Osteoarthritis

Disease Description (Causes and Symptoms)

• Definition summary: Osteoarthritis is a degenerative joint disease in which the articular cartilage gradually wears down, causing changes in the bone beneath the cartilage and the tissues around the joint, resulting in inflammation, pain, and functional impairment.
• Main causes and risk factors: Age, genetic predisposition, obesity (increased weight-bearing load), repetitive trauma or joint overuse, joint instability (previous injury or surgery), and secondary cartilage damage caused by inflammation.
• Pathophysiology summary: Structural and biochemical breakdown of cartilage → subchondral bone sclerosis, osteophyte formation, mild synovial inflammation → pain, stiffness, restricted joint movement, and reduced function.
• Main symptoms: Joint pain (especially worsening after activity and relieved by rest in the early stages), morning stiffness (usually less than 30 minutes), joint swelling or effusion, joint sounds (crepitus), and reduced range of motion. Commonly affects the knees, hips, fingers, and lumbar spine.

Treatment Methods and Precautions

• Conservative (non-surgical) treatment (recommended as the first option)
  • Weight loss: In knee OA, losing 5–10% of body weight produces clear improvements in pain and function.
  • Exercise and physical therapy: Strengthening exercises (especially the quadriceps), flexibility and aerobic exercises, and low-impact activities in daily life (swimming, cycling) are recommended.
  • Assistive devices: Canes, knee braces, and shoe insoles (to correct foot alignment) can reduce pain and load.
  • Self-management: Balance activity and rest, and avoid movements that place excessive load on the joints.
• Medication treatment
  • Oral analgesics: Acetaminophen (for mild to moderate pain), although its effect is limited.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Oral NSAIDs (short-term or when necessary); gastrointestinal, kidney, and cardiovascular risks should be considered (for high-risk patients, concomitant administration of a PPI or consideration of a COX-2 inhibitor may be appropriate).
  • Topical treatment: Topical NSAID ointments (effective for knee/hand OA) and topical analgesics.
  • Other medications: In cases of chronic pain, duloxetine may sometimes be recommended for the purpose of relieving nervous system-related pain.
  • Opioids: Consider only in limited circumstances and for short-term use (due to the risk of adverse effects and dependence).
  • Cartilage supplements: Evidence for glucosamine, chondroitin, and similar supplements is mixed, although some patients experience symptom improvement. Standard recommendations are not clear.
• Intra-articular injections
  • Steroid injections: Useful for relieving acute symptoms, but frequent injections may accelerate cartilage damage. Limiting the frequency (e.g., 3–4 times/year) is generally recommended.
  • Hyaluronic acid (viscosupplementation): Pain relief has been reported in some patients, but opinions differ regarding its effectiveness and cost.
  • Biological injections such as PRP: Evidence is still limited and results are inconsistent.
  • Adverse effects such as post-injection infection (rare) and worsening pain may occur.
• Procedures and surgery
  • Arthroscopic treatment: Extensive arthroscopic procedures are generally not recommended for degenerative OA (selective/limited use only).
  • Osteotomy: Suitable for relatively young patients with unilateral knee joint surface imbalance (for the purpose of preserving the joint).
  • Partial joint replacement (unicompartmental) or total (artificial) joint replacement (partial/total joint replacement): The standard definitive treatment when pain and functional impairment are severe and do not respond to conservative treatment.
• Complications and precautions (treatment-related)
  • NSAID use may increase the risk of gastrointestinal bleeding, kidney failure, and cardiovascular problems → Underlying conditions should be identified and monitored.
  • Frequent use of steroid injections may worsen cartilage → Limiting the frequency is recommended.
  • In older patients and patients with comorbidities, the risk of postoperative complications (infection, blood clots, and implant problems) should be considered.
  • Exercise is essential, but high-impact activity and overuse (such as running) may worsen symptoms → Exercise should be prescribed according to the individual’s condition.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/records to prepare:
  • A list of currently used medications (including prescription drugs, OTC medications, and supplements) and a history of allergies.
  • Symptom diary: Pain intensity (quantified, e.g., VAS 0–10), when symptoms began, daily and activity-related patterns of worsening and improvement, duration of morning stiffness, and the presence of swelling or redness.
  • Previous test results (X-rays, MRI, joint aspiration results, etc.) and a history of previous surgery or injury.
  • Weight, activity level, and occupation (in relation to the load placed on the joints).
  • Assistive devices (bring them if currently in use).
• Self-check before seeing the doctor:
  • Which activities mainly worsen the pain (stairs, walking, standing for long periods, etc.).
  • The effects of pain on daily life, sleep, and work duties.
• Possible outpatient tests:
  • Weight-bearing (standing) joint X-ray (for the knee, including anteroposterior/AP, lateral, and inguinal views), and MRI if necessary.
  • Joint aspiration in cases of joint effusion (to rule out infection and inflammation).
  • Blood tests (inflammatory markers ESR/CRP, rheumatoid factor/anti-CCP, etc., if necessary).

General Example Questions to Ask the Doctor

• "What are the expected effects and possible side effects of this medication (or injection)?"
• "Given my current condition, what is the treatment goal (conservative treatment/surgery), and what is the prognosis?"
• "What activities should I avoid in daily life, and what exercises are recommended?"
• "How should I set a weight-loss goal, and what effects can I expect in the short term?"
• "Are there any tests or complications that need to be monitored regularly?"

Examples of Condition-Specific Questions

• "Based on my current X-ray/MRI findings (or symptoms), is my condition severe enough to consider artificial joint replacement? What are the criteria for recommending surgery?"
• "Among intra-articular injections (steroid vs. hyaluronic acid vs. PRP), which option is most suitable for my condition, and what are the expected duration of effect and risks of each?"