Osteoarthritis - Understanding Symptoms &Treatment

Osteoarthritis (OA) is a mechanical wear-and-tear condition of the cartilage that cushions joint surfaces. It develops slowly with age (typically 50+), obesity, repetitive stress, prior injury, or genetic predisposition. It usually affects knees, hips, base-of-thumb finger joints, and spine. Rheumatoid arthritis (RA) is an autoimmune disease — the immune system attacks the joint linings, can start at any age (often 30-50), affects small joints of hands and feet symmetrically, causes prolonged morning stiffness (more than an hour), and progresses much faster without treatment. Distinguishing them clinically: OA morning stiffness is brief (under 30 min) and worsens with activity; RA stiffness lasts hours and improves with movement. OA is usually asymmetric; RA is symmetric. Blood tests: OA has normal inflammation markers; RA typically shows raised ESR/CRP and positive anti-CCP or RF. X-rays: OA shows joint-space narrowing and bone spurs; RA shows periarticular erosions and soft-tissue swelling. Getting the diagnosis right matters — treatment is very different.

Radiologists use the Kellgren-Lawrence (KL) grading on a standing knee X-ray. Grade 0 — normal, no changes. Grade 1 — doubtful joint-space narrowing, possibly small osteophytes; symptoms minimal or absent. Grade 2 — definite osteophytes, possible joint-space narrowing; mild symptoms, usually manageable with lifestyle and occasional painkillers. Grade 3 — multiple moderate osteophytes, definite joint-space narrowing, some sclerosis, possible deformity; moderate symptoms limiting activity; injections often considered. Grade 4 — large osteophytes, marked narrowing, severe sclerosis, definite deformity; symptoms often severe; knee replacement is a genuine option if function is affected. MRI can pick up cartilage changes earlier than X-ray. Weight-bearing (standing) X-rays are essential — non-weight-bearing views underestimate the severity.

In rough order of evidence strength: weight loss (biggest single intervention — even 5 kg lost meaningfully reduces knee load and pain); quadriceps strengthening under a physiotherapist for 6-8 weeks; low-impact aerobic exercise (swimming, cycling, walking on soft surfaces); paracetamol for baseline pain; topical diclofenac gel, which is as effective as oral NSAIDs for knee OA with far fewer systemic side effects — particularly useful when you have diabetes, hypertension or kidney disease; short-course oral NSAIDs for flares (paired with a stomach-protecting PPI); intra-articular steroid injections for 3-6 months of relief; and PRP injections, which have emerging evidence and appear better than steroid at 6-12 months in some trials. Glucosamine-chondroitin supplements consistently underperform placebo in large trials — not worth recommending.