, worsening over months or years. Stiff and painful joints are the main symptoms. There may also be a creaking noise as the joint moves. Swelling is common and may be soft due to fluid or hard due to bony O.A.. The damp Irish winters especially when there is low atmospheric pressure can worsen symptoms.
Over using the affected joints makes symptoms worse whilst too much rest weakens the supporting muscles so a balance must be found that works for the individual.
In severe O.A. pain may become constant even when resting the joint. Activities of daily living such as putting on socks and getting in or out of the bath may become very difficult. A range of aides are available to help a patient remain independent.
How is Osteoarthritis diagnosed?
It is usually the signs and symptoms mentioned above that lead a doctor or physiotherapist to diagnose O.A.. X-rays are useful to confirm clinical findings. Blood tests may be done to rule out other forms of arthritis such as rheumatoid arthritis.
What is the prognosis?
O.A. does not necessarily worsen and only very few people become severely disabled by it. If the hip or knee become badly arthritic the joint can be replaced. These total hip or knee replacements are very successful. Other joint replacements can also be performed but are less common.
It is impossible to predict how a patient will do once they been diagnosed with O.A.. Treatments such as physiotherapy can greatly help alleviate symptoms. Medication in the form of anti-inflammatories and analgesics (painkillers) can also help. Maintaining a healthy bodyweight will help avoid overloading leg joints. Appropriate exercise to maintain joint mobility and keep supporting muscles strong as prescribed by a chartered physiotherapist will be helpful.
Arthritis Physiotherapy Treatment
Treatment is based on assessment findings which will be explained to the patient.
A physiotherapist will assess the joint mobility and the length and strength of the muscles surrounding it. Swelling and pain levels will also be monitored.
Electrotherapeutic modalities will help decrease pain and swelling. Manual therapy will help loosen up stiff joints. Exercise will strengthen surrounding muscles to give the joint better support.
Mild to moderate arthritis can be managed conservatively with medication and physiotherapy. If symptoms cannot be improved with physiotherapy the patient will be referred to an orthopaedic surgeon for further tests (X-Rays, MTI scans etc..) and a joint replacement may be considered. Steroid injections into the joint can be effective in reducing pain quickly , with relief lasting several weeks.