Osteoarthritis: Understanding "Age Arthritis," Symptoms, Risk Factors, and Management

What is age arthritis?

“Age arthritis” is a commonly used, informal term that primarily refers to osteoarthritis (OA), a degenerative joint disease characterized by the breakdown of cartilage that cushions the ends of bones, leading to pain, stiffness, and reduced joint function, often increasing in prevalence with age.

Understanding "Age Arthritis": A Closer Look at Osteoarthritis

While the term "age arthritis" suggests that arthritis is an inevitable consequence of getting older, it's more accurate to understand it as osteoarthritis (OA), a condition whose risk significantly increases with age, but is not solely caused by it. OA is the most common form of arthritis, affecting millions worldwide. Unlike inflammatory arthritides such as rheumatoid arthritis, OA is primarily a mechanical breakdown of the joint's protective cartilage, although low-grade inflammation can also play a role. It's a progressive condition, meaning it tends to worsen over time, but its progression can often be managed and slowed.

The Anatomy of a Healthy Joint and What Goes Wrong

To comprehend osteoarthritis, it's essential to understand the structure of a healthy synovial joint, which allows for smooth, pain-free movement.

• Cartilage: A smooth, slippery tissue called articular cartilage covers the ends of the bones where they meet to form a joint. This cartilage acts as a shock absorber and allows bones to glide effortlessly past each other.
• Synovial Fluid: Within the joint capsule, synovial fluid lubricates the joint and nourishes the cartilage.
• Joint Capsule and Synovium: The joint is enclosed by a tough fibrous capsule lined with a synovial membrane, which produces synovial fluid.
• Bones: The underlying bone provides the structural framework of the joint.

In osteoarthritis, the following changes occur:

• Cartilage Erosion: The smooth articular cartilage begins to wear away, fray, and thin, losing its ability to cushion and allow frictionless movement.
• Bone Spurs (Osteophytes): As cartilage deteriorates, the body may attempt to repair itself by growing new bone, forming osteophytes or bone spurs, which can cause pain and restrict movement.
• Subchondral Bone Changes: The bone beneath the cartilage (subchondral bone) can become thickened and develop small cysts.
• Synovial Inflammation: Fragments of cartilage or bone can irritate the synovium, leading to inflammation and swelling within the joint.
• Reduced Joint Space: As cartilage diminishes, the space between the bones in the joint narrows.

Why Does It Happen? Risk Factors for Osteoarthritis

While age is a significant risk factor for OA, it's crucial to recognize that it's a multifactorial condition. Several elements contribute to its development:

• Age: The risk of OA increases significantly after age 50, as cartilage naturally becomes less elastic and more prone to damage over time.
• Genetics: A family history of OA can increase an individual's susceptibility, suggesting a genetic predisposition.
• Obesity: Excess body weight places increased stress on weight-bearing joints such as the knees, hips, and spine, accelerating cartilage breakdown. Adipose tissue also produces inflammatory chemicals that can contribute to OA.
• Joint Injury or Trauma: Previous injuries, such as fractures, ligament tears (e.g., ACL tear), or meniscal tears, can disrupt joint mechanics and increase the risk of developing OA years later.
• Repetitive Stress: Certain occupations or sports that involve repetitive movements or high-impact stress on specific joints can contribute to wear and tear.
• Gender: Women are more likely to develop OA than men, especially after menopause, suggesting a hormonal influence.
• Bone Deformities: Individuals born with malformed joints or defective cartilage are more susceptible to OA.
• Other Diseases: Conditions like diabetes, hemochromatosis, and gout can increase the risk of OA.

Common Symptoms and Affected Joints

The symptoms of osteoarthritis typically develop gradually and worsen over time. They can vary in severity and location.

• Pain: Often described as a deep ache, which typically worsens with activity and improves with rest. In advanced stages, pain may be present even at rest or during sleep.
• Stiffness: Joints may feel stiff, especially after periods of inactivity, such as first thing in the morning or after sitting for a long time. This "gelling" phenomenon usually improves within 30 minutes of movement.
• Loss of Flexibility: The affected joint may not be able to move through its full range of motion.
• Grating Sensation (Crepitus): A crackling, popping, or grinding sound or sensation may be felt when moving the joint, due to roughened cartilage surfaces rubbing together.
• Swelling: Soft tissue swelling around the joint can occur due to inflammation or accumulation of fluid.
• Tenderness: The joint may feel tender when pressure is applied to or near it.
• Bone Spurs: Hard lumps may be felt around the affected joint, particularly in the fingers.

OA most commonly affects weight-bearing joints and joints that experience high repetitive stress:

• Knees
• Hips
• Spine (especially the neck and lower back)
• Hands (base of the thumb, middle, and end joints of the fingers)
• Feet (particularly the big toe)

Diagnosis of Osteoarthritis

Diagnosing osteoarthritis typically involves a combination of assessing symptoms, physical examination, and imaging tests.

