Osteoarthritis

Osteoarthritis is the commonest joint disease and it involves the whole joint. The smooth cartilage capping the ends of the bones thins and roughens, the bone underneath thickens and grows spurs at the margins, the lining of the joint becomes inflamed in spells, and the ligaments and muscles around it weaken.

Calling it wear and tear undersells it. Age matters, but so do previous injury to that joint, the alignment of the limb, the strength of the muscles supporting it, inherited factors and body weight. Weight is the largest of the factors you can act on: walking puts several times your body weight through each knee, so every kilogram lost is worth several at the joint.

The knee is the joint most often affected in India, followed by the hip, the small joints at the base of the thumb and the ends of the fingers, and the spine. It usually develops over years, in better and worse spells instead of a steady slide, and a bad month does not mean the joint has suddenly deteriorated. Pain that is worse after activity and eases with rest, and stiffness after sitting that loosens within a few minutes of moving, are the typical pattern.

Your doctor will watch you walk into the room, which tells them about pain, alignment and how you are compensating before they touch anything. They then look at the standing limb for bowing or knock knee, at swelling, and at the bulk of the thigh muscle compared with the other side, since wasting is both a consequence of the pain and a cause of more of it.

They move the joint through its range, feeling for the grating that comes from a roughened surface, noting where the range stops and whether it stops because of pain or because of a mechanical block. They press along the joint line and around it, since pain from a tendon or a bursa beside the joint is common and is treated quite differently. They test stability, examine the joint above and below, and look at your other joints to see whether a pattern is present.

An X-ray taken standing shows the space left between the bones, the spurs and the changes in the bone. Expect the X-ray and the pain to disagree, because they often do, and your doctor treats the person in front of them.

Progress is measured in what you can do and not in what the X-ray shows. A structured strengthening programme for the muscles around the joint is the treatment with the best evidence behind it, and it takes six to twelve weeks of regular work before the difference is clear. It has to continue after that, because the gains are lost within a couple of months of stopping.

Losing five to ten per cent of body weight, where there is weight to lose, produces a reduction in knee pain comparable to that from medication. Anti-inflammatory tablets and gels work within days and are used in short courses, with the tablets reviewed by your doctor if you have stomach, kidney, blood pressure or heart problems.

An injection into the joint gives relief in a few days that lasts weeks to a few months, and it buys time to do the strengthening work. Where surgery is reached, expect a night or two in hospital, walking with support from the first day, six weeks before walking is comfortable, three months to return to most activities and up to a year for the final result. Plan six to twelve weeks off work depending on how physical the job is.