Osteoarthritis

Also called OA, Degenerative joint disease, Wear and tear arthritis

The commonest joint condition in the UK. And the phrase wear and tear has done a great deal of harm.

What it is

Around 10 million people in the UK have osteoarthritis. Almost all of them have been told it is wear and tear, and that phrase leads directly to the worst possible advice: rest the joint.

Cartilage does break down. But the joint is an active tissue that responds to load, and the evidence is unambiguous that exercise reduces pain and improves function in osteoarthritis. Resting it does the opposite.

X-ray changes correlate poorly with pain. Plenty of people have severe X-rays and little pain, and vice versa, which is why treatment should follow symptoms rather than pictures.

Signs you might notice

Joint pain worse with use and better with rest, though early morning stiffness lasting under 30 minutes is common.

Stiffness after sitting still, easing within minutes of moving.

Grating or crunching. Reduced range of movement.

Knees, hips, hands and the base of the thumb most often.

Not present: prolonged morning stiffness over an hour, hot swollen joints, or feeling systemically unwell. Those suggest an inflammatory arthritis instead.

How it can affect day-to-day life

The activity spiral is the main avoidable harm. Pain leads to less movement, which weakens the muscles supporting the joint, which increases load through it, which increases pain.

Waiting-list time for joint replacement has become long, and people deteriorate while waiting. Prehabilitation, getting stronger before surgery, measurably improves recovery and almost nobody is offered it.

Sleep and mood suffer, and both raise pain sensitivity.

Supporting someone well

Exercise is the treatment. Strengthening the muscles around the joint, plus general aerobic activity. It has better evidence than any tablet, and it needs to be sustained rather than tried.

Losing weight, where relevant, reduces load through the knee by several times the amount lost.

Use heat for stiffness and cold for a flare. Simple, and it works.

Consider a walking aid earlier than pride suggests. It reduces load and keeps people moving.

Use topical anti-inflammatories before oral ones, especially for knees and hands, because the side-effect profile is far better.

Prepare for surgery if it is coming: get as strong as possible first.

Where to get help

A GP or physiotherapist can start treatment, and in many areas you can self-refer to physiotherapy.

Arthritis UK have exercise guides and a helpline on 0800 5200 520.

ESCAPE-pain is an evidence-based group programme available in many areas. Ask for it by name.