Osteoarthritis - A primary health care checklist

Different types of arthritis require different types of treatment and so a medical assessment is essential to diagnose osteoarthritis and exclude other causes. A GP can often diagnose OA without needing too many special investigations.

Do not automatically assume that a new joint problem is OA – it might be but it might also be a sign of something more serious so it is worth checking with a doctor.

Exercise
Exercise is proven to help people with osteoarthritis – this includes helping to reduce pain. Exercise should include muscle strengthening as well as aerobic exercise. The type of exercise that is best will depend on things like co-existing health problems, pain levels, and local opportunities. Physiotherapy can help identify the correct exercises for you.

Lose weight if you are overweight or obese
Being overweight can make joint pain worse. Expert support with weight management is recognised as medical treatment for OA.

Footwear
Appropriate footwear – including shock-absorbing properties – is essential for people with OA affecting a hip, knee, ankle or foot joint(s).

Some people can benefit from specialist joint support (braces, insoles etc) or assistive devices eg walking frames, sticks, tap turners, to make it easier to get around and performing everyday tasks. Your primary health care team can help organise these as appropriate.

The process will usually involve a physiotherapist and/or occupational therapist. It might also involve other specialties such as an orthotics (specialists in design of artificial devices such as braces). These specialists are often organised into services such as rehabilitation. Arrangements for these services vary across the country but they are common and effective and your GP will be able to advise on access. The teams can help source appropriate aids and devices as well as showing you exercises and techniques to improve life with arthritis.

This leaflet from the professional body representing physiotherapists summarises how physiotherapists can help treat and live better with arthritis – support for exercise, pain relief .

Occupational therapists can also play a key role in helping to manage and minimise the impact of arthritis. OTs can help to tackle joint problems which affect daily activities and ensure those activities minimise any negative impacts on joints.

Paracetamol and/or anti-inflammatory creams/ointments are currently recommended as the first step for pain relief.

Stronger painkiller medication and other ointments are available on prescription but you should explore these with a doctor or pharmacist. Medication for pain relief is a complex field and the different medicines often have serious side effects or can interact with other medicines so they are best discussed with a prescriber. Even over the counter painkillers like Ibuprofen can cause serious side effects so are best discussed with a doctor or suitable pharmacist.

There is not a great deal of evidence from research studies to show that herbal remedies are effective however capsaicin gels and creams have been recommended as being effective for reducing osteoarthritis (OA) pain, especially for knee or hand OA. Capsaicin is a herbal medicine extracted from chilli peppers.

Some people get some pain relief from using hot or cold packs on the affected joint(s). This is also called thermotherapy. You can use a hot water bottle filled with either hot or cold water and apply it to the affected area. Or, special hot and cold packs that can either be cooled in the freezer, or heated in a microwave, are also available.

Heat rubs (topical rubefacients) are widely used but there is little scientific evidence to say that they actually work.

Some people have found that transcutaneous electrical nerve stimulator (TENS) machines help to ease pain from OA. A TENS machine delivers small electrical pulses to the body via electrodes placed on the skin. If appropriate or indicated, then your GP can help to arrange a TENS machine for you.

Experts DO NOT recommend acupuncture as treatment for OA.

Corticosteroid joint injections can be helpful to relieve moderate to severe pain. Depending on local circumstances these injections can be provided by local GP surgeries, physiotherapy services or hospital specialists.

Injections of hyaluronic acid have been trialled and evaluated but the research showed little evidence that these injections are effective and they might cause some other problems.

Joint washouts – also known as arthroscopic lavage and debridement – are operations which can clean out a joint and trim cartilage from inside. Experts (NICE) recommend that these procedures should not be offered as part of treatment for OA unless you have a clear history of your knee locking.

Most people with osteoarthritis (OA) do not have it badly enough to need surgery.

Hip and knee replacement surgery has become a standard treatment for severe OA of these joints. Some other joints can also be replaced.

Joint replacement surgery has a high success rate. However, like any operation, it is not without risk.

This website is recommended by surgeons in England (Royal College of Surgeons) and will give you lots of information about hip and knee joint replacement surgery – whether considering, preparing or recovering from surgery.

Another helpful organisation is the British Hip society, a close ally to the British Orthopaedic Association (the professional body representing orthopaedic surgeons)

If you are considering surgery then you might want to look at the national joint registry which collects information on all hip, knee, ankle, elbow and shoulder replacement operations in order to monitor and evaluate the performance of different joint replacement implants and the effectiveness of different types of surgery. It also includes information about different hospitals and surgeons – including how many operations they perform and how well patients fare post operatively.

OA can have a profound impact on day to day quality of life – chronic pain, ability to mobilise fully, relationships, participation, independence, can all be compromised and affect everyday wellbeing.

Arthritis can have a negative effect on mental health, commonly resulting in depression or anxiety. Conversely, mental health problems can worsen arthritis symptoms.

Research indicates that the relationship between arthritis and mental health relates to levels of pain and functional limitation. People with high pain levels are the most likely to be anxious or depressed. The vicious cycle of pain, poor health and negative mood can significantly change the course and management of arthritis.

If you are concerned about any mental health symptoms then seek professional help before either your mood or your arthritis become too badly affected. Because of the interdependency between your mood and your arthritis, a GP should be the first person to approach for help.