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Musculoskeletal Pain

Is there a difference between Osteoarthritis and Rheumatoid arthritis?


At some stage in our lives we will all become sufferers of "arthritis" through normal everyday wear and tear. Osteoarthritis comes from the Greek language, osteo meaning bone, arthro meaning joint and itis meaning inflammation.
Osteoarthritis affects mainly the large joints especially the hips, knees and base of the thumbs. Due to repetitive use, injuries or infection the cartilage (soft spongy material which does not contain nerves) surrounding the bone, is gradually worn down exposing the hard, nerve rich bone beneath. The exposed bone on one side of the joint rubs against exposed bone on the other during any movement causing extreme pain and inflammation in the affected joint. The joint becomes swollen, painful and creaks and crackles as you move around getting worse as the day wears on.

Currently there is no proven cure to regenerate the damaged cartilage and reverse the process of osteoarthritis (this is controversial as there are many products on the market claiming to be able to regenerate cartilage, e.g. supplements containing glucosamine and hyaluronic acid). Prevention is the best form of cure and includes weight-loss, gentle regular exercise and a well balanced diet with sufficient calcium. Treatment of symptoms includes pain killers, anti-inflammatory tablets, physiotherapy and hydro-therapy. When the arthritis has progressed to a point where it is either impairing your job or the pain is affecting your life and not being controlled by the pain killers, consult your doctor or Orthopaedic surgeon for further treatment. This will range from washing out the joint through key-hole surgery to a total joint replacement. The outcome is excellent and most patients return to their normal lives free from pain.

Rheumatoid arthritis

Rheumatoid arthritis is an auto-immune disease, meaning your body incorrectly thinks that the lining of your joints (synovial membrane) are an enemy and sends its soldier cells (inflammatory cells) to attack and destroy the lining causing joint destruction in the process. This is a systemic disease, affecting all the organs and system of the body and not just the joints. The disease begins by destroying the lining of the joints, but the inflammatory cells also damage the surrounding cartilage and slowly "eat" away at the bones of the joints, destroying the articulating surfaces in the process. If left untreated it can progress to become a devastating disease leaving the sufferer contorted and crippled.

Rheumatoid arthritis starts at a much younger age and first involves the small joints of the hands and feet. Only in the late stages does it affect the larger joints. Those affected, experience morning stiffness in symmetrical joints of hands or feet with the joints slowly loosening up as the day progresses. Inflammation causes warm, swollen and painful joints which slowly begin to deform the fingers and toes giving them the typical crooked "witch fingers" appearance.

Treatment is a team approach consisting of general practitioners, rheumatologist, orthopaedic surgeon, physiotherapist and occupational therapist. Markers in your blood can be tested to confirm the disease and tailor the most effective treatment. Disease modifying drugs are used to bring the inflammation and synovitis (joint lining inflammation) under control (cortico-steroids and cancer type drugs e.g. methotrexate). The Occupational therapist and physiotherapist will supply exercises that keep the joints mobile and avoid deformities that may occur from the destruction of the joints. Once pain and deformity have set in the Orthopaedic surgeon steps in to perform preventative or corrective surgery.

Why do I get back pain and when should I worry?

Back pain is the most common musculoskeletal complaint. The back consists of the boney vertebrae, each separated by a spongy vertebral disc. Large powerful muscles surrounded and supported the vertebral column. Through each vertebra runs the spinal cord with individual nerves that supply movement and sensation exiting between two vertebras. Injuries to any one of these structures results in back pain.

Lower back pain originates from muscular strain or instability of the vertebral bodies. It is an intense pain isolated to the lower back, which is normally the result of excessive bending or lifting of heavy objects. Treatment involves rest, pain killers, anti-inflammatory drugs and a muscle relaxant, surgery is rarely indicated. Back education by a physiotherapist, stretching and core strengthening prevents the occurrence of lower back pain.

Back pain that radiates down one leg, commonly known as sciatica (named after the sciatic nerve which is the most commonly pinched nerve) is the more debilitating and serious of the two types of back pain. The pain starts in the back or buttock and shoots down one leg most often all the way into the foot, this can be accompanied by a change in skin sensation and muscle power in the affected leg. This is caused by a nerve that is pinched by a herniated vertebral disc as it exits the spinal cord. Only one leg is affected as the disc normally herniates to one side due to a thick ligament in the centre of the spinal canal.

It is advisable to contact your doctor who will prescribe the most suitable treatment consisting of rest, pain killers, anti-inflammatory drugs and a muscle relaxant. Should this not relieve your symptoms a specialist will refer you for a MRI-scan to visualize the spinal cord and nerve roots. Surgery may be required which involves removing the herniated piece of disc using a microscope.

Should you experience any change in bladder or bowel function, and numbness around the anus seek immediate medical attention (known as cauda equina syndrome). If the herniated disc is not removed immediately it may result in permanent neurological damage.
Back pain affects us all and if treated properly is simply cured with minimal impