Osteoarthritis (OA)

Features Suggestive of OA

• Commonly age-related, often with symmetrical joint pain and stiffness

• Reduced joint mobility and function

• Joint swelling, possible crepitus on movement

• Counselling points:

  • OA often progresses slowly or may stabilise

  • Symptoms can fluctuate and do not always correlate with imaging findings

  • Aim for optimised function and quality of life rather than cure

  • Emphasise weight loss, exercise, and pacing daily activities

Self-Management Strategies

1. Weight Loss (if overweight/obese)

   • Aim for 5–10% reduction to decrease load on weight-bearing joints

2. Exercise

   • Regular aerobic (land- or water-based), e.g. walking, swimming, aqua aerobics

   • Resistance exercises (e.g. light weights, Tai Chi) for muscle strengthening

   • Joint-friendly activities → Minimises further joint stress

3. Activity Pacing

   • Use pain diaries to gauge tolerance

   • Schedule rest periods or lighter tasks between more strenuous activities

   • Joint protection (assistive devices, splints) if needed

4. Physical Aids & Assistive Devices

   • Consider walking sticks, orthoses, or braces to reduce stress on affected joints

   • Splints for hand OA (especially the thumb CMC joint)

OA of the Hand – Additional Management

• Exercises: Strengthening and stretching for the fingers, thumbs, wrists

• Splints: Particularly helpful for thumb carpometacarpal joint support

• Heat Therapy: Short-term pain relief

• Avoid repetitive thumb movements and prolonged gripping

Non-Pharmacological Management

• Exercise: Land-based and aquatic aerobic plus strengthening exercises

• Weight Loss: Key for knee/hip OA or obese patients to reduce joint load

• Physiotherapy: Muscle strengthening, joint mobilisation, gait training

• Psychological Support: CBT or counselling for chronic pain coping strategies

Pharmacological Management

1. Paracetamol: First-line oral analgesic (mild–moderate pain)

2. Topical NSAIDs (e.g. diclofenac gel): Useful for localised joint pain in knees/hands

3. Oral NSAIDs: For moderate–severe OA pain, use lowest effective dose. Consider GI/cardiovascular risk.

4. Duloxetine: Can help with chronic knee OA pain

5. Intra-Articular Steroids: Short-term relief for severe flares (limit frequency to avoid cartilage damage)

When to Refer for Surgery

• Persistent symptoms despite maximal conservative (non-surgical) therapy

• Significant functional limitations or impaired daily activities

• Advanced disease on imaging (though symptoms and function guide decisions more than imaging alone)

Additional Notes

• Regularly assess interventions for efficacy and patient alignment with goals.

• Trial approaches in OA management: adapt medication/exercise programs to patient response.

• Combined strategies (lifestyle + medications) often yield best outcomes.