you suffering from: ‘wear and tear’ arthritis?
one of the most common debilitating joint conditions that can affect
anyone. Despite technological advances in the medical field, there is no
cure for this condition and the only solution is to prevent it.
Physiotherapist, Dr Gopi Kitnasamy, talks about the disease and how it
can be prevented by following some simple rules.
Q: Osteoarthritis seems to be rapidly increasing among Sri
Lankans judging by the number of patients currently undergoing treatment
for this condition. Explain what exactly is osteoarthritis?
A: Osteoarthritis (OA) is sometimes called degenerative joint
disease or ‘wear and tear’ arthritis. It is the most common chronic
condition of the joints. It occurs when the cartilage or cushion between
joints breaks down leading to pain, stiffness and swelling. In normal
joints, a firm, rubbery material called cartilage covers the end of each
bone. Cartilage provides a smooth, gliding surface for joint motion and
acts as a cushion between the bones. In OA, the cartilage breaks down,
causing pain, swelling and problems moving the joint. OA can affect any
joint, but it occurs most often in knees, hips, lower back and neck,
small joints of the fingers and the bases of the thumb and big toe.
Q: Who are those most at risk of getting it?
A: Although OA occurs in people of all ages, osteoarthritis is
most common in people older than 50. Common risk factors include
increasing age, obesity, previous joint injury, overuse of the joint,
weak thigh muscles, and genes. One in two adults will develop symptoms
of knee OA during their lives. One in four adults will development
symptoms of hip OA by age 65. One in 12 people 60 years or older have
Q: What is the most common form of OA?
A: Osteoarthritis of the knee. It occurs mostly in people 50
years and older, but may occur in younger people, too.
Q: What causes this condition? How long does it take to
A: In OA Knee, the cartilage in the knee joint gradually wears
away. As the cartilage wears away, it becomes frayed and rough, and the
protective space between the bones decreases. This can result in bone
rubbing on bone, and produce painful bone spurs. Osteoarthritis develops
slowly and the pain it causes worsens over time.
Dr Gopi Kitnasamy
A: A knee joint affected by arthritis may be painful and
inflamed. Generally, the pain develops gradually over time, although
sudden onset is also possible. Other symptoms include:
1) The joint may become stiff and swollen, making it difficult to
bend and straighten the knee.
2) Pain and swelling may be worse in the morning or after sitting or
3) Vigorous activity may cause pain to flare up.
4) Loose fragments of cartilage and other tissue can interfere with
the smooth motion of joints. The knee may ‘lock’ or "stick" during
movement. It may creak, click, snap or make a grinding noise (crepitus).
5) Pain may cause a feeling of weakness or buckling in the knee.
6) Many people with arthritis note increased joint pain with rainy or
Q: Contributory or risk factors leading to OA?
A: Genes: Various genetic traits can make a person more likely
to develop OA. One possibility is a rare defect in the body’s production
of collagen, the protein that makes up cartilage. This abnormality can
cause osteoarthritis to occur as early as age 20. Other inherited traits
may result in slight defects in the way the bones fit together so that
cartilage wears away faster than usual.
Weight: Being overweight puts additional pressure on hips and knees.
Many years of carrying extra pounds can cause the cartilage that
cushions joints to break down faster.
Injury and overuse: Repetitive movements or injuries to joints (such
as a fracture, surgery or ligament tears) can lead to osteoarthritis.
Some athletes, for example, repeatedly damage joints, tendons and
ligaments, which can speed cartilage breakdown.
Certain careers that require standing for long periods of time,
repetitive bending, heavy lifting or other movements can also make
cartilage wear away more quickly.
An imbalance or weakness of the muscles supporting a joint can also
lead to altered movement and eventual cartilage breakdown in joints.
Other factors include; bone and joint disorders like rheumatoid
arthritis, certain metabolic disorders such as hemochromatosis, which
causes the body to absorb too much iron, or acromegaly, which causes the
body to make too much growth hormone.
Q: How is it diagnosed?
