Arthritis Awareness Month serves as a crucial reminder of the widespread impact of osteoarthritis (OA) – the most prevalent form of arthritis, affecting over 528 million people worldwide as of 2019 (Vos et al., 2020). 

Far from being an inevitable consequence of aging, OA is a complex, multifactorial condition with significant implications for joint function, mobility, and overall quality of life. 

 

What Is Osteoarthritis?

 

Osteoarthritis is a chronic, degenerative joint disorder characterized by the breakdown of articular cartilage, subchondral bone remodeling, synovial inflammation, and osteophyte (bone spur) formation. Traditionally described as “wear and tear,” contemporary research recognizes OA as a whole-joint disease involving biochemical, mechanical, and inflammatory components (Hunter & Bierma-Zeinstra, 2019).

 

Causes and Risk Factors

 

OA is considered multifactorial, with both intrinsic and extrinsic contributors:

  • Age: Risk increases with age due to cumulative joint stress and reduced regenerative capacity.
  • Genetics: Family history can predispose individuals to OA.
  • Obesity: Increased body weight adds mechanical load and systemic inflammation (Lohmander et al., 2009).
  • Joint injury or trauma: Previous injuries such as ACL tears or meniscal damage increase risk.
  • Biomechanical factors: Poor posture, abnormal gait, joint misalignment, and repetitive stress contribute.
  • Gender: Women, especially postmenopausal, are at higher risk due to hormonal and structural factors.

 

What Happens in the Body?

 

At the cellular level, OA involves:

Cartilage degradation: Chondrocytes attempt repair, but enzymatic activity (e.g., matrix metalloproteinases) exceeds regenerative capacity, leading to cartilage loss.

Subchondral bone sclerosis: Bone beneath the cartilage thickens and becomes sclerotic.

Osteophyte formation: Bone spurs develop at joint margins in response to instability.

Synovial inflammation: Although OA is not classically inflammatory, synovitis plays a role in symptom severity.

Altered joint biomechanics: Loss of cartilage and joint congruency changes load distribution and function.

These changes lead to pain, stiffness, reduced range of motion, crepitus, and functional limitations.

 

Effects on the Body

 

The consequences of OA extend beyond the affected joint:

  • Decreased mobility and independence, especially in hip and knee OA
  • Muscle weakness and atrophy due to reduced use
  • Impaired proprioception, increasing fall risk
  • Systemic effects such as reduced physical activity, cardiovascular fitness, and mental health (anxiety, depression)
  • Work and social participation limitations, contributing to lower quality of life

 

Conventional Medical Management

 

Medical treatment focuses on pain control and maintaining function, as there is currently no cure for OA.

 

Pharmacological Approaches

 

  • Paracetamol (acetaminophen): Common first-line agent, though modest efficacy (Da Costa et al., 2016)
  • NSAIDs: Reduce pain and inflammation but carry gastrointestinal, renal, and cardiovascular risks
  • Topical agents: Diclofenac gel and capsaicin cream may be safer alternatives
  • Intra-articular injections:
    – Corticosteroids: Provide short-term relief
    – Hyaluronic acid: Controversial efficacy
  • Surgical options: Total joint replacement is considered in advanced, treatment-resistant cases

 

Non-Pharmacological Strategies

 

  • Weight management
  • Exercise therapy: Strengthening, aerobic, and flexibility programs reduce symptoms and improve function (Fransen et al., 2015)
  • Physical therapy
  • Patient education and self-management programs

 

Holistic and Complementary Approaches

 

Increasingly, people with OA are turning to complementary therapies to manage chronic symptoms and improve quality of life.

 

Diet and Nutrition

 

  • Anti-inflammatory diets (e.g., Mediterranean diet) may reduce systemic inflammation (Veronese et al., 2016)
  • Nutraceuticals:
    – Glucosamine and chondroitin have mixed evidence
    – Omega-3 fatty acids may reduce inflammation

 

Mind-Body Practices

 

  • Tai Chi and yoga improve joint function, balance, and psychological wellbeing (Wang et al., 2009)
  • Cognitive Behavioral Therapy (CBT) can help with pain coping and reduce depression and anxiety

 

The Role of Osteopathy

 

Osteopathic manual therapy offers a holistic approach to managing OA by addressing the biomechanical and systemic aspects of the disease. Osteopaths aim to improve joint mobility, soft tissue function, lymphatic drainage, and neuromuscular balance, thereby reducing pain and improving functional movement.

 

Evidence-Based Benefits

 

While direct evidence for osteopathy in OA is still emerging, studies support manual therapy’s general efficacy in musculoskeletal conditions:

  • A systematic review by French et al. (2011) found manual therapy to be effective in reducing pain and improving function in knee OA when combined with exercise.
  • Osteopathic techniques such as myofascial release, mobilizations, and muscle energy techniques can improve range of motion, reduce compensatory strain patterns, and promote circulatory and lymphatic flow.
  • Osteopaths also incorporate exercise prescription, lifestyle advice, and interdisciplinary referral as part of a comprehensive care plan.

 

Mechanisms of Action

 

Osteopathic treatment may benefit OA patients through:

  • Reducing mechanical load on affected joints by optimizing postural alignment
  • Improving soft tissue flexibility and joint lubrication
  • Enhancing proprioception and movement coordination
  • Supporting psychological wellbeing through touch-based therapy and holistic care

Osteoarthritis is a complex condition that requires a multidimensional approach to care. While conventional medicine addresses pain and function, holistic strategies – including osteopathy – can support the patient’s whole-body health and wellbeing. By combining evidence-based therapies with a person-centered perspective, practitioners can help individuals with OA lead more active, fulfilling lives.

 

References

Da Costa, B. R., Reichenbach, S., Keller, N., et al. (2016). Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: A network meta-analysis. Lancet, 387(10033), 2093–2105. https://doi.org/10.1016/S0140-6736(16)30002-2

Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: A Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554–1557. https://doi.org/10.1136/bjsports-2015-095424

French, H. P., Galvin, R., Horgan, N. F., & Cusack, T. (2011). Manual therapy for osteoarthritis of the hip or knee—A systematic review. Manual Therapy, 16(2), 109–117. https://doi.org/10.1016/j.math.2010.10.008

Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. Lancet, 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9

Lohmander, L. S., Gerhardsson de Verdier, M., Rollof, J., Nilsson, P. M., & Engström, G. (2009). Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: A population-based prospective cohort study. Annals of the Rheumatic Diseases, 68(4), 490–496. https://doi.org/10.1136/ard.2008.089748

Veronese, N., Stubbs, B., Noale, M., et al. (2016). Adherence to a Mediterranean diet is associated with lower incidence of frailty: A longitudinal cohort study. Clinical Nutrition, 36(4), 1126–1131. https://doi.org/10.1016/j.clnu.2016.06.009

Vos, T., Lim, S. S., Abbafati, C., et al. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9

Wang, C., Schmid, C. H., Hibberd, P. L., et al. (2009). Tai Chi is effective in treating knee osteoarthritis: A randomized controlled trial. Arthritis & Rheumatism, 61(11), 1545–1553. https://doi.org/10.1002/art.24832