Illustration by Matthew Billington
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Several years ago, in the first month of my practice as a full-fledged family physician, I met a pleasant woman in her early 60s who came to see me about her osteoarthritis (OA). She showed me her hands, which looked typical for a woman her age: some prominence of the knuckles, blue veins meandering across tendons, and a smattering of sunspots. She was a pianist, and while not a professional she was accomplished enough to play daily. But she said the pain in her fingers was getting worse and, with tears in her eyes, told me she worried she would soon have to give up playing her beloved piano.
It was a reminder that regardless of the size or number of joints affected, OA can easily undermine a patient’s quality of life. Osteoarthritis is a progressive disease that commonly affects the hips, knees, spine and smaller joints of the hands and fingers. According to the Public Health Agency of Canada, OA affects nearly 3.9 million Canadians (13.6 per cent) aged 20 and over, with prevalence increasing with age and higher among women. While previously thought of as “wear and tear” on the joints with injury and age, we now know that OA is the result of an imbalance between local joint repair and destruction. This can lead to inflammation and breakdown of the cartilage and bone, causing pain and reduced mobility.
With Canada’s rapidly aging population and OA being so common, it’s worth reviewing some key facts about the disease. While OA is a chronic condition for which there is no quick fix, there are effective ways to treat and manage it. Here are a few things to know.
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You probably don’t need tests for your OA
Your primary care provider can make a clinical diagnosis of OA based solely on a physical exam and reviewing your medical history. They may order additional tests or blood work if they suspect another underlying condition causing joint pain, such as an autoimmune disorder or infection. While X-rays or other imaging studies might be helpful when planning surgical interventions or procedures such as joint injections, such investigations are not required to confirm or monitor the progression of this disease. In fact, the correlation between what a joint looks like on X-ray and the amount of pain a patient is experiencing is quite poor; someone with a nasty-looking joint on X-ray may experience little or no pain at all.
Joints – even painful ones– should move
While sufferers of OA joint pain often worry about causing more damage, there is a plethora of evidence demonstrating that exercise reduces inflammation and promotes cartilage repair. Furthermore, purposeful movement and strength exercise can enhance nerve-muscle communication, improving joint stability and ensuring that forces are better distributed along the joint surface.
If cost is not a barrier, a supervised exercise program under the guidance of a physiotherapist will likely be more beneficial than going it alone, but even light exercise such as walking has been shown to reduce progression to disability. As always, be sure to talk to your primary care provider before starting any new exercise regime.
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Weight loss can help
Patients are often told to lose weight to help with their OA pain, though there is some nuance to that advice. Research looking at weight loss in patients with OA has shown that patients who lose weight by diet changes alone without any change in their physical activity did not experience any clear improvement in their pain, compared to those who underwent both diet and exercise changes to lose weight. Movement seems to have benefits independent of weight loss.
Medications and some supplements might help with the pain
Though non-steroidal anti-inflammatories, such as ibuprofen or naproxen, are often prescribed as first-line therapies for OA, these medications may not be safe to take long-term for older adults, particularly those with decreased kidney function or history of gastrointestinal bleeding. Topical anti-inflammatories, such as diclofenac (Voltaren), and acetaminophen (Tylenol) are safer alternatives and are sold over the counter. Opioids are not recommended for treatment of OA pain, given their minimal benefit treating chronic pain and long side-effect profile. Steroid injections into affected joints can be done to temporarily reduce inflammation, but their benefit can vary. Furthermore, repeated injections may accelerate OA progression so they should be done sparingly for symptomatic flares of pain.
Many patients, looking for more natural options, ask about taking glucosamine or chondroitin supplements for their OA pain. These supplements are probably safe, but studies looking at supplements in OA haven’t consistently shown any benefits in treating pain. Interestingly, a 2016 study did demonstrate significant improvement in OA pain for patients taking turmeric extract supplements versus placebo. If patients are keen to try supplements, I tend to tell them that it may or may not help their pain, but it likely won’t hurt anything except their wallet.
Don’t hesitate to talk to your primary care provider about different strategies to treat your OA; whether it’s playing the piano or lifting up the grandkids, we want to help you to continue what you love to do as much as possible.
Dr. Carolyn Wong is a family physician in Calgary with a focused practice in caring for older adults. She works in clinical settings, long-term care, and on home visits in the community. Dr. Wong is also heavily involved in medical education at the Cumming School of Medicine and Department of Family Medicine at the University of Calgary.
