Osteorathritis or Sore Joints

Osteoarthritis is the leading health problem among older Australians. In fact, by the age of 65 years, one-third of women and one-fifth of men report having osteoarthritis.

Osteoarthritis affects mostly the knee, hip, and hand joints and causes the usually smooth cartilage covering the bone ends to thin and become rough. The joint pain usually ‘comes and goes’ in the beginning, often after periods of increased physical activity. Over time, the pain periods may become more frequent even to the point of disturbing sleep. The joint stiffness associated with osteoarthritis has a characteristic pattern. It is sometimes described as ‘inactivity stiffness’ as it typically follows periods of inactivity, e.g. getting out of a car or a chair. Symptoms such as ‘locking of the knee’ or instances of the knee giving way are unusual for osteoarthritis; if they occur this is often an indication of other problems such as mensical or cruciate ligament tears. Over time, moving the joint can become increasingly painful, to the point where people start avoiding activities involving walking or climbing stairs, and getting out of a chair or car becomes very difficult.

The biggest risk factors for developing painful hips or knee are ageing, being overweight, or having had a major injury to these joints in the past. Therefore, the number of people affected by osteoarthritis will increase dramatically in the near future due to the ageing population, the increasing number of overweight people, and the increasing occurrence of serious sports-related knee injuries requiring hospitalisation.

Most medical guidelines advise that paracetamol, only used when needed, should be ‘the preferred long term oral analgesic’ for people with osteoarthritis. This advice is based on the increased risk of gastrointestinal, cardiovascular, and kidney problems associated with the long-term use of anti-inflammatory drugs. However, many people find anti-inflammatory drugs provide more effective pain relief when the joint pain is severe. While some anti-inflammatory drugs are freely available over-the-counter, it is best to seek advice from your GP if you feel that paracetamol if not providing sufficient pain relief and you are considering using anti-inflammatory drugs.

While there is no cure for osteoarthritis, there is much that you can do to reduce the risk of developing this disabling condition, or to manage the pain and stiffness effectively if osteoarthritic changes are already present in your joints.

Osteoarthritis myths

There are many myths associated with osteoarthritis. The first is that osteoarthritis is the ‘inevitable result of ageing’. This is not true. While older people are more likely to have osteoarthritis in their hips or knees, not all older people do. There is very strong scientific evidence that maintaining a normal body weight and good muscle strength around the hips and knees will significantly reduce your risk of developing osteoarthritis in later years.

A second myth is that joint pain is inevitable if signs of osteoarthritis are detected on X-ray. This is also not true. Many people with obvious signs of osteoarthritis on X-ray do not report joint pain, stiffness, or difficulty with everyday activities. For the hips and knees, having strong lower limb muscles and maintaining a normal body weight will reduce the risk of experiencing joint pain in the presence of osteoarthritis. Strong thigh muscles act as ‘shock absorbers’, particularly for the knee joint, protecting the joint structures from the sudden impact of weight bearing that occurs with every step, even at a normal walking pace.

A third well-known myth about osteoarthritis is that it is a ‘wear and tear’ disease; that if you use your hips and knees a lot, you will wear them out. This myth was probably supported by the fact that everyone knows that many professional footballers or other athletes develop knee osteoarthritis in later years. In fact, it is their high rate of knee injuries that has proven to be the culprit. It is more a case of ‘use them or lose them’ when it comes to joints.

Regular moderate physical activity provides a wide range of health benefits for people of all ages. Unfortunately a large proportion of older people with osteoarthritis of the hips or knees become very sedentary as they believe that exercise is increasing their joint pain. A physiotherapist can help grade an exercise program, allowing muscle strength to build up without increasing ongoing joint pain. With increased muscular protection of the hips and knees, many physical activities previously enjoyed may again become possible. A physiotherapist will also be best placed to advise you on forms of regular physical activity appropriate to your joint problems. A physically active lifestyle will help with weight loss, or keeping a normal body weight as you age. A physically active lifestyle will also reduce the risk of various serious chronic illnesses associated with a sedentary lifestyle such as high blood pressure and diabetes.

Glucosamine and chondroitin

Glucosamine and chondroitin are dietary supplements purchased by many patients with chronic osteoarthritis hoping to relieve joint pain, as well as slow the rate of joint destruction and cartilage loss (it is thought that they are good for cartilage ‘health’). Most Australians believe that dietary supplements, if not beneficial, are at least ‘safe’ in contrast to anti-inflammatory drugs, and this belief possibly explains much of the popularity of these dietary supplements. Glucosamine and chondroitin are compounds occurring naturally in the body and are one of the principal building blocks of proteoglycan, a compound essential for maintaining cartilage integrity. More than 200 of these two dietary supplements are listed on the Australian Register of Therapeutic Goods (ARTG) and available over-the-counter (no prescription required). Listed goods have been evaluated for quality and safety but not, in contrast to registered pharmaceuticals, for effectiveness. Worldwide, there have been several scientific studies trying to establish whether glucosamine or chondroitin, singly or in combination, provide effective pain relief for people with osteoarthritis. Unfortunately, the results of these studies have been conflicting with some reporting significant benefits and others reporting no effect above that achieved with ‘dummy’, or placebo, capsules or powder.

To answer this import research question, The National Health and Medical Research Council of Australia has funded the Long-Term Evaluation of Glucosamine Sulphate (LEGS) study. This study is managed by The George Institute, a research institute affiliated with the University of Sydney. People living in the Sydney region, aged 45 to 75 years and experiencing chronic knee pain due to osteoarthritis, are invited to participate in this landmark study. There will be no changes to any physiotherapy treatments required during the two-year study. For further study information and contact details visit the study website.

If the regular daily intake of glucosamine or chondroitin could result in less joint pain and reduce the use of anti-inflammatory drugs, or slow the rate of joint destruction, promoting glucosamine and chondroitin to become standard medical treatment would markedly reduce the burden of osteoarthritis in Australia. If, however, these dietary supplements prove to be no more effective than placebo, and no specific patient group with osteoarthritis can be identified that may benefit from these products, then this information will result not only in dollar savings for many patients, but will also help redirect the focus of many patients, doctors and health services providers to disease management strategies of proven effectiveness.

According to our current knowledge, well-graded muscle strengthening exercise programs and achieving or maintaining a normal body weight are the most effective strategies for pain-free hips or knees, even in the presence of osteoarthritis. However, it is best not to wait too long before commencing to manage your osteoarthritis as it is likely to be more difficult to control pain if the damage to the joints is severe.