I’m Dr. Jackie Whittaker, physiotherapist and research scientist at Arthritis Research Canada. I’m working to prevent the most common type of arthritis: osteoarthritis. AMA!

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The research shows that the most effective way to manage osteoarthritis is regular exercise-therapy (structured exercise program developed & progressed in consultation with a healthcare professional, most commonly a physiotherapist). Everyone with osteoarthritis should have a structured exercise program. One example is the GLAD program https://gladcanada.ca/. The exercise program can be supplemented with pain medications as needed. There really is not a lot of beneficial evidence that cortisone injections reduce knee pain in the long term, and joint replacement should really be a last resort when exercise-therapy and pain medications have been exhausted. Even after a joint replacement exercise-therapy is important because people are often quite weak.

Hi Dr. Jackie , since you are an expert on the field can I forward your response to the correlation between cracking my knuckles and getting arthritis to my mother ? She's always telling me to stop but I simply can't help it lol

Yes, you can tell your mother that there is no scientific evidence that knuckle cracking leads to arthritis! :)

Hi Dr Whittaker,

Hope you’re well

I have recently been told I have stage 1 hip OA (bilateral) due to undiagnosed hip impingement.

The think is I don’t get any pain in my hips, just a strange tightness but have had severe pain in my medial left knee for months.

My knee mri came back clear, could this be referred pain from the hip.

I am also researching the h1 ceramic hip resurfacing trial and am considering getting this done.

Can you explain to me why most surgeons won’t do resurfacing until end stage arthritis is reached?

I really don’t see the point of putting myself through 10 years of worsening pain and becoming more inactive when I could do this and continue a fully active life

Also do you have any thoughts on the H1 Trial (Prof Cobb, imperial London)

Thanks so much for your time

It is difficult for me to respond to specific cases without knowing more and doing an assessment but a couple of things to consider (also not familiar with the Hi trial);

1- just because you have some findings on an MRI does not mean that you need surgery or need to do anything. A lot of people with no pain have what we call ' abnormalities' on imaging and we know that if they do surgery it does not always make the situation better, often it makes it worse. 2- similarly just because you have a 'normal' knee MRI does not mean there is not something you need to do for your knee. MRI's are not perfect and often don't really help guide care. 3- surgery, even arthroscopic (scope) surgery is invasive to the joint and had been associated with accelerating osteoarthritis and can lead to earlier joint replacement, so it is not always the answer. 4- you might want to see a health practitioner like a physiotherapist who can assess your knee and hip and help you to set up a plan as an alternative to surgery.

Again, really tough to provide advice but just a few things to consider.

I feel like people don’t understand what living with osteoarthritis is really like. What are the biggest myths about this disease?

One of the biggest myths is that weight-bearing exercises like walking, running, and jumping cause osteoarthritis and people with osteoarthritis should not do them.

The interesting thing about cartilage (the tissue that covers the end of the bones in our joints and where osteoarthritis starts) is that it has no blood supply, so it can’t get its nutrition the way that most of the tissues in our body do. Instead, the food that the cartilage needs is found in the fluid inside the joint. So the way that it works is that the cartilage acts as a firm sponge, when it is compressed or squeezed all the fluid moves out of it, and when the compression is released the fluid moves back in. So we squeeze the fluid moves out of the cartilage, we release and it moves back in bringing the nutrition that it needs to stay healthy.

How do we naturally compress and decompress our cartilage, well we do that with weight-bearing. Activities where we cycle between compression and decompression, squishing the cartilage and unsquishing the cartilage.

In fact, there is a recent review that has looked at all the research on running and osteoarthritis https://pubmed.ncbi.nlm.nih.gov/34478109/ and it shows that cartilage recovers after a single bout of running and adapts over time. So really gradually adapting to weight-bearing activities are the key to keeping the cartilage in your knee healthy even if you have osteoarthritis.

What would you recommend to physiotherapists that work frequently with patients with osteoarthritis?

I think the big thing is education and exercise. The keys are: 1- working with them to help them find exercises that work for them to get to a healthy weight, develop and maintain strong leg muscles (particularly the quadriceps) and feed their cartilage regularly (weight-bearing activities), 2- work with them so they can learn how to adapt their exercise dose on their own (also to know when to reach out for help), 3- make sure if they have any co-morbidities (i.e., diabetes) these are under control, 4- provide them with the knowledge that exercise is the MOST important thing they can be doing and debunking myths around not doing weight-bearing exercises and that the only treatment option open to them is a joint replacement.

More in this paper https://pubmed.ncbi.nlm.nih.gov/33242604/

How does osteoarthritis risk differ around the world? And why do more North Americans have it?

This is a great question! I don't think we totally know but it likely comes down to the fact that people in higher-income countries are more overweight and less active then in middle to lower-income countries. Lifestyle is a key issue.

