Lower limb osteoarthritis in active older adults

LOWER LIMB OSTEOARTHRITIS IN ACTIVE OLDER ADULTS

-Overview

-Risk Factor

-Symptoms

-Vs. rheumatoid arthritis

-Types

-Stages

-Complications

-Diagnosis

-Treatment

-Prevention

-Key Point

-Reference

Overview

Lower limb osteoarthritis (OA) is a common joint condition, particularly in older adults.

Osteoarthritis is a degenerative joint condition that causes, inflammation, stiffness and pain in the joints.causesTrusted Source

It primarily affects the knees and hips, and it’s estimated that around 10% to 20% of individuals aged 60 and above worldwide experience knee pain due to osteoarthritis.

Risk Factors

Age: OA risk increases with age
Sex: Women are more likely to develop OA than men
Obesity: Being overweight increases the risk of OA, particularly in the knee.
Joint Injury: Trauma or injuries, such as ACL ruptures, can lead to early-onset OA
Joint Malalignment: Abnormal joint alignment can increase OA risk
Joint Deformity/Abnormal Joint Shape: Variations in bone/joint shape can contribute to OA development
Occupation: Physically demanding jobs, such as construction work or farming, increase OA risk.
Family History: Having a family history of OA can increase an individual’s risk
Comorbidities: Certain conditions, such as hypertension and cardiovascular disease, may be associated with OA risk.

Symptoms

1-Knee OA:

Pain and stiffness around knee
Knee pain can develop slowly and worsen over time.
Pain during rest and night in severe cases
Stiffness after sitting or prolonged rest typically loosen up in less than 30 minutes.
Grinding or popping sounds
Swelling
Locking, and giving way of the knee
Difficulty in walking, climbing stairs

2-Hip OA:

Pain around the hip joint (generally located in the groin area). Pain is worse at the end of the day, and activity related (particularly while walking or climbing stairs).
The pain can develop slowly and worsen over time.
Pain and stiffness can develop in the morning or after sitting or resting. Stiffness typically lasts for only a few minutes and subsides over 30 or fewer minutes.
Reduced ROM
Night pain in severe cases

Versus Rheumatoid Arthritis (RA)

In Rheumatoid Arthritis, patients will present with the following symptoms.
RA is a symmetric disease that involves multiple joints bilaterally.
Patients typically present with pain and swelling in the joints of the hands and feet.
Morning joint stiffness lasting more than 30 minutes.

OSTEOARTHRITIS	RHEUMATOID ARTHRITIS
Cause is degenerative	Cause is autoimmune
Localised at specific joints	Can affect multiple joints bilaterally.
Affects mainly large joints like hip, knee, shoulder.	Affects both large and small joints like knee, hip, hands, feet.
Morning stiffness less than 30 minutes	Morning stiffness more than 30 minutes

Types

1. Primary OA:

Age-related and occurs without any apparent underlying cause.

2. Secondary OA:

Results from an underlying condition such as injury, obesity, or congenital disorders.

Stages

Stage 0 (Normal): No signs of OA, joint functions normally.
Stage 1 (Minor): Minor wear and tear; possible bone spur growths; typically asymptomatic.
Stage 2 (Mild): Noticeable bone spurs and joint discomfort, especially after long activity.
Stage 3 (Moderate): Cartilage erosion, narrowing joint space, pain during activity, and stiffness.
Stage 4 (Severe): Significant loss of cartilage, chronic pain, inflammation, and reduced mobility.

Complications

The OA-related challenges, focusing in particular on how they affect patients’ quality of life:

Articular Erosions:

As joint cartilage gradually deteriorates, articular erosions may occur, ultimately leading to a loss of joint function.

Chronic Pain and Stiffness:

Joint stiffness and persistent pain are prevalent, frequently made worse by exercise, and they impair mobility.

Reduced Range of Motion:

Degeneration of the joints restricts movement, which impacts everyday tasks and general functioning.

Muscle Weakness:

Atrophy of the surrounding muscles brought on by inactivity in affected joints might further reduce joint stability.

Psychosocial Impact:

Mental health problems like anxiety and depression may arise as a result of chronic pain and limited movement.

Diagnosis

A combination of clinical evaluation, imaging, and occasionally laboratory testing to rule out other disorders are used to diagnose lower limb osteoarthritis (OA). The hip and knee are the lower limb joints most frequently impacted.

Treatment

Managing osteoarthritis involves a combination of self-care strategies, medication, and supportive therapies. Here are the primary approaches: –

1-Lifestyle Changes:

Regular Exercise:

Staying active is one of the most effective ways to manage osteoarthritis, regardless of your age or fitness level. A balanced exercise routine that includes strength training and cardiovascular activities can help build muscle, support joint function, and improve overall well-being.

Healthy Weight Management:

Excess body weight can worsen osteoarthritis by putting added pressure on your joints, particularly the knees and hips. Achieving and maintaining a healthy weight through regular exercise and a nutritious diet can significantly ease symptoms and slow progression.

2- Pain Relief Medication:

For mild to moderate osteoarthritis pain, your doctor may recommend over-the-counter medications like paracetamol to provide short-term relief. Paracetamol is widely available at pharmacies and supermarkets and can help manage daily discomfort.

3- Supportive Therapies:

Hot and Cold Therapy:

Applying heat or cold packs to affected joints can help reduce pain and stiffness. Heat can relax muscles and increase circulation, while cold can numb sharp pain and reduce inflammation.

Assistive Devices:

Using supportive tools such as braces, walking aids, or specially designed footwear can make daily activities easier and reduce joint strain.

Manual Therapy:

Hands-on treatments performed by a physiotherapist or specialist can improve joint mobility, reduce stiffness, and enhance function.

Exercise Therapy:

Exercise and stretches can help improve joint strength, flexibility and range of motion.

Psychological support:

This can be done through joining different community social group for osteoarthritis. This connects individuals with community resources to address physical, emotional and social needs. It includes exercise programs like yoga or swimming, pain management workshops, dietary advice, mental health support and social activities. This holistic approach enhances overall wellbeing, reduces isolation and fosters community connection.

Prevention

Preventing OA or slowing its progression involves a combination of lifestyle modifications and early interventions.

1- Weight Management:

Maintaining a healthy weight reduces stress on joints, particularly the knees and hips.
Weight loss in overweight individuals can significantly decrease OA risk and symptom severity .
The Centers for Disease Control and Prevention (CDC) created materials to support individual and community initiatives to prevent and manage obesity.
Individual resources: Patients can print off pamphlets with recommendations on fruits and vegetables, portion size, healthy beverages, and more.

2-Physical Activity:

Regular low-impact exercises (e.g., walking, swimming, tai chi) strengthen muscles around joints, improving stability and reducing pain.
Exercise also enhances flexibility and balance, decreasing fall risk.
At least 150 minutes per week of moderate-intensity aerobic activity, or anything that gets your heart rate up.
At least two days each week of muscle-strengthening activity, or activities that require your muscles to work harder than usual.

3-Injury Prevention:

Avoiding joint injuries through proper techniques during physical activities can prevent OA onset.
Using protective equipment and ensuring safe environments are crucial, especially for older adults.

4- Education and Self-Management:

Educating individuals about OA and its risk factors empowers them to take proactive steps.
Self-management programs focusing on coping strategies, pain management, and lifestyle changes have shown positive outcomes.
OA management options include self-care, collaborative care, social/phone support, pharmacotherapy, music, educational movies on OA procedures, and yoga.
Integrating self-care, collaborative care, and social/phone support can improve OA management by reducing comorbid anxiety and depression, as well as physical and emotional pain.

Key Point

Osteoarthritis is a chronic condition that may cause inflammation, pain, and stiffness in your joints.

A treatment plan could help manage your symptoms, increase mobility, and improve your quality of life.

Speak with a healthcare professional if you think you may have osteoarthritis. They could provide a proper diagnosis and develop a treatment plan that’s right for you.

Overall, managing LLOA in active older adults requires a holistic approach that addresses the physical, social and psychological needs of the individual.

