Lisa Pomfrey-Talbot thought she was just nursing an old knee injury. “I’ve had pain in my knee for years,” she says. “Once, when my kids were little, I fell in the playground and twisted my knee and, years later, I assumed this pain was from that fall.”
But then that didn’t explain the throbbing and unrelenting pain in her hands that developed last year – first in her right hand and then in her left. She couldn’t drive, was struggling to cook and had to work from home because of the mystery pain. Finally, a trip to the emergency room put the pieces together for her: Her family physician and then-rheumatologist confirmed that the 44-year-old Bridgewater, NS, resident had osteoarthritis (OA).
Pomfrey-Talbot is hardly alone in her diagnosis; the Arthritis Society of Canada estimates that more than three million Canadians (that’s one in 10 people) have OA, often referred to as “wear and tear” arthritis. However, due to further research and understanding, it’s now characterized as a painful condition that develops when your body can’t repair damaged joint tissues – it also has a strong inflammatory component. Joint inflammation is a major cause of symptoms in many cases of OA, including joint pain and stiffness, says Dr. Tom Appleton, a rheumatology fellow and researcher at Western University in London, ON. OA is also known to be a condition of aging: A 2014 Statistics Canada report notes that the average age of diagnosis is 50.4 years. “While it’s the most common type of arthritis, it’s more common in men under 50,” says Dr. Janet Pope, a rheumatologist and professor of medicine, at Western University. “Over the age of 50, women have it more often.”
What is Osteoarthritis?
As a condition, OA is a breakdown of the cartilage between joints. As that cushiony cartilage erodes, it becomes harder to move the joints, leaving them stiff, swollen and painful. The cartilage thins and the bones develop cysts and extra bone in an attempt to repair. “Sometimes OA is caused by prior joint injury or trauma to the site,” says Dr. Cheryl Barnabe, a rheumatologist based in Calgary. “Appropriate treatments for the injury, like physiotherapy, can prevent it from developing into osteoarthritis.” The fact that OA is a condition of progression explains the age factor: “When you’re in your 20s, it’s rare to know someone with OA, but by the time you’re in your 80s, pretty much everyone has it,” she says.
Genetics can also play a role (though uncommon compared to other factors), as can weight: The more weight you have, the more stress it puts on your joints, plus being overweight leads to more inflammation in the body, which can aggravate arthritis.
While OA has long had a reputation for being a disease of aging, Dr. Appleton notes that this is starting to change in the minds of arthritis specialists. “There has been a shift in the past five years in identifying people with earlier stages of OA,” he says, “so we’ve started looking at the entire joint – looking at it as an organ, the same way we’d think of a kidney or heart.”
Similar to how a heart attack might be the result of a coronary artery narrowing over time, not being able to walk anymore because of OA is the result of earlier signs of joint trouble. “We’re interested in inflammation of the joints, particularly the lining of the joints, much earlier,” says Dr. Appleton.
Better imaging tools to inspect those joints are also helping with earlier diagnosis. “Diagnosing OA still goes back to clinical symptoms that people are having, such as pain,” says Dr. Barnabe, “but there have been lots of advances in imaging. Compared to 10 years ago, more people can get ultrasounds of their joints or MRI scans to characterize changes in the structure of their joints.”
In fact, a 2015 study from Northwestern University noted that, in those with a history of knee injuries or those who are overweight, MRIs can indicate early signs of knee OA. And while they’re still only in the research phase, labs are doing research to see if there are biomarkers to detect early OA (before it is advanced or clinically obvious). This is important because early diagnosis will be essential when the time comes that we finally have a treatment that can stop the progression of joint damage.
Patients can play a role in earlier diagnosis, too. For instance, don’t wait until the pain is excruciating before seeing a physician. Instead, dial your doctor if you see a sudden swelling of the joints that you can’t account for or if your pain lasts longer than six weeks.
Osteoarthritis Treatment Options
While surgery is an option for OA, the first step is likely physiotherapy, over-the-counter (OTC) pain medications, joint braces and walking aids. As for OTC medications, acetaminophen may ease pain and ibuprofen can reduce swelling, although one recent study from the University of Bern in Switzerland found that non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, proved more effective at managing OA pain than acetaminophen. In some cases, doctors will inject the hormone cortisone into the joint to reduce swelling and provide pain relief or use viscosupplementation, where synthetic lubricants are injected into the joint.
However, exercise is also being hailed as an untapped resource for OA management. “Physiotherapists have developed an exercise treatment to help people live much better with OA and remain more functional for several years before they need to go to a surgeon,” says Dr. Appleton. “A lot of people never end up needing a surgeon. Instead, they may have symptoms for a long, long time, and those are people who could benefit most from exercise prescriptions.”
While all forms of activity count, joint-friendly activities like swimming, light yoga and tai chi may be a good place to begin your exercise program comfortably. “The exercise doesn’t necessarily have to be aerobic,” says Dr. Barnabe. “Anything that helps maintain muscle strength and range of motion is good.”
That leaves surgery as a last step to managing the pain and improving function. “Surgery may include joint replacements – the majority of people have very good to excellent outcomes for hip and knee replacements,” says Dr. Pope, who adds that there’s research into drugs that can stop the progression of OA.
Prevention efforts – more specifically, adding more exercise and modifying other lifestyle habits – can help greatly, say researchers. “These are the strongest prevention efforts we have,” says Dr. Barnabe. “As long as you’re engaging your muscles and maintaining strength around your joints, you’re less likely to develop an injury. If there is an injury, it’s imperative that people get access to appropriate physiotherapy to help recover so they won’t set off a chain of events leading down the road to OA.”
Maintaining a healthy body weight can help ease pressure, particularly on the lower limb joints, such as hips and knees. A 2015 study from the University of California showed that people who lost a large amount of weight (more than 10 percent) slowed the loss of cartilage in their knees. “There could be an effect that fat induces inflammation proteins, leading to more pain and stiffness and possibly triggering inflammation in joints of the hands,” says Dr. Barnabe. “We know that obesity and weight gain lead down the path to more OA.”
In fact, getting back to her healthy weight was one of the steps that Pomfrey-Talbot took to further manage the progression of her OA. In addition to the cortisone shots she received after diagnosis – shots that helped her not only feel less pain but also get back to going for walks again – she has vowed to boost her own efforts to improve her health. While it may not be getting back to playing badminton three nights a week like she used to, it will be all about moving her body more. “My physiotherapist gave me activities and stretches to do every day,” she says. “Staying active keeps me moving and prevents me from being stiff. I’m going to be able to do everything I did before I was diagnosed.”