Osteoarthritis (OA) is the most common chronic joint condition, affecting millions worldwide. It’s often referred to as “wear-and-tear” arthritis, but the reality is more complex.

Osteoarthritis presents a significant health challenge in Malaysia, especially with an ageing population and increasing obesity rates. Statistics indicate that the prevalence of OA in Malaysia is estimated to be around 10-20% of the adult population. Notably, a Malaysian Elders Longitudinal Research (MELoR) study revealed that nearly 27% of older adults in Malaysia experience knee OA symptoms.

Knee OA is a leading cause of disability in the country, particularly among the elderly. Several factors contribute to its prevalence, including age, gender (with a higher occurrence in women), obesity, and ethnicity. The economic burden of OA in Malaysia is substantial, encompassing healthcare costs, productivity loss, and the diminished quality of life for affected individuals.

This article delves into the causes, symptoms, and various treatment options available for managing OA.

What are the 4 Stages of Osteoarthritis?

Osteoarthritis (OA) progresses through four main stages: early (minor), mild, moderate, and severe. Each stage is characterised by increasing joint pain, stiffness, and cartilage degradation, ultimately leading to bone-on-bone contact.

Here’s a breakdown of each stage:

1. Early (Minor): This stage involves mild cartilage wear and tear, often with minimal or no noticeable pain or discomfort. You might notice some minor bone spur growth, but the joint space is still largely intact.
2. Mild: At this stage, you may start to experience pain and stiffness, especially after periods of inactivity. X-rays may show some narrowing of the joint space and bone spurs.
3. Moderate: The cartilage loss becomes more significant, leading to increased pain, particularly during activities like walking, running, or bending. You might also notice more stiffness and difficulty moving the joint. X-rays may show more pronounced narrowing of the joint space, bone spurs, and some cartilage damage.
4. Severe: The cartilage is almost completely gone, resulting in bones grinding together, which causes severe pain, stiffness, and reduced range of motion. At this stage, you might consider joint replacement surgery. X-rays will show significant narrowing of the joint space, bone spurs, and substantial cartilage damage.

Osteoarthritis Causes and Risk Factors

The exact cause of OA remains elusive, but it likely arises from a combination of several contributing factors such as:

• Age is a primary risk factor, as the cartilage’s ability to repair itself declines over time.
• Genetics can also play a role, with some individuals inheriting genes that predispose them to the disease. Previous joint injuries, such as fractures or ligament tears, can increase the likelihood of developing OA later in life.
• Repetitive motions or overuse of a joint can contribute to the breakdown of cartilage.
• Obesity is another significant factor, as excess weight places additional stress on weight-bearing joints like the hips and knees and may also promote inflammation that further damages cartilage.
• Gender – Women are more susceptible to OA than men, particularly after menopause.
• Muscle weakness around a joint can also contribute to the condition.
• Certain underlying medical conditions, including diabetes, rheumatoid arthritis, and hemochromatosis, can elevate the risk of OA.

Symptoms of Osteoarthritis

OA symptoms develop gradually and worsen over time. They can vary from person to person, but common symptoms include:

• Pain: Joint pain is the most common symptom of OA. It may get worse with activity and relieved by rest, but as the disease progresses, pain may be present even at rest.
• Stiffness: Joint stiffness is often worse in the morning or after periods of inactivity. It usually improves with movement.
• Tenderness: The joint may be tender to the touch.
• Swelling: Swelling may occur after activity or due to inflammation.
• Loss of flexibility: It may become difficult to move the joint through its full range of motion.
• Grating sensation: A grating or grinding sensation, called crepitus, may be felt or heard when the joint moves.
• Bone spurs: Extra bits of bone, called bone spurs, may form around the joint, which can be painful.

Diagnosis of Osteoarthritis

OA is typically diagnosed based on a combination of:

Medical history: Your doctor will ask about your symptoms, when they started, and how they affect your daily life.

Physical examination: Your doctor will examine the affected joint, checking for tenderness, swelling, redness, and range of motion.

Imaging tests:

• X-rays: X-rays can show cartilage loss, bone damage, and bone spurs.
• Magnetic resonance imaging (MRI): MRI can provide more detailed images of cartilage and other soft tissues, but it’s not always necessary for diagnosing OA.

Blood tests: Blood tests are not typically used to diagnose OA, but they may be done to rule out other conditions, such as rheumatoid arthritis.