A: Diagnostic methods include:
1) Physical Examination where the doctor will examine the joints and
test their range of motion (how well each joint moves through its full
range). He will be looking for areas that are tender, painful or swollen
as well as signs of joint damage. The doctor will examine the position
and alignment of the neck and spine.
2) Diagnostic Tests .A diagnosis of osteoarthritis may be suspected
after a medical history and physical examination is done.
3) X-ray. X-rays can show damage and other changes related to
osteoarthritis to confirm the diagnosis.
4) MRI. Magnetic resonance imaging (MRI) offers better images of
cartilage and other structures to detect early abnormalities typical of
Q: How is it treated? Is it curable?
There is no cure for arthritis but there are a number of treatments that
may help relieve the pain and disability it can cause. Initial treatment
Your doctor may recommend a range of treatment options. They include:
Lifestyle modifications in your daily life, which can protect your knee
joint and slow the progress of arthritis; minimizing activities that
aggravate the condition, such as climbing stairs. Switching from high
impact activities (like jogging or tennis) to lower impact activities
(like swimming or cycling) will put less stress on your knee. Losing
weight can reduce stress on the knee joint, resulting in less pain and
Q: As a physiotherapist, how does physiotherapy help OA
A: Our treatment includes both Exercise and Electrotherapy
like SWD, Ultrasound, and Laser. with specific exercises to increase
range of motion and flexibility, and strengthen the muscles in your leg.
Your Physiotherapist will develop an individualized exercise program
that meets your needs and lifestyle.
Q: Are there any other options?
A: Use of assisted aids such as a cane, wearing
shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can
be helpful. A brace assists stability and function, and may be
especially helpful if the arthritis is centered on one side of the knee.
Q: Other remedies?
A: Applying heat or ice, using pain-relieving ointments or
creams, wearing elastic bandages to provide support to the knee may
provide some relief from pain. Alternative therapies to treat pain
include the use of acupuncture and magnetic pulse therapy. If you do try
them, find a qualified practitioner and keep your doctor informed of
Q: What about medications?
A: Several types of drugs are useful in treating arthritis of
the knee. Because people respond differently to medications, your doctor
will work closely with you to determine the medications and dosages that
are safe and effective for you.
Q: What about surgery? When is it recommended?
A: Your doctor may recommend surgery if your pain from
arthritis causes disability and is not relieved with non surgical
treatment. Rehabilitation post surgery must be properly supervised.
Q: Can eating the right food prevent arthritis?
A: A diet rich in fruits and vegetables has been shown to help
reduce inflammation and pain in your joints. Antioxidants may help
prevent arthritis, slow its progression, and relieve pain. Being at a
healthy weight is a critical component to managing OA of the knees. The
antioxidant vitamin C is necessary for cartilage development. A lack of
vitamin C can lead to weakened cartilage and increase osteoarthritis
symptoms. Some research shows that vitamin D can help prevent the
breakdown of cartilage, and decrease the risk of joint space narrowing.
The healthiest fats for people with osteoarthritis (or other
inflammatory disorders) are omega-3 fatty acids. Some foods which are
rich in omega-3 are salmon, herring, mackerel, sardines, anchovies,
rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed and
walnuts. Some spices have anti-inflammatory effects, too. Among the most
promising are ginger and turmeric.
A: Exercise is the best non drug therapy for OA.
The best exercises are strengthening exercises to maintain and
improve muscle strength. Strong muscles can support and protect joints
that are affected by arthritis. Two types of exercise are particularly
good for most people with osteoarthritis.
Walking lowers the risk of fractures (by stopping or slowing down the
loss of bone mass) and tones muscles that support joints, but avoid
going for long walks and walking on hills.
Aquatic (water) exercises, particularly helpful for people just
beginning to exercise as well as those who are overweight.
Aquatic exercises do not involve swimming; rather they are performed
while standing in about shoulder-height water.
The water helps relieve the pressure of your body’s weight on the
affected joints (hips and knees in particular), while providing
resistance for your muscles to get stronger. Regular aquatic exercise
can help relieve pain and improve daily function in people with hip and
Q: Your advice to patients?
A: Lose weight, eat right and exercise.