OSTEO-NZ

I have vivid memories of my gorgeous grandma sitting in her favourite chair in our living room at the end of the day, watching the chaos and bustle of family life unfolding around her.

In my mind, she is always rubbing her knees, and when it came time for her to go to bed, helping her up was always accompanied by groans and utterances (she was far too polite to swear) as her joints had seized up and moving was agony.

I know now that she had osteoarthritis (OA), and probably quite severely. But back then it was just "grandma's knees" and something that was to be expected for all older people.

Sadly for many older people, and some younger ones too, this is true – this type of joint disease is incredibly common, and more so as we age. Figures show that half of us will get OA in our knees during our lives, and 1 in 4 of us will have it in our hips by the time we reach 85 years old. Other joints commonly involved include hands, neck and lower back.

OA is really a process of "wear and tear". The overuse of our primary weight bearing joints (ie knees and hips) as well as joints we are constantly moving (such as the small joints in our hands) eventually leads to destruction of the cartilage, whose role is to provide a cushion between the bones ends.

Once this cartilage starts to erode, fluid and inflammation build up in the joint, the bone ends become ragged and can even start to chip off, and eventually all that is left is bone rubbing against bone.

The symptoms caused by this process vary depending on which joints are affected, but classically include:

- Pain on movement, especially when getting out of bed in the morning, or, as in my grandma's case, after sitting or resting for a long time

- Pain in the affected joints at rest

- Swelling in and around the joints – this may be particularly evident in joints such as knees and hands

- Weakness of the muscles around the joints

- Creaking or crackling in the joints with movement

- Restricted movement in the affected joints

- Permanent deformity of the joints, especially evident if the fingers are affected.

Sadly, there is no magic cure for avoiding OA, but knowing if you are at risk is important, as there are steps you can take to try and look after your joints.

Although most of us will develop some degree of OA as we get older, there are definitely groups of people who are likely to be affected at a much younger age – these include those with a strong family history of OA, athletes who have "overused" their joints or had repeated injuries (the classic being rugby players who often need joint replacements in their 40s and 50s), people with high impact occupations such as farmers, and those who are obese as the extra weight puts more strain on ageing joints.

If you think you fall into a high risk group, it's important to try and minimise the impact on your joints as much as you can – you can do this by altering what kind of exercise you do (for example water based activities are far less likely to cause a problem than running on a hard surface); ensuring you wear good, cushioned footwear at all times; reducing your weight if that is an issue; following a good "Mediterranean" diet high in olive oil, fruit, vegetables, fish and nuts; and avoiding injury where possible. Easier said than done I know.

The other key piece of advice for anyone suffering from OA is to talk to a health professional early. The pain and immobility OA causes can have a huge impact on your life, and eventually may start to affect your mental well-being as well as your ability to function as you would like. You don't need to suffer to that extent and managing your symptoms early will lead to a much better quality of life.

There are great options now for pain relief, most of which work best if they are used regularly, as well as good exercise regimes that will help ensure your joints stay mobile and functional for as long as possible. Alternative therapies such as acupuncture can help some people reduce the swelling and pain, and good physio or hydrotherapy can vastly improve functioning.

If the "first line" treatments haven't worked, I would suggest you ask your doctor what else can be done – more invasive management includes steroid injections into the affected joints, surgery to "clean up" the wear and tear in a joint, or joint replacement where the affected joint is removed and replaced with an artificial one. The good news is that OA is an area where much research is happening, so the future will hopefully bring different treatment options that avoid the need for major surgery.

If you or a loved one suffer from OA, or any other type of joint problem, I would highly recommend you get in touch with Arthritis New Zealand (www.arthritis.org.nz) – they are there to help, support, connect and advise and have a wealth of really useful resources.

Written by Dr Cathy Stephenson. Republished with permission of Stuff.co.nz.

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