References

NICE. (2014). Osteoarthritis: care and management (Clinical guideline CG177). Retrieved from

https://www.nice.org.uk/guidance/cg177

Roemer, F.W., Kwoh, C.K., Hannon, M.J., Hunter, D.J., Eckstein, F., Bowes, M.A., Guermazi, A., 2022. Imaging in osteoarthritis. Osteoarthritis and Cartilage, 30(7), pp.913–934.

https://doi.org/10.1016/j.joca.2021.04.018

Sen, R. and Hurley, J.A. (2025) ‘Osteoarthritis’, StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: (Accessed: 21 May 2025).

https://www.ncbi.nlm.nih.gov/books/NBK482326/

NHS, 2023 Treatment and support osteoarthritis. Available from: (accessed on 20^th May 2025)

https://www.nhs.uk/conditions/osteoarthritis/treatment/

Abdel-Aziz, M.A., Ahmed, H.M.S., El-Nekeety, A.A., Hassan, N.S., & Abdel-Wahhab, M.A. (2021) ‘Osteoarthritis complications and the recent therapeutic approaches’, Inflammopharmacology, 29(5), pp. 1653–1667. Available at: https://doi.org/10.1007/s10787-021-00888-7 (Accessed: 21 May 2025).
O’Neill, T.W., McCabe, P.S. and McBeth, J., (2018). Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best practice & research Clinical rheumatology, 32(2), pp.312-326.
Aletaha, D. and Smolen, J.S., (2018.) Diagnosis and management of rheumatoid arthritis: a review. Jama, 320(13), pp.1360-1372.
Aresti, N., Kassam, J., Nicholas, N. and Achan, P., (2016). Hip osteoarthritis. BMj, 354.
Lespasio, M.J., Piuzzi, N.S., Husni, M.E., Muschler, G.F., Guarino, A.J. and Mont, M.A., (2017). Knee osteoarthritis: a primer. The Permanente Journal, 21, pp.16-183.
Lespasio, M.J., Sultan, A.A., Piuzzi, N.S., Khlopas, A., Husni, M.E., Muschler, G.F. and Mont, M.A., (2018). Hip osteoarthritis: a primer. The Permanente Journal, 22, pp.17-084.
Kraus, V.B., Sprow, K., Powell, K.E., Buchner, D., Bloodgood, B., Piercy, K., George, S.M. and Kraus, W.E., (2019). Effects of physical activity in knee and hip osteoarthritis: a systematic umbrella review. Medicine and science in sports and exercise, 51(6), p.1324.
Goh, S.L., Persson, M.S., Stocks, J., Hou, Y., Lin, J., Hall, M.C., Doherty, M. and Zhang, W., (2019). Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: a systematic review and meta-analysis. Annals of physical and rehabilitation medicine, 62(5), pp.356-365.
Osteoarthritis Action Alliance. OA Prevention Module. Link
CDC. About Physical Activity and Arthritis. Link
Arthritis Canada. Osteoarthritis Self-Management. Link
Ali, S., Kokorelias, K.M., Macdermid, J. and Kloseck, M., 2018. Education and social support as key factors in osteoarthritis management programs: A scoping review. Arthritis, 2018.
Hunter, D.J. and Bierma-Zeinstra, S., 2019. Osteoarthritis. The Lancet, 393(10182), pp.1745-1759.
Sharma, A., Kudesia, P., Shi, Q. and Gandhi, R., 2018. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatology: Research and Reviews, 10, pp.103-113.
Wallis, J.A., Taylor, N.F., Bunzli, S. and Shields, N., 2019. Experience of living with knee osteoarthritis: a systematic review of qualitative studies. BMJ Open, 9(9), p.e030060.
Zhang, L., Fu, T., Zhang, Q., Yin, R., Zhu, L., He, Y., Fu, W. and Shen, B., 2020. Effects of psychological interventions for patients with osteoarthritis: A systematic review and meta-analysis. Psychology, Health & Medicine, 25(3), pp.253-265.
National Institute for Health and Care Excellence (NICE), 2022. Osteoarthritis in over 16s: diagnosis and management. NICE guideline [NG226]. [online] Available at: https://www.nice.org.uk/guidance/ng226 [Accessed 21 May 2025].