23 Jun 2011
By: CHIA HUI JUN
Fifteen years ago, Madam Ong Hai Kim was hit by a sudden pain in her knees and could not stand or squat.
She was taken to a hospital where an X-ray showed degeneration of her left knee cap.
She was diagnosed with osteoarthritis, a degenerative joint disease affecting one in five women and one in 10 men over 60 years old. Of them, 80 per cent have limited movement and 25 per cent are severely disabled by the pain.
Wear and tear of cartilage lining the ends of the bones that meet at the joint can occur as part of the ageing process or because of injury.
When the cartilage fails to repair, it thins out, leaving the underlying bone exposed. The exposed bone ends thicken, form bone spurs and restrict movement.
Joints can become damaged beyond repair when too much weight is put on them, said Dr Katy Leung, a consultant at the department of rheumatology and immunology of Singapore General Hospital.
When a person is overweight, it increases the load that a joint sustains during movement such as walking, climbing stairs and squatting. The excess burden adds to the damage in the cartilage and affects its healing.
Injuries, deformities and diseases also influence the rate of degeneration.
Osteoarthritis usually affects joints in the knees, hips, spine and hands. Patients experience pain, swelling and loss of movement and function, said Dr Francis Wong, an orthopaedic surgeon at Mount Elizabeth Medical Centre.
People over 60 years old and those involved in frequent kneeling, stooping and stair-climbing are more prone to the condition. Those with past joint injuries, are overweight or take part in high-impact exercises are also at risk, said Dr Leung.
Madam Ong, who used to be a dressmaker, carried heavy grocery bags in her 30s and 40s, and also lugged 30kg of luggage while travelling. Her right knee also turned osteoarthritic five years ago.
Now a 69-year-old retiree and grandmother of eight, she rests frequently while walking and tries to avoid climbing stairs. She also does qigong and physiotherapy exercises that she was taught in the hospital.
“When the pain is unbearable, I turn to painkillers,” she said.
Osteoarthritis is usually treated with drugs such as non-steroidal anti-inflammatory drugs and steroid or hydraluronic acid injections into joints to relieve the pain.
Treatment also includes weight loss, physiotherapy and low-impact aerobic exercises like swimming to strengthen muscles, relieve pain and restore function.
Walking accessories such as canes, walking aids and special shoes may take the load off the injured joint and prevent further damage. Special insoles and shoes can also relieve joints and pain and prevent further damage.
In severe cases, joint replacement surgery is an option to restore function, said Dr Leung.
Another kind of joint disease called rheumatoid arthritis – an autoimmune inflammatory disorder, which causes the immune system to attack its own joints – is even worse.
Patients with this suffer from persistent joint pain and swelling that is more prominent than in osteoarthritis, said Dr Leung.
Rheumatoid arthritis also progresses faster and results in joint destruction within the first two years, she added.
Sometimes, patients can become lethargic or lose their appetite or weight.
Fortunately, rheumatoid arthritis affects fewer people – 0.5 per cent of the population.
The hand and the wrist joints are often affected and sometimes the shoulders, elbows, knees, ankles and feet too. There may be inflammation in the lungs, skin, eyes and hard nodules at the elbow. If untreated, the joints will be irreversibly destroyed, said Dr Leung.
Even though the cause of rheumatoid arthritis is currently unknown, it is believed that gender, genetic and environmental factors may have a role in its development. The disease usually strikes those in the 30 to 40 age group and women are more likely than men to get it.
It can be treated by biological agents that act much faster and control inflammation more effectively than traditional drugs, Dr Leung said.
These are disease modifying anti-rheumatic drugs that act on the immune system and anti-tumour necrosis factors that stop the action of tumour necrosis factors secreted by white blood cells during joint inflammation.
Patients may undergo physical and occupational therapy too.
When there is joint damage like in synovitis, the synovium (soft tissue that lines the non-cartilaginous surfaces within joints with cavities called synovial joints) may need to be surgically removed to reduce the rate of joint destruction, Dr Wong added.
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