There are two main views about osteoarthritis: the old, outdated one, and the new, evidence-based one! Read on to debunk 5 of the biggest misconceptions about this condition.
If you’d love to take a deep dive into this topic, my workshop Demystifying Arthritis and Joint Health aims to give yoga teachers a contemporary, evidence-based perspective of arthritis.
1) It’s caused by persistent loading and “wear and tear”,
Currently, OA is no longer viewed as a quintessential degenerative disease resulting from exposure to average bodily wear and tear, but rather as a multifactorial disorder in which low-grade, chronic inflammation has a central role.
During OA progression, the entire synovial joint, including cartilage, subchondral bone, and synovium, are involved in the inflammation process (Malfait 2016).
Language is so important! When people with pain have a scan and normal age-related changes are reported as “degeneration” or “abnormalities”, those people recover more slowly regardless of the nature or cause of their original problem.
Old vs new view of osteoarthritis
2) Symptoms will inevitably get worse over time.
Currently, x-rays are often used to confirm the diagnosis of OA. Clinicians are now beginning to think of classic x-ray findings as normal age-related structural changes. Having these structural changes only increase the chance of experiencing pain: It does not guarantee pain.
Between 19% and 40% of people with structural changes on an x-ray don’t have pain (Culvenor et al 2019).
If someone with OA does experience pain, these structural changes are only one factor in the bigger picture. Someone can have structural changes on an x-ray and their pain can decrease over time while their x-ray looks the same.
Things don’t have to get worse. Knee OA is characterised by persistent rather than inexorably worsening symptoms even when the x-rays show more joint changes.
Like pain, stiffness changes, and can improve over time! Stiffness is a protective *feeling* being produced by the brain.
Stanton et al (2017) found that pleasant whooshing noises made people’s joints feel less stiff while unpleasant creaking noises made their joints feel more stiff! Even though the actual stiffness of their joints did not change!
3) Pain is caused by bone rubbing against bone.
There are no nerve endings in the bone itself. So, if the ends of two bones are rubbing together and all else is well, that itself won’t generate pain.
Articular cartilage also does not have nerve endings in it. So thinning cartilage will not hurt in and of itself.
Pain in OA can come from the periosteum (connective tissue covering the outer bone, except at the joint), synovitis (synovial membrane inflammation) and oedema in the bone marrow.
Not everyone with OA will have these issues. If someone does have pain because of those issues, it will often calm down after a few weeks or months.
For the majority of people, the status of their joint will return to baseline once again.
4) Being active wears out your joints.
Although pain and functional limitations can present challenges to individuals with arthritis in terms of performing physical activity, regular exercise is essential for managing OA.
Individuals with arthritis are more likely to have muscle wasting (sarcopenia) and excess body fat than same age and sex healthy individuals.
Therefore, regular exercise plays an important role in weight control and achieving a healthy body composition both through the anabolic and lipolytic effects of exercise itself and via the anti-inflammatory effects of regular physical activity.
Aerobic, strengthening, aquatic exercises, Tai Chi and yoga are beneficial for improving pain and function in people with OA with benefits seen across a range of disease severities.
Moderate exercise may be a good treatment not only to improve joint symptoms and function, but also to improve the knee cartilage glycosaminoglycans content in patients at high risk of developing OA (Roos and Dahlberg 2005).
Running does not increase symptoms or structural progression in people with knee OA (Lo et al 2018).
5) Everyone with OA will end up needing a joint replacement.
A 12-week non-surgical knee OA management program (including exercise therapy, education, insoles, dietary advice and analgesia) can prevent total knee replacement surgery in people deemed candidates for this in 68%-74% of people with knee OA (Skou et al 2015 and Skou et al 2018).
There is evidence that people with OA commonly do not receive care that aligns with quality indicators; in a meta-analysis involving 16,103 patients, only 39% received a referral or recommendation to exercise (Hagen et al 2016).
A study involving 489 people with knee OA reported that 54% had never tried muscle strengthening exercises (Hinman et al 2015).
References:
Culvenor, A., Øiestad, B., Hart, H. (2019) ‘Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.’ British Journal of Sports Medicine 53, 1268-1278.
Hagen K., Smedslund G., Østerås N., Jamtvedt G. (2016) Quality of community-based osteoarthritis care: a systematic review and meta-analysis. Arthritis Care Res. 68(10):1443–1452.
Hinman R., Nicolson P., Dobson F., Bennell K. (2015) Use of nondrug, nonoperative interventions by community-dwelling people with hip and knee osteoarthritis. Arthritis Care Res. 67(2):305–309.
Lo, G., Musa, S., Driban, J., Kriska, A., McAlindon, T., Souza, R. (2018) ‘Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative.’ Clinical rheumatology 37, 9, 2497–2504.
Malfait, A. Osteoarthritis year in review 2015: biology. Osteoarthritis Cartilage 2016; 24: 21–26.
Roos, E. and Dahlberg, L. (2005) ‘Positive Effects of Moderate Exercise on Glycosaminoglycan Content in Knee Cartilage: A Four-Month, Randomized, Controlled Trial in Patients at Risk of Osteoarthritis.’ Arthritis and rheumatism 52, 3507-14.
Skou, S., Roos, E., Laursen, M., Rathleff, M., Arendt-Nielsen, L., Simonsen, O., and Rasmussen, S. (2015). A Randomized, Controlled Trial of Total Knee Replacement. The New England journal of medicine, 373(17), 1597–1606.
Skou, S., Roos, E., Laursen, M., Rathleff, M., Arendt-Nielsen, L., Rasmussen, S., and Simonsen, O. (2018). Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis and cartilage, 26(9), 1170–1180.
Stanton, T. R., Moseley, G. L., Wong, A. Y. L., & Kawchuk, G. N. (2017). Feeling stiffness in the back: a protective perceptual inference in chronic back pain. Scientific reports, 7(1), 9681.