Osteoarthritis Care and Management

Perhaps the most recognised form of arthritis, osteoarthritis is a chronic condition in which the whole joint is affected, including the bone, cartilage, ligaments and muscles.

There are over one hundred types of arthritis. Each type affects the joints in different ways and the degree of pain experienced will vary between patients (Arthritis Australia 2017b).

With its prevalence on the rise in Australia (AIHW 2019) it is essential that you know how to recognise and respond to arthritis in your practice.

Osteoarthritis is a condition resulting in pain, swelling and/or reduction in motion. Like other forms of arthritis, osteoarthritis tends to worsen over time (AIHW 2019).

As the condition progresses, everyday tasks that were once simple can become a challenge. Initially, a person will experience pain during and after physical activity, but as the condition progresses pain will be present during minor movements or even while resting (Arthritis Australia 2017a).

Osteoarthritis and its Prevalence in Australia

It is reported that roughly 2.1 million Australians (9.0%) are living with osteoarthritis (AIHW 2019).

Three in five people who have osteoarthritis are female and although osteoarthritis can affect people of all ages, the chance of developing osteoarthritis increases considerably after the age of 45 (AIHW 2019).

Socioeconomic factors influence the chance of a person developing osteoarthritis. People living in lower socioeconomic areas had a prevalence rate of 26% compared to 16% for people in higher economic areas – as found in the recent National Health Survey (AIHW 2019).

From 2005 to 2017 there was a 38% increase in the rate of total knee replacements as a result of osteoarthritis (AIHW 2019).

What is Osteoarthritis?

• Inflammation to the tissues around the joints;
• Cartilage tear/damage;
• Bony spurs growing around the edge of the joint;
• Ligament deterioration.

(Arthritis Australia 2017a; Health Direct 2018; Healthy WA n.d.)

Osteoarthritis can affect any joint. However, it occurs most often in:

• Knees;
• Hips;
• Finger joints;
• ‘Big’ toes.

(Arthritis Australia 2017a; Better Health Channel 2019)

Symptoms

The following is a list of common symptoms (bear in mind that symptoms will differ depending on the joint affected):

• Stiffness and pain in joints;
• Crepitus: clicking noises, grating sensations, crunching sensations (crepitus);
• Loss of flexibility and reduced range of movement.

(MSK n.d.; Arthritis Australia 2017a; Better Health Channel 2019)

Who is Most at Risk of Osteoarthritis?

• People who have a previous injury;
• People who are overweight or obese;
• Older people;
• People who have joint misalignment;
• People who work in roles that require repetitive tasks that put strain on joints;
• People with a genetic disposition to osteoarthritis;
• Women are more likely to develop osteoarthritis than men.

(Better Health Channel 2019; Arthritis Queensland n.d.)

Diagnosis

A doctor will diagnose osteoarthritis from a combination of a patient’s symptoms, their medical history, and a physical examination. An x-ray might show the narrowing and changes in the shape of the joint, however, an x-ray may not be enough to demonstrate how much pain a patient is in. Blood tests will only rule out other types of arthritis (Arthritis Australia 2017a; MSK n.d.).

Managing Osteoarthritis

There is no cure for osteoarthritis, but if managed effectively patients will still be able to enjoy a high quality of life. A patient should create a treatment plan with a general practitioner (GP).

Management options for osteoarthritis include:

• An exercise program tailored to their condition and ability;
• A weight management plan;
• Manipulation and stretching of affected areas as well as the application of local heat or cold;
• Medicine-centric pain management, including the use of medicines such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs);
• Mindfulness and meditation for pain management;
• Devices such as braces, walking sticks, and shoe insoles; and
• Joint replacement surgery, in the event of the failure of other therapies.

(Arthritis Australia 2017a; Healthy WA n.d.)

Exercise is a crucial part of any osteoarthritis management plan. Regular exercise has the potential to improve joint mobility and strength and reduce some of the symptoms caused by the condition (MSK n.d.).

Osteoarthritis Prevention

• Maintain a healthy weight:
  • Excess weight presents a risk for osteoarthritis as a person’s weight-bearing joints are put under additional pressure.
• Control glucose levels:
  • Research suggests that diabetes, which affects the body's ability to regulate blood glucose, could be a significant risk factor for osteoarthritis;
  • Diabetes can trigger inflammation which leads to cartilage loss.
• Exercise:
  • Moderate exercise is a key way to keep joints healthy;
  • As little as 30 minutes of exercise per day aids joint and muscle function.
• Rest:
  • In the case of ligament tears and strains, dislocation and fractures, it is important to rest and recover properly;
  • It is estimated that 50 percent of people who experience a traumatic joint-related injury develop osteoarthritis.
• Practice a healthy lifestyle:
  • This inclusive of diet (including drinking and smoking habits), sleep, stress management, and socialisation.

(Arthritis Foundation n.d.)

Conclusion

Encourage patients to acknowledge and express their feelings – it is likely that they will experience a mix of emotions including fear, anger and frustration – this is normal. It may be worth encouraging patients to seek counselling in order to talk and process their emotions (Arthritis Australia 2017b).

Empower your patients with information and resources to understand their particular type of arthritis. This will provide them with a sense of control and will give them a better idea of their treatment options.

Additional Resources

• Arthritis Australia: https://arthritisaustralia.com.au/what-is-arthritis/understanding-arthritis/
• A Big Picture Look at Arthritis in Australia: https://www.ausmed.com.au/cpd/articles/arthritis-in-australia

References

• Arthritis Queensland n.d., Osteoarthritis, Arthritis Australia, viewed 3 October 2019, https://www.arthritis.org.au/arthritis/types-of-arthritis/osteoarthritis/
• Arthritis Australia 2017a, Osteoarthritis, Arthritis Australia, viewed 3 October 2019, https://arthritisaustralia.com.au/types-of-arthritis/osteoarthritis/
• Arthritis Australia 2017b, Understanding Arthritis, Arthritis Australia, viewed 3 October 2019, https://arthritisaustralia.com.au/what-is-arthritis/understanding-arthritis/
• Arthritis Foundation n.d., Osteoarthritis Prevention: What You Can Do, Arthritis Foundation, viewed 3 October 2019, https://www.arthritis.org/about-arthritis/types/osteoarthritis/articles/oa-prevention.php
• Australian Institute of Health and Welfare (AIHW) 2019, Osteoarthritis, AIHW, viewed 3 October 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis/contents/what-is-osteoarthritis
• Better Health Channel 2019, Osteoarthritis, Better Health Channel, viewed 3 October 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoarthritis
• Health Direct, Osteoarthritis, Health Direct, viewed 3 October 2019, https://www.healthdirect.gov.au/osteoarthritis
• Healthy WA, Osteoarthritis, Healthy WA, viewed 3 October 2019, https://healthywa.wa.gov.au/Articles/N_R/Osteoarthritis
• Musculoskeletal Australia (MSK) n.d., Osteoarthritis Treatment Overview, MSK, viewed 3 October 2019, https://www.msk.org.au/osteoarthritis/

(Answers: b, d, a)