Understanding the disease can help patients live with it better, writes Aznim Ruhana Md Yusup
OSTEOARTHRITIS is a disease that affects the joints and is seemingly inevitable as a person gets older.
It’s a painful condition and occurs when cartilage cushioning the ends of bones thins out over time. This puts stress on the surrounding tendons and ligaments. When the cartilage wears out completely, the bones rub against each other.
“You can’t prevent osteoarthritis,” says Dr Ahmad Hisham Abd Rashid from Sunway Medical Centre.
“Some will get it earlier, some will get it later but if you live long enough, you will eventually get osteoarthritis. But the severity differs and the pain ranges from mild to severe,” adds the consultant orthopaedic and trauma surgeon.
Osteoarthritis commonly affects joints in knees and hips. Women are twice as likely to suffer from knee osteoarthritis than men, says Dr Ahmad Hisham, adding that it is a genetic predisposition.
While there is no study on the number of Malaysians suffering from osteoarthritis, it’s estimated that more than 60 per cent of the worldwide population aged 65 and above has some form of the disease.
But secondary osteoarthritis has no age barrier. “I’ve seen a 15-year-old with a very bad hip from post-traumatic osteoarthritis following an accident,” says Dr Ahmad Hisham. Other causes include infection, metabolic diseases such as gouty arthritis or rheumatoid arthritis and problems related to steroid use.
DELAYING TACTICS
Professional athletes have four times the risk of developing osteoarthritis compared to non-athletes, particularly for contact sports like football, and other sports like weightlifting and marathon running.
But recreational athletes are not exposed to the same rigours as the pros, and health benefits from regular exercise outweigh the concerns of possible osteoarthritis. Exercise can even hold it back.
“Being active nourishes your cartilage and helps to delay the onset of osteoarthritis. So there’s no problem with doing sports as long as you do it correctly with the proper technique and equipment.”
Exercise also helps to keep an individual’s weight in check, which is a major contributing factor for osteoarthritis. “When you’re heavier, you put more stress on the joints, especially the knee joints. A patient with knee pain can cut down on pain medication just by losing weight,” he adds.
There’s no harm for osteoarthritis patients who enjoy sports and exercise to continue doing them, provided the activity is suitable. Dr Ahmad Hisham recommends swimming and cycling as well as cardio workouts, but contact sports must be avoided.
BAD ADVICE
Older osteoarthritis patients sometimes receive well-meaning but misguided suggestions from their adult children on how to live with their condition, like staying put and not doing any activities.
“But you need to move the joint to maintain a healthy cartilage, and also to maintain the movement of the joint so that you don’t lose the ability,” says Dr Ahmad Hisham.
“Also, just staying home is not good, physically and psychologically. What you should do is modify the activities to suit your condition. Say you have knee pain, but you can still go for a walk in the park. This increases general health because you stimulate your cardiovascular system as well as your joints.”
MODIFY ACTIVITIES
Activity modification is a major part of dealing with osteoarthritis. This includes moving to the ground floor of a two-storey home if the patient has difficulty climbing stairs.
“Sometimes we advise patients to use a walking aid,” says Dr Ahmad Hisham. “But there are those who don’t want to use it because it makes them feel really old. There’s also the hassle of bringing it. But a walking aid can help relieve stress on the joints.”
Meanwhile, physiotherapy helps patients maintain their joint movement while preserving the strength of muscles around the joint. Some patients may also benefit from alternative treatments like acupuncture.
There are also leg braces and special shoes that the patients with knee osteoarthritis can be fitted with. The shoes, however, need to be worn pretty much constantly for them to be effective, and so aren’t very user-friendly here as we don’t tend to wear shoes inside the home.
TREATING THE PAIN
Medication for osteoarthritis is usually painkillers. Patients are also asked to take supplements, glucosamine sulphates and chondroitin sulphates, to help build new cartilage.
“The effect is not immediate,” says Dr Ahmad Hisham. “I usually ask patients to take it for three months and see if there’s any improvement.”
Patients with knee pain can also opt for intra articular knee injections. The procedure uses hyaluronic acid as a kind of synthetic joint fluid or PRP — plasma rich platelet — that is obtained from the patient’s own blood and is rich with growth factors.
The last option is surgery, and it’s reserved for those with serious pain or whose joints are severely deformed. It used to be that surgery involves fusing the joint together but advancements in the field have led to more amenable procedures.
“We now have the option of high tibial osteotomy, total knee or partial knee replacement. The first procedure involves cutting the tibia bone and aligning the joint to reduce stress on the affected side,” he explains.
“With the other two procedures, we replace the part of the joint that moves with prostheses so there shouldn’t be any more pain after that. The downside is that you can’t fully flex the knee, so you can’t squat down or sit with legs folded during prayers, although you shouldn’t have a problem climbing stairs.”
As patients become more informed about osteoarthritis, they are more open to undergoing surgery, says Dr Ahmad Hisham. “They see its benefits and have accepted it as part of the treatment.”