• Medical History and Physical Exam: Your doctor will inquire about your symptoms, pain patterns, and medical history. During the physical exam, they will check your joint for tenderness, swelling, range of motion, and crepitus.
• Imaging Tests:
  • X-rays: Can show narrowing of the joint space (indicating cartilage loss), bone spurs (osteophytes), and changes in the subchondral bone. While X-rays don't show cartilage directly, they reveal the consequences of its loss.
  • MRI (Magnetic Resonance Imaging): Provides more detailed images of cartilage, ligaments, and other soft tissues, but is not routinely used for diagnosing OA unless other conditions are suspected.
• Laboratory Tests: Blood tests are not used to diagnose OA directly but may be performed to rule out other forms of arthritis, such as rheumatoid arthritis or gout, by checking for inflammatory markers or specific antibodies.

Management and Kinesiology-Based Strategies

While there is no cure for osteoarthritis, a multi-faceted approach focusing on pain management, improving joint function, and slowing disease progression can significantly enhance quality of life. Kinesiology plays a pivotal role in these strategies.

• Non-Pharmacological Strategies (Kinesiology-Focused):

  • Exercise: This is arguably the most crucial component of OA management. A well-designed exercise program can:
    • Strengthen Muscles: Improve stability and support around the affected joint, reducing stress on the cartilage.
    • Improve Flexibility and Range of Motion: Maintain joint mobility and reduce stiffness.
    • Enhance Cardiovascular Health: Low-impact aerobic activities (e.g., swimming, cycling, walking) can improve overall fitness without excessive joint loading.
    • Weight Management: Exercise contributes to weight loss, which significantly reduces stress on weight-bearing joints.
    • Proprioception and Balance: Exercises that improve balance can reduce the risk of falls, which could further injure osteoarthritic joints.
    • Pain Reduction: Regular, appropriate exercise can release endorphins and improve pain tolerance.
    • Guidance: Working with a physical therapist or exercise physiologist is highly recommended to develop a safe and effective exercise plan tailored to individual needs and joint involvement.
  • Weight Management: Losing even a small amount of weight can dramatically reduce the load on hips and knees, slowing the progression of OA and reducing pain.
  • Physical Therapy: Therapists can teach specific exercises, provide manual therapy, and use modalities like heat/cold therapy, ultrasound, or electrical stimulation to manage pain and improve function.
  • Assistive Devices: Canes, walkers, braces, or orthotics can help reduce stress on affected joints and improve mobility.
  • Heat and Cold Therapy: Applying heat can relax muscles and increase blood flow, while cold can reduce swelling and numb the area.

• Pharmacological Treatments:

  • Over-the-Counter Pain Relievers: Acetaminophen (Tylenol) for mild to moderate pain.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Oral NSAIDs (ibuprofen, naproxen) or topical NSAIDs (diclofenac gel) can reduce pain and inflammation.
  • Corticosteroid Injections: Can provide temporary pain relief and reduce inflammation in the joint.
  • Hyaluronic Acid Injections: Can provide lubrication and shock absorption, offering temporary relief for some.

• Surgical Interventions:

  • Joint Replacement (Arthroplasty): For severe OA that significantly impacts quality of life and doesn't respond to conservative measures, surgical replacement of the damaged joint with artificial components (e.g., total knee or hip replacement) can be highly effective.
  • Other Procedures: Arthroscopy (for debridement or loose body removal) or osteotomy (realigning bones) may be considered in specific cases.

Living with Osteoarthritis: A Kinesiologist's Perspective

Living with osteoarthritis requires a proactive and informed approach. From a kinesiologist's standpoint, the message is clear: motion is lotion. While rest is important during flare-ups, prolonged inactivity can worsen stiffness and muscle weakness, creating a vicious cycle.

• Embrace Movement: Incorporate regular, low-impact exercise into your routine. Focus on strengthening muscles around the affected joints, improving flexibility, and maintaining cardiovascular health.
• Listen to Your Body: Learn to differentiate between "good pain" (muscle soreness from exercise) and "bad pain" (sharp, persistent joint pain that signals overexertion). Adjust activity levels accordingly.
• Pacing Activities: Break down tasks into smaller, manageable chunks. Alternate periods of activity with rest to prevent overuse and fatigue.
• Maintain a Healthy Weight: This is one of the most impactful lifestyle changes you can make to reduce stress on your joints.
• Proper Biomechanics: Pay attention to how you move. Use proper lifting techniques, posture, and body mechanics to minimize strain on your joints. A physical therapist can provide invaluable guidance here.
• Stay Hydrated and Nourished: A balanced diet supports overall health and tissue repair.
• Educate Yourself: Understanding your condition empowers you to make informed decisions about your care and actively participate in your management plan.

While osteoarthritis is often associated with aging, it is not an inevitable decline. Through strategic exercise, weight management, and a proactive approach to joint health, individuals can significantly manage symptoms, maintain function, and lead active, fulfilling lives.