Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is the most common musculoskeletal disease in the world, affecting over 500 million people globally. Long considered a simple "wear and tear" disease, we now understand OA as a complex, metabolically active disease of the entire joint organ — involving cartilage degradation, subchondral bone changes, synovial inflammation, and periarticular muscle weakness. This new understanding has opened exciting avenues for treatment far beyond simple painkillers.

OA most commonly affects the knees, hips, hands (particularly the distal interphalangeal joints and the base of the thumb), and the cervical and lumbar spine. In India, knee OA is endemic and is a leading cause of pain and disability in people over 50, significantly impacting quality of life and independence.

X-ray of knee OA showing joint space narrowing, osteophyte formation, and subchondral sclerosis — the hallmarks of established OA.

Symptoms

OA symptoms develop slowly and worsen over time. The key distinguishing features from inflammatory arthritis include:

• Activity-related pain: Pain that worsens with use and is relieved by rest — the opposite of inflammatory arthritis.
• Brief morning stiffness (<30 minutes) or "gelling" phenomenon — stiffness after prolonged inactivity that quickly eases with movement.
• Crepitus: A creaking, crackling sound or sensation in the joint during movement.
• Bony enlargement: Hard, bony swellings at the joint margins (Heberden's nodes at DIP joints, Bouchard's nodes at PIP joints in hand OA).
• Loss of range of motion: Gradually reduced ability to fully bend or straighten the joint.
• Joint instability: A "giving way" sensation, particularly in the knee, due to muscle weakness and ligamentous laxity.

Physiotherapy and targeted muscle strengthening are among the most effective interventions for managing knee osteoarthritis.

Modern Non-Surgical Management Options

A major advance in OA care is the shift from passive (just taking painkillers) to active management. Dr. Prateek Deo emphasises a multimodal approach:

Core Treatments (Always First)

Patient education, therapeutic exercise (strengthening the quadriceps reduces knee loads dramatically), and weight management form the irreplaceable core of OA treatment. Every kilogram of weight lost reduces the load on each knee by 4 kilograms.

Pharmacological

• Topical NSAIDs (Diclofenac gel) — highly effective for knee OA with minimal systemic absorption.
• Oral NSAIDs — short courses for pain flares.
• Duloxetine — an SNRI antidepressant with proven efficacy in chronic OA pain, particularly useful for central sensitization.

Intra-Articular Therapies

• Corticosteroid injections: Provide rapid, short-term relief of joint inflammation and pain. Particularly useful during acute flares.
• Hyaluronic Acid (Visco-supplementation): Injections of hyaluronic acid replenish the natural joint lubricant, improving joint function and reducing pain for 6-12 months.
• Platelet-Rich Plasma (PRP): An autologous therapy using the patient's own growth factors to potentially stimulate cartilage repair and reduce inflammation.