Joint fluid analysis: In some cases, your doctor may take a sample of fluid from the affected joint to check for inflammation or infection.

Treatment Options for Osteoarthritis

While there is no cure for OA, but various treatments can help manage symptoms, reduce pain, and improve joint function. Treatment options include:

Lifestyle Modifications

The following lifestyle modifications may be considered:

• Weight management: Losing weight can reduce stress on weight-bearing joints and slow the progression of OA.
• Exercise: Regular exercise can strengthen muscles around the joint, improve flexibility, and reduce pain. Low-impact exercises like walking, swimming, and cycling are generally recommended.
• Rest and joint care: Balancing rest with activity is important. Avoid activities that put excessive stress on your joints and use assistive devices if needed.
• Hot and cold therapy: Applying heat or cold to the joint can help relieve pain and stiffness.

Therapies

Your medical team may also suggest any of the following therapies or a combination of several of them:

• Physical therapy: A physical therapist can teach you exercises to strengthen muscles, improve flexibility, and reduce pain. They can also help you learn how to protect your joints and perform daily activities safely.
• Occupational therapy: An occupational therapist can help you find ways to perform daily activities with less stress on your joints. They may recommend assistive devices or modifications to your home or workplace.
• Acupuncture: Some people find that acupuncture helps relieve OA pain.
• Massage therapy: Massage may provide short-term pain relief and improve joint function.
• Transcutaneous electrical nerve stimulation (TENS): A TENS unit uses electrical impulses to stimulate nerves and may help reduce pain.

Injections

The following types of injections may be considered:

• Hyaluronic acid injections: Hyaluronic acid is a substance found naturally in joint fluid. Injections of hyaluronic acid into the joint may help lubricate it and reduce pain.
• Platelet-rich plasma (PRP) injections: PRP is a concentrated solution of platelets from your own blood. PRP injections may help stimulate cartilage repair and reduce inflammation, but more research is needed to confirm their effectiveness.

Surgery

Surgery is usually considered when other treatment options have not been effective. Surgical procedures for OA include:

• Joint replacement: Damaged joints, such as the hip or knee, can be replaced with artificial joints. Joint replacement surgery can relieve pain and improve function, but it’s a major surgery with potential risks and a long recovery period.
• Arthroscopy: This minimally invasive procedure involves inserting a small camera and instruments into the joint to repair or remove damaged tissue. Arthroscopy is not always effective for OA and is less commonly used than in the past.
• Osteotomy: In this procedure, bone is cut and reshaped to relieve pressure on the joint. Osteotomy is sometimes used to treat OA of the knee.

Prevention of Osteoarthritis

While OA cannot always be prevented, several measures can help reduce your risk or slow its progression. Here are some of the things you can do:

• Maintain a healthy weight: This is one of the most important things which can protect your joints.
• Exercise regularly: Regular physical activity can strengthen your muscles, improve flexibility, and help maintain joint health.
• Avoid joint injuries: Take precautions to prevent injuries during sports or other activities.
• Practice good posture and body mechanics: This can help reduce stress on your joints during daily activities.
• Manage other medical conditions: Conditions like diabetes and rheumatoid arthritis can increase your risk of OA, so it’s important to manage them effectively.

By adopting these preventive strategies, individuals can significantly reduce their risk of developing OA or delay its progression, ultimately promoting healthier joints and an improved quality of life.

Living with Osteoarthritis

Living with OA can be challenging, but there are many things you can do to manage your condition and maintain an active, fulfilling life.

• Follow your treatment plan: Work with your doctor and other healthcare providers to develop a treatment plan that’s right for you and stick to it.
• Manage pain: Use a combination of medications, therapies, and lifestyle modifications to manage your pain.
• Stay active: Regular exercise is important for maintaining joint health and overall well-being.
• Maintain a healthy weight: Losing weight can significantly reduce stress on your joints.
• Use assistive devices if needed: Canes, walkers, braces, and other assistive devices can help support your joints and make it easier to move around.
• Seek support: Talk to your family, friends, or a support group about your condition. Sharing your experiences and feelings can help you cope.
• Educate yourself: Learn as much as you can about OA and its treatment options. The more you know, the better you’ll be able to manage your condition.

Sources:

• https://www.verywellhealth.com/stages-of-osteoarthritis-5095938
• https://www.healthline.com/health/osteoarthritis-stages-of-oa-of-the-knee
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8038539/