Osteoarthritis

Normally, the human body has an ability to repair itself, but with osteoarthritis, it can be understood as a failed repair process. In other words, the joint can no longer keep up with events that exceed the joint's capacity.

Joints in the body are a central part of the locomotor system, and therefore the first symptoms are often related to movements when you use the joint. The symptoms of osteoarthritis usually come gradually, and some of the symptoms you may experience are:

• Pain

• Stiffness

• Difficulty moving

• Swollen and thickened joints

• A grinding feeling in the joints when moving them

• Muscle weakness

The symptoms can vary over time. One can experience both good and bad periods. The duration of good and bad periods can vary from days to months and from person to person.

Osteoarthritis can be detected in several ways. For some, the symptoms and findings are so clear that it is sufficient to diagnose through a medical history (conversation with a doctor) and examination. In other cases, further examinations may be necessary, such as X-ray examination and/or MRI examination.

Osteoarthritis can occur in all joints, but it is most common in the knee, hand, and hip (3). The disease often does not have a single cause, but is rather diverse and complex. However, we do know that there are several factors that may be associated with the development of osteoarthritis (4):

Osteoarthritis risk factors: 

Age: Age is one of the most well-documented risk factors for osteoarthritis. This is likely due to increased exposure to other risk factors over time, as well as age-related biological changes in the joints.

Gender: Women have a higher prevalence of osteoarthritis than men. The exact cause of this is somewhat unclear, but hormonal factors and anatomical differences are potential theories.

Genetics: There is strong evidence that our genes play a role in osteoarthritis. Genes may affect when the disease starts.

Ethnicity: The prevalence of osteoarthritis varies among different ethnic groups, suggesting that ethnicity may influence its development.

Overweight: Being overweight is likely the most significant modifiable risk factor for osteoarthritis.

Previous Injuries: Injuries can disrupt the normal structure of a joint, affecting how it functions and wears down over time.

Joint Deformities: Joint deformities can affect the movement of a joint. Some conditions, such as cam deformity and hip dysplasia, have shown a strong association with the development of osteoarthritis.

Physically Demanding Work: The link between work and osteoarthritis is believed to be due to repeated stress on the joint, leading to damage over time.

Sports: High-impact sports with repetitive movements, such as football, handball, and ice hockey, have shown a moderate to significant increase in the risk of hip and knee osteoarthritis. However, it is unclear whether the development of osteoarthritis is solely related to the activity or also linked to injuries

How is osteoarthritis treated?

Non-drug treatment:

Non-drug treatments are a central part of osteoarthritis treatment and are recommended for everyone with osteoarthritis. These treatments can improve symptoms with minimal side effects, and they are usually the first recommendations from clinicians.

Patient education:

Patient education aims to provide you as a patient with competence and tools so that you can more easily influence your own health and better manage your condition.

Exercise and Physical Activity:

In the beginning, exercising may cause discomfort for patients with osteoarthritis, but this is not harmful. It's normal to experience some discomfort as long as the pain decreases after exercise and doesn't worsen by the day. Exercise and physical activity are recommended as treatments as they can improve and maintain mobility and muscle function around the affected joints. Studies have shown that exercise reduces pain, improves physical function, and makes daily activities easier (7). As a bonus, exercise and an active lifestyle have many other positive health effects.

Weight Loss:

For those who are overweight, weight reduction can have a beneficial effect on pain relief and other symptoms. In weight-bearing joints affected by osteoarthritis, such as the hip and knee, weight loss can reduce stress on the joint. For example, every 1kg of body weight equates to approximately 4kg of load on the knee for each step taken while walking (9). Additionally, studies have shown a connection between overweight and hand osteoarthritis, which is explained by hormonal and biological factors (10).

Orthoses:

Orthoses are devices that can help support the joints and keep them aligned, allowing them to move or function better. There are various types of orthoses that can alleviate symptoms and contribute to maintaining function in individuals with osteoarthritis.

