Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Osteoarthritis And Sport

Athletes who suffer from osteoarthritis should take the advice of their doctors with regard to continuing sporting activities. Each case has to be considered on its own merits. In the early stages there is usually no
reason to cease participation in sport, although there may need to be a change in the type of exercise. Cycling and swimming may be recommended rather than running in order to eliminate or at least reduce load on an affected joint. Active mobility and muscle-strengthening exercises should be encouraged to prevent or delay deterioration. Once a damaged hip or knee has been replaced surgically by a prosthetic joint, sporting activity should only be resumed after consultation with the doctor in charge.

Rheumatoid arthritis

Rheumatoid arthritis, which is classified as an autoimmune disease (a disease of the body’s own immune system) although its precise cause is not known, is a chronic inflammatory condition which affects joints, tendons, tendon sheaths (fascia), muscles, and bursae, as well as other tissues throughout the body. It is three times more common in women than in men and usually begins in the age ranges 20–30 years or 45–55 years; however, it can begin in childhood.

Pathological changes

The first stage in rheumatoid arthritis is inflammation of the synovial (joint lining) membrane (synovitis) associated with the deposition of protein (fibrin). As a result of the inflammation, fluid is secreted into the joint, causing swelling. The inflammatory tissue grows towards the center of the joint space and coats the articular surfaces and the surrounding ligaments and tendons. At the same time, the articular cartilage is destroyed systematically from its surface inwards to the underlying bone, and cysts form in the adjacent bone. As the inflammatory tissue begins to be replaced by scar tissue, the joint capsule becomes thickened and can consequently impede the mobility of the joint and increase the swelling.


Symptoms and diagnosis

The following symptoms suggest a diagnosis of rheumatoid arthritis:

– pain and swelling of joints;
– joint stiffness which is particularly pronounced in the mornings and after activity;
– joint deformities, muscular hypotrophy, and tendon abnormalities;
– periods of relapse and remission in the course of the condition.
For practical purposes, rheumatoid arthritis is considered to be present if three or four of the following
criteria are fulfilled:
1. Morning stiffness.
2. Pain and tenderness in at least one joint.
3. Soft tissue swelling or excessive fluid in at least one joint.
4. When (2) or (3) is present, swelling in at least one other joint.
5. Symmetrical joint swelling.
6. Nodules on tendons at sites typical of rheumatoid arthritis.
7. X-ray changes typical of rheumatoid arthritis.
8. Blood tests showing changes typical of rheumatoid arthritis.

Treatment

As with osteoarthritis, there is no cure for rheumatoid arthritis. However, its manifestations and progress can temporarily be controlled and symptoms relieved by:
– physiotherapy and maintenance of general physical fitness;
– anti-inflammatory medication;
– steroid medication;
– current medication to treat the cause of the disease;
– local treatment with steroids or gold in advanced cases;
– surgery, in severe cases.

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