Osteoarthritis
Osteoarthritis is the commonest joint disease. It develops slowly: the cartilage covering the ends of the bones loses its springiness and thins, the bone…
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Medicines commonly prescribed for Osteoarthritis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 400 mgActive substance: ibuprofenManufacturer: Dermogen-Farma S.A.Prescription not requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Qualix Pharma S.L.Prescription required
Osteoarthritis is the commonest joint disease. It develops slowly: the cartilage covering the ends of the bones loses its springiness and thins, the bone underneath remodels, and bony ridges grow around the rim of the joint. What people notice is not the process but its consequences — pain after activity, a stiff joint first thing in the morning, creaking, stairs that have become hard work. The condition does not go away, but neither is it bound to get worse year after year: in many people it stays much the same for a long time, and sometimes the pain even eases.
What is really happening inside the joint
Osteoarthritis is often described as wear and tear, and that picture misleads. A joint is not a machine part that grinds down; it renews itself continuously, and in osteoarthritis that renewal goes wrong. Cartilage loses water and frays, the bone beneath it hardens, bony outgrowths called osteophytes appear at the edges, and the lining of the joint flares up from time to time and produces fluid. Hence the waves: a quiet week, then a difficult one.
Two practical things follow. First, a joint needs movement: cartilage is fed by the alternation of loading and unloading, and it deteriorates faster when a joint is kept still. Second, the X-ray and the symptoms match each other poorly. Striking changes on a film are common in people with no complaints at all, and severe pain occurs with an almost normal picture. It is the person who is treated, not the image.
How it feels
The main complaint is pain that appears or worsens when the joint is used and settles with rest. Over the years it may start waking you at night. The second is stiffness: the joint seizes up after sleep or after a long spell of sitting and loosens off within a few minutes. One detail matters to the doctor: morning stiffness in osteoarthritis is short, usually under half an hour.
Other things people notice:
- grating, creaking or clicking on movement;
- the joint becomes broader and firmer to the touch and changes shape;
- swelling and warmth after activity that settle within a day or two;
- less range of movement: the knee will not straighten fully, the arm will not reach behind the back;
- the muscles around the joint weaken and waste;
- the knee occasionally gives way on level ground.
The usual sites are the knees, the hips, the hands — the base of the thumb and the small finger joints, where firm painless nodes appear — and the spine. As a rule one or two joints are involved rather than everything at once.
What raises the risk
There is no single cause; several circumstances add up:
- age, as the ability of cartilage to repair itself declines over the years;
- a previous joint injury: a torn meniscus or ligament, a fracture running into the joint. After one of these, osteoarthritis can begin as early as the thirties;
- excess weight. Every kilogram is multiplied across the knee with each step, but mechanics is not the whole story: fatty tissue sustains low-grade inflammation, which is why weight affects the hand joints too;
- work that loads the same joints again and again — hours spent kneeling, heavy lifting, vibration;
- weak thigh muscles, which leave the load falling straight onto the joint;
- family history, particularly in osteoarthritis of the hands;
- being female, with the difference becoming clear after the menopause;
- another disease of that same joint: rheumatoid arthritis, gout, a past infection, congenital hip dysplasia.
If osteoarthritis starts early and no injury explains it, it is worth looking for a reason: dysplasia, a disorder of iron metabolism, the aftermath of an old inflammation.
How the diagnosis is made and what must be ruled out
In most cases the diagnosis needs no elaborate tests. The doctor relies on age, on the mechanical pattern of the pain, on short morning stiffness and on the examination: the shape of the joint, the range of movement, tenderness along the joint line.
An X-ray confirms the picture — narrowing of the joint space, osteophytes, denser bone, cysts. Not everyone needs one, though: it is requested when the diagnosis is unclear, when surgery is being considered, or when the symptoms do not fit the usual pattern. An MRI scan is not needed in straightforward osteoarthritis.
A separate job is not to mistake for osteoarthritis something that is treated quite differently:
- rheumatoid arthritis: morning stiffness lasting over an hour, small hand joints swollen symmetrically, a general sense of illness;
- gout: the attack builds within hours, most often in the joint of the big toe, with hot purple skin;
- psoriatic arthritis: a rash or nail changes, a whole finger inflamed;
- infection in the joint, the most dangerous of these; see below;
- pain that does not come from the joint at all: inflamed tendons and bursae, or a diseased hip referring pain to the knee.
Blood tests do not show osteoarthritis itself; they are taken precisely in order to rule out the conditions above.