Assistive Devices:

There are many types of aids that can be helpful depending on the severity of your symptoms. Typically, a physiotherapist or an occupational therapist can assist in assessing what may be suitable for you. For example, aids such as a cane, walker, chair lift/lifting cushions, raised toilet seat, and grab bars for the bathtub and shower can reduce stress on the joints and make it easier to perform daily tasks.

Medical treatment:

Medical treatment is typically initiated after non-medical treatments have been tried and can often be used in combination. The primary aim of medical intervention is typically to alleviate pain and enabling individuals to function more effectively in their daily lives. There are several over-the-counter pain-relieving medications available in tablet form and as gels, which are commonly the first choice for self-treatment of pain.

Artrose innebærer slitasje av ledd og dette kan i noen tilfeller føre til irritasjon av leddet i form av inflammasjon. I slike tilfeller kan bruk av NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) eller betennelsesdempende medikamenter benyttes. Merk at bruk av betennelsesdempende behandling er forbundet med spesielle bivirkninger og må derfor føre til spesiell oppmerksomhet generelt, men spesielt ved langtidsbehandlinger. Anbefales at dette derfor gjøres i samarbeid med lege. 

Surgery:

Surgical interventions are typically considered first for very severe symptoms but can often improve pain, stiffness, and mobility. Depending on the affected joint and the type of injury, there are various options available.

Why exercise with osteoarthritis?

The body has its own pain-relief system, which can be activated by physical exercise. Firstly, muscle activity itself is pain-relieving through the same mechanisms as acupuncture. Additionally, physical activity stimulates the production and release of endorphins, a hormone. This hormone has a similar effect to morphine, which is a chemically produced pain-relieving medication.

Furthermore, exercise helps maintain muscle mass, skeletal health, and physical functionality. By increasing muscle strength and improving neuromuscular function, we can enhance stability around the joints, thereby reducing joint stress (11-12). 

In osteoarthritis, the cartilage in the joint gradually wears down, and its main task of enabling the hard bones to move against each other is impaired. Exercise not only improves muscle strength but can also enhance the quality of the cartilage (13). 

Despite extensive research, no treatment has yet been found to reverse joint changes in established osteoarthritis, but exercise can slow further development based on the above reasons (14). Unlike pain medications or surgical interventions, which only reduce pain, exercise has the added benefit of many other health gains. Additionally, exercise is often associated with weight loss, which can help reduce the overall stress on the joints.

How to get started?

It can be challenging to find the right type of activity. Furthermore, finding the right balance between exertion, frequency, and rest can be difficult. Therefore, it is important that the exercise and physical activity are tailored to you, your level, and your needs. As a first priority, it is recommended to find an activity that is enjoyable and preferably closely aligned with your own desires and functional goals. In other words, if you enjoy walking in the woods, that may be the best activity for you! But to do this safely and with a smile on your face, you need to progress with time. Much like when professionals prepare to run a marathon, it requires good planning and gradual training so that the body can handle the strain required to run a marathon.

Increased pain may occur at the beginning of the training period. This could be due to general soreness or muscle aches resulting from the activity, and it's completely normal. If you haven't been training for a long time, this discomfort can last anywhere from a few days to a couple of weeks. It may be wise to differentiate between new pain and the original pain. Exercise can often be combined or supplemented with some form of pain relief, such as paracetamol or NSAIDs.

Once you've determined which activities or exercises to do, the next step is to gradually increase the intensity or volume of the activity. Exercise usually involves challenging the body's "status quo," and gradual progression means continuously challenging the body's "status quo." However, it's this gradual progression over time that stimulates the body to adapt. Therefore, discomfort is normal. As a general rule, it's acceptable as long as the pain diminishes after exercise and doesn't worsen each day.

Finding the right balance between increased workload and volume, and rest is challenging. Often, one must adjust and experiment along the way before finding the right balance. Be patient, maintain consistency over time, and the results will come! Exercise is a ongoing process!