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A person holds their knee with pain at Brij Medical Centre in Kavi Nagar.

Osteoarthritis

A degenerative disease of the cushioning cartilage. It affects people over the age of 40 years. Generally, it develops slowly over the period of time. Affects isolated joints or on one side of the body. This type of Arthritis does not cause redness and warmth of the joints. It doesn't migrate to other parts too. Most commonly affects weight bearing joints (E.g. knees and hips). Discomfort is usually related to the affected joint. Brief periods of stiffness are seen and rarely causes fatigue

What Is Osteoarthritis?

Osteoarthritis is a group of overlapping distinct diseases, which may have different aetiologies but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but also involve the entire joint, including the subchondral bone, ligaments, capsule, synovial membrane, and peri-articular muscles. Ultimately, the articular cartilage degenerates with fibrillation, fissures, ulceration, and full thickness loss of the joint surface

What Happens in Osteoarthritis?

  • Synovitis
  • Eburnation of exposed bone
  • Bony remodelling
  • Osteophyte formation
  • Subchondral cysts
  • Degeneration of menisci
  • Peri-articular muscle atrophy
  • Thickening of joint capsule
  • Loss of articular cartilage (may appear thicker than normal in early stages)

Causes and Prevalence

The Greek word “Arthro” means joint and “itis” means inflammation. Arthritis may occur in conditions such as viral fever, malaria, or typhoid. Other important causes include Rheumatoid Arthritis, Gout, Ankylosing Spondylitis, Systemic Lupus Erythematosus (SLE), and Psoriasis. In children, Juvenile Rheumatoid Arthritis (JRA) and Juvenile Idiopathic Arthritis (JIA) may occur.

  • Genetic: Seen in families due to shared environmental and hereditary factors
  • Age: Common after 40 years; by 50–60 years, 80–90% of individuals may be affected
  • Sex: Females are more affected than males (ratio ~3:1)
  • Trauma: Joint injuries can lead to degenerative changes
  • Occupation: Repetitive micro-trauma from certain occupations
  • Obesity: Increased weight leads to higher joint stress and degeneration
  • Infection: Previous joint infections may leave residual damage

Clinical Presentation of Osteoarthritis

Pain

Pain may arise from multiple joint structures:

  • Muscles: Due to strain from misalignment
  • Joint Capsule: Stretching due to increased intra-articular pressure
  • Subchondral Bone: Micro-fractures
  • Bursa: Inflammation
  • Enthesis: Inflammation at tendon insertions
  • Synovium: Inflammation due to cartilage breakdown products
  • Ligaments: Stress and strain
  • Stiffness: “Gelling” phenomenon (stiffness after rest)
  • Tenderness: Pain on touch with possible crepitus
  • Swelling: Typically cold effusion (unlike hot swelling in RA)
  • Loss of Function: Reduced range of movement and muscle wasting

Management of Osteoarthritis

Diagnosis

  • Accurate diagnosis and grading of disease stage

Treat Secondary Causes

  • Specific treatment for conditions like gout and rheumatoid arthritis
  • Weight reduction in obesity
  • Prevention of occupational or activity-related stress

Patient Motivation

  • Patient education
  • Encouragement and motivation for long-term management

Self-Help Measures

  • Self-management programs
  • Personalized social support
  • Aerobic exercise programs

Secondary Health Care

  • Physical therapy and range-of-motion (ROM) exercises
  • Muscle strengthening exercises
  • Lateral-wedged insoles (for genu varum)
  • Bracing and patellar taping
  • Appropriate footwear
  • Assistive devices for mobility and daily activities
  • Joint protection and energy conservation techniques
  • Physiotherapy and occupational therapy

Pharmacological Therapy

Oral Medications:

  • Acetaminophen (Paracetamol)
  • COX-2 selective inhibitors
  • Non-selective NSAIDs with gastro-protection
  • Non-acetylated salicylates
  • Analgesics such as Tramadol
  • Opioids (in selected cases)

Intra-articular Injections:

  • Glucocorticoids
  • Hyaluronan

Topical Therapy:

  • Capsaicin
  • Methyl salicylate

Surgical Management

  • Osteotomy: Wedge removal (e.g., in hallux valgus)
  • Arthrodesis: Joint fusion (salvage procedure)
  • Arthroplasty: Joint replacement (typically lasts 10–15 years)

Note: A joint that has not moved for two years may not regain movement immediately after surgery.