Risk Factors for Osteoarthritis
Introduction
Osteoarthritis (OA) is the most common form of arthritis. It affects 1 in 4 adults over the age of 40. It is a condition that affects all the tissues of a joint, including the bone, cartilage, ligaments, tendons and muscles.
OA involves the breakdown of these tissues and over time as the joint tries to repair itself, other problems arise such as bone reshaping, and joint inflammation. This can give rise to pain and stiffness. OA however does not necessarily progress to more severe disease and a significant number of people experience no progression or even improvement. Less than 20% of people with OA will require joint replacement surgery.
Osteoarthritis usually occurs after the age of 50, although it can start earlier in the case of joint injury or surgery, and is more prevalent in women. It commonly affects the knees, hips and hands but can affect most other joints.
The exact cause of OA is unknown but we do know of things that predispose to its development, these include:
● A family history of OA
● Older age
● Being female
● Obesity
● Diabetes
● High cholesterol
● Joint injury
● Joint surgery
● Other joint disorders (Rheumatoid arthritis, childhood hip diseases etc)
● Heavy manual professions
The structural changes seen in the joint on an x-ray do not correspond well to the symptoms experienced. It can be that the structural changes may be severe but the person feels very little pain, similarly an x-ray may show very little structural change but the person feels severe pain. We know therefore that OA symptoms can be driven by things other than structural changes within the joint.
Global clinical treatment guidelines agree that the mainstay of OA treatment should be education about the condition, exercise and weight management with other treatments being considered if these are unsuccessful.
A physiotherapist is instrumental in educating about the condition and tailoring bespoke exercise recommendations to the unique individual in front of them. Every individual will have different triggers that can cause their symptoms to flare and different methods of calming things down. A physio will help them identify these.
OA pain can be exacerbated by everyday things such as:
● Weather changes
● Stress
● Doing “too much”
● Doing “too little”
● Worry
● Sadness
● Tiredness
● Nutritional choices
● Lifestyle habits
Identifying these as triggers helps to lay the foundation for a treatment plan.
Exercise is thought to be helpful in OA for many reasons:
● A joint receives its nutrition and clearance of waste products through fluid moving across its joint surfaces. Movement is instrumental in allowing this flow and thus optimising joint health.
● Aerobic exercise is systemically anti-inflammatory, thus helping decrease the inflammation known to be within an osteoarthritic joint. A physio will help an individual identify which exercise they can consistently adhere to within the scope of their personal situation and preferences, and help to identify how much exercise is currently the right amount for them.
● Muscle strengthening has two main benefits in OA. Stronger muscles will relieve some of the load going through arthritic weight bearing joints and any increase in muscle mass will help with glucose control thus helping manage any systemic inflammation.
● General exercise along with adequate rather than excessive nutrition will help with weight management. Obesity not only excessively loads arthritic joints but also contributes to systemic inflammation which can drive symptoms.
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