Part of the "What is...?" series
Arthritis is the general name for a joint complaint. It comes from the latin "arthr-", meaning joint, and "-itis" meaning inflammation.
There are actually over 100 different types of arthritis - far too many to go into detail about here - but they fall under 2 simple categories.
- Inflammatory Arthritis/Rheumatic Diseases happens when the immune system attacks something in the joint, whether that's the cartilage, the bone, the joint lining or other parts of the joint. It is characterised by redness and swelling, which often happens in flare-ups, and will affect lots of joints around the body and other areas of the body.
- Osteoarthritis happens when there is an irregular surface in the joint. This means the joint cannot glide through its movements like it used to and often becomes stiff. This is by far the most common type of arthritis, especially in those over 50, and is what most people mean when they say they have "a bit of wear and tear". This is the type of arthritis I'll be addressing in the rest of this post.
(If you want to read more about inflammatory arthritis, see this post.)
It's a joint condition characterised by stiffness, mild swelling and pain. It happens mostly commonly in the weight-bearing joints, such as knees and hips, but also joints that get a lot of use, like the hands. On examination, it's often found that the muscles that travel across the joint have become tighter and weaker.
When we see OA on an x-ray, this is what is looks like:
- The normal space between 2 bones in a joint is narrower than it should be. This is because the layer of cartilage (which you can't see on an x-ray, so it just looks like empty space) which would allow the joint to glide freely has become thinner.
- The surface of the bone looks bumpy instead of smooth, giving the appearance that is has been worn away.
- There is less fluid in the joint than there would usually be.
There isn't a cure for osteoarthritis, since it essentially occurs in response to everyday living, but there are lots of strategies that can be used to reduce the symptoms and many of these are incredibly effective and easy to do.
So here's the interesting thing. OA isn't painful at all. None of the changes associated with OA that we see on an x-ray actually cause pain in and of themselves. In fact, many people don't even know they have OA because the don't experience any pain or stiffness at all.
There are cases where the OA can become very severe and cause pain in other structures (for example, if the extra bone deposits started pushing on a nerve or a tendon) or if eburnation - bone rubbing directly on bone - occurs in the joint then this can also be painful. In cases like these a joint replacement is often recommended. However, when a clinician sees evidence of OA on an x-ray or another scan, it doesn't automatically mean that it will be painful or symptomatic.
When viewed on an x-ray, OA gives the appearance of a bumpy and irregular surface, and so many people assume that the bone is gradually being worn away over time. But in fact what we are seeing on the x-ray is more bone being deposited onto the joint surface, not less. The bumpy surface we see is actually the site of extra bone growth, which is taking place to make the bone stronger in an area where the body feels it needs building up.
In response to force or load through a particular joint, cells called osteoblasts become more active. It's the osteoblasts' job to deposit calcium and other minerals into the structure of the bone to increase its density and strength.
In the same way, the cartilage within the joint is capable of regrowing and, although this is a slow process, even a small amount of regrowth can reduce the symptoms of OA.
In OA, the body is simply adapting to the stresses and stimuli of everyday life, and most of the time that is beneficial. It's also true to say that if we change those stresses and stimuli we can halt - or sometimes even reverse - the changes in the joint that we see in OA.
Here are my top tips for managing OA:
- Exercise - research shows that exercise prescribed by a professional (such as a physical therapist, chiropractor or physiotherapist) is more effective than medication for managing pain and stiffness in arthritis.
- Manage your weight - putting extra weight through your joints will accelerate the process of wear and make it harder for your immune system to keep up with the healing process
- Increase your intake of GAGs - glycosaminoglycans (GAGs) are the building blocks of new cartilage, and you can find them in bony oily fish like sardines and mackerel. They are also available in tablet form, in supplements like Glucosamine and Celadrin.
- Get a good night's sleep and deal with unresolved stress - both stress and poor sleep will slow down your body's healing processes, but a good night of rest for your joints will help take the load off
- Don't smoke - this stunts blood flow to everywhere in the body, including your joints, which need good blood flow to repair. Smoking increases your risk of developing many different kinds of arthritis.
Acupuncture has also been shown to be beneficial for reducing pain associated with OA, and for helping with the tension and weakness that develops in the surrounding muscles. Here at Flourish we treat many patients with OA and get great results!