Osteoarthritis is defined as degeneration of (synovial) joints. Synovial joints are made up of hyaline cartilage or fibrocartilage that line the bony surfaces. They contain synovial fluid which lubricates the joint.

Osteoarthritis affects women to men 2:1. It is the most common form of arthritis in patients over 50 years of age and affects 50% of over 60 year olds.

There are different types of osteoarthritis:

- Primary osteoarthritis
- Secondary osteoarthritis
- Endemic osteoarthritis

Primary Osteoarthritis
This type of Osteoarthritis is diagnosed when there is no obvious cause to the joint. Primary Osteoarthritis can be further divided into:
- Classical Osteoarthritis (affecting weightbearing joints)
- Generalised Nodal Osteoarthritis (affecting finger joints – commonly in middle-aged women)

Secondary osteoarthritis
This form of osteoarthritis is the result of another clearly defined cause. These causes include damage to the cartilage or bone, or altered dynamics, e.g. change in gait.

Other causes of Osteoarthritis
Biomechanical Factors

- Trauma lifestyle – sports injuries, road traffic accidents (RTA), falls, etc.
- Predisposing factors – poor posture, poor walking gait, musculoskeletal imbalance all can lead to osteoarthritis.
- Age – incidence of osteoarthritis increases with age.
- Obesity – increase weight affect the load on weightbearing joints, thus increasing likelihood of developing osteoarthritis.
- Genetic – family history of osteoarthritis.

Clinical Features of Osteoarthritis
- Localised pain
- Worse in evening
- Aggravated by use
- Relieved by rest
- Stiffness: for approximately first 30 mins in the morning and after rest
- Localised joint and tissue swelling
- Hard bony mild effusion
- Crepitus
- Limitation of movement with muscle wasting
- Mild inflammatory signs
- Joint deformities due to spurs (osteophytes)
- Cartilage deteriorates (chondormalacia – abnormal softening of cartilage)

Pattern of involvement of Osteoarthritis
- Occasionally monoarticular (i.e. affects one joint)
- Bilateral, symmetrical
- Knees are the commonest site
- Hands, hips, feet, ankle and lumbar spine

Osteoarthritis of the Hand

Osteoarthritis of the hands usually occurs as part of nodal osteoarthritis – commonly affecting the base of the thumb and the joints at the end of the fingers. Osteophytes form gradually over years on the fingers or toes and are known as Heberden’s nodes (if on the DIP joint) or Bouchard’s nodes (if on the PIP joints).

Although the fingers are knobbly and sometimes slightly bent, they work well and rarely cause long-term problems. However, having nodal osteoarthritis in middle age means you are more likely to develop osteoarthritis of the knee, and occasionally a few other joints, as you get into your 60s and 70s. This is why it is sometimes called ‘generalised’ (widespread) osteoarthritis. Nodal osteoarthritis is mainly related to genes that are inherited and so it runs in families. It is almost completely confined to white people

Treatment
- Manual therapy e.g. Osteopathy
- Arthroscopy

Cartilage and ligament abnormalities and damage can be detected and sometimes repaired through the arthroscope (providing a much quicker recovery than open joint surgery if successful)

Posted by Mr. Trishul Vadi (Principal Osteopath in West Wickham, Beckenham, Bromley & South East London) on Tuesday, September 7th, 2010