When it cannot wait
Seek help immediately, including calling an ambulance (112 is the single emergency number across much of Europe), if:
- within a few hours a joint becomes hot, deeply red and so painful that it can barely be moved, and a temperature develops — that is how joint infection presents, and it is treated urgently in hospital;
- the pain came on straight after an injury, the leg will not take weight, or the joint has locked;
- the joint has visibly changed shape after a fall.
Arrange to be seen within days, rather than waiting for a routine appointment, if joint pain comes with unexplained fever, night sweats or weight loss, if numbness or weakness develops in an arm or a leg, or if familiar pain abruptly changes character.
Movement, weight and support
This is the foundation of treatment, not an extra alongside tablets. Exercise does not grind the joint away; it unloads it, because a stronger muscle takes on part of the work. Two kinds of activity are needed: strength work for the muscles around the affected joint, and general fitness — walking, cycling, swimming. In the first few weeks pain may increase a little, which is expected. The rule of thumb is simple: if by the next day everything is back to its usual level, the amount of exercise is right. It is best to work out the plan with a physiotherapist, because starting too hard or choosing the wrong exercises does harm.
Second in importance is weight. In osteoarthritis of the knee, losing roughly a tenth of body weight noticeably reduces pain, and the more so the more the person is also moving.
What helps day to day:
- shoes with a cushioned sole and a firm heel;
- a walking stick, held in the hand on the good side so that it unloads the bad one;
- a knee brace or support for long spells of activity;
- heat for stiffness and cold for swelling after exertion;
- adapting the home: a higher chair, a grab rail in the bathroom, thickened handles on kitchen tools if the hands are affected;
- alternating effort with rest instead of pushing through to finish the job.
Medicines and injections
Medicines ease pain, but they do not halt the disease.
- Gels and creams containing anti-inflammatory painkillers are a sensible starting point for the knee and the hands: little reaches the bloodstream and the stomach suffers less.
- Paracetamol does not work for everyone and helps less than people expect. It is used in short courses, without exceeding the dose on the packet.
- Anti-inflammatory painkillers in tablet form are stronger but come with conditions. They are taken at the lowest effective dose for the shortest time, usually together with a medicine that protects the stomach lining. They are unsuitable if there is a stomach ulcer, can trigger an attack in some people with asthma, raise blood pressure and put a load on the kidneys, and after a heart attack or stroke, or with angina and heart failure, they are prescribed with great caution. Always tell the doctor if you take blood-thinning medicines or low-dose aspirin: the combination clearly increases the risk of a stomach bleed.
- Capsaicin cream is an option when topical anti-inflammatories have not worked. It takes time to act, and mild burning in the first days is normal.
- A steroid injection into the joint settles a bad flare-up for several weeks. It is useful before an important occasion, or to make it possible to start exercising, but it should not be repeated often.
- What not to count on: opioid painkillers are not used long term in osteoarthritis, since the benefit is small while drowsiness, constipation and dependence are real; chondroitin and glucosamine have not shown any convincing effect.
When surgery is discussed
An operation is considered when pain stops you sleeping and limits ordinary life, and movement, weight and medicines have already given what they can. There is no point in hanging on to the limit: the weaker the muscles and the worse the movement by the time of surgery, the harder the recovery.
Most often this means joint replacement, of the hip or the knee: the worn surfaces are replaced with an artificial joint. Pain goes for the great majority of those operated on, and a modern replacement lasts many years, but getting back to normal life takes months and requires rehabilitation. Other procedures are used less often: osteotomy, in which the bone is cut so that load is redistributed across the knee in a relatively young person, or fusing the joint in a fixed position when losing the pain matters more than keeping the movement. Arthroscopic washout of an osteoarthritic knee, on the other hand, does not work and is not performed.
Online consultation
Osteoarthritis is a good reason to start remotely. In an online consultation the doctor goes through what the pain is like and when it comes, judges whether the picture fits osteoarthritis or whether something else has to be excluded, and explains which investigations are genuinely needed and which are not.
Worth preparing: when it all started, which joints are troublesome, what makes the pain worse and what relieves it, how long morning stiffness lasts, a list of your medicines and other conditions, and the reports of any previous X-rays and blood tests. A short video showing how you get up from a chair and take a few steps is very useful.
The doctor will help you build a realistic exercise plan, match pain relief to your contraindications, and tell you when it is time to see an orthopaedic surgeon. If your description is worrying — a hot swollen joint with fever, a recent injury, numbness — you will be directed to a face-to-face assessment the same day.
This material is for information only and does not replace medical advice.
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