Thanks, everyone for your great questions! I hope the answers are helpful. Key takeaways are to get, or stay active. If you can't find a way to be active without pain get some help (physiotherapists are a great place to start)!

You mentioned ‘12 million Canadians will have this painful disease by 2040’ — is the prevalence of osteoarthritis growing? If so, why?

I would also add that most Canadians don't get the right treatment for osteoarthritis when they are diagnosed. Management of osteoarthritis in Canada is very passive (just wait until it is so bad you need a joint replacement) which is the opposite of what research tells us is best. Every Canadian that is diagnosed with osteoarthritis should receive exercise therapy, education, and if appropriate weight management. Until we do this it is likely the prevalence and severity of osteoarthritis will continue to grow.

https://oarsi.org/sites/default/files/images/2020/oarsi-20-final-oa-infographic-_revised_copyright.pdf

Yes it is likely that the number of people with osteoarthritis is increasing. There are a few reasons for this: 1-the population is getting older and osteoarthritis is more common in older people, 2-more people are having knee injuries (at sport and work) and knee injuries increase the risk of osteoarthritis, 3-people are getting fatter (meaning have more fat tissue) and fat tissue (also called adipose tissue) is a risk factor for osteoarthritis, 4- people are getting less active and inactivity likely also increases the risk for osteoarthritis.

Hi Dr. Whittaker, I have been through 3 ACL surgeries since 2008 (2 on the L knee and 1 on the R knee). I've been told that arthritis is inevitable for me and that I should expect to require knee replacements in my future. Is this true and is there anything I can do to prevent this?

People that have an ACL tear are at increased risk of developing osteoarthritis. It is not inevitable, but given that you have several injuries on your one knee you do have an elevated risk. The good news is that now that you know, that there are things you can do to reduce your risk and reduce the severity (amount of pain and disability) you experience if you get osteoarthritis. The two big things are to maintain a healthy weight (fat or adipose tissue - can accelerate cartilage degeneration) and work hard to build your leg muscles strength, particularly your quadriceps. We know that people with stronger quadriceps have a a lower risk of knee osteoarthritis. Another important thing is to slowly build up your ability to do weight-bearing activities (i.e., walking) daily to help to feed the cartilage in your knee joints.

What exactly is osteoarthritis?

Osteoarthritis is a degenerative joint disease, it is NOT just 'wear and tear' in response to aging. Under normal circumstances our tissue (including the cartilage in our joints) are constantly turning over, meaning that we are reabsorbing older parts of the tissue and laying down newer tissue.

If the amount of new cartilage tissue = the amount reabsorbed then we have happy cartilage and happy joints. With osteoarthritis, the balance gets thrown off (we are not totally sure why and there are likely many reasons), we see more reabsorption or break down and degeneration of the cartilage. This can then impact the whole joint and the muscles around the joint and may (but not always) lead to pain and disability.

If osteoarthritis isn’t something that people get as a result of aging, then what causes it?

We don't totally know, but what we do know is that there are likely multiple reasons for why our biology related to joint cartilage gets unbalanced (examples include; joint injury, micro-inflammation associated with fat tissue, genetics).

Thanks you for taking the time to answer questions today!

I am an ultraendurance athlete, but also suffer from OA (genetic) - particularly at joints that have suffered acute damage (i.e. big toe tarsal from stubs, finger joints from bracing falls, SI joint from repetitive use). These can inflame painful under various conditions.

Questions:

1. What is the recommendation for exercise on joints that have suffered OA? I find that motion is lotion.
2. What are the dietary dos and don'ts for OA?

I think it all comes down to balance.

1 - Yes joints are made to move, but sometimes the best answer is to do less, or spread your training load around (likely not something you want to hear or that resonates with you). 2- as far as diet there is no great evidence. I think the key is a healthy diet and some would advocate for fewer refined sugars. 3- PRP - no evidence of any lasting effect for PRP

What symptoms will I experience if I have osteoarthritis? How do I know when to seek help from a doctor or physiotherapist?

The most common symptoms of osteoarthritis are persisting joint pain, short-lived joint stiffness after prolonged positions and functional restrictions (i.e., can't move and do some physical things). It is important to know that x-rays are actually not great for determining if you need help or not. People that have x-rays that show 'osteoarthritis' sometimes don't have any symptoms, and people with 'normal' joint x-rays often can have symptoms of osteoarthritis.

You know you need help when you start to notice that joint pain is interfering with your ability to be active or do the things you want to. I would offer that although your doctor is an important part of your healthcare team them may or may not be the best place to start and if you are in Canada a better option might be a physiotherapist because they are specifically trained to assess and treat joint pain, and are really good at helping you overcome functional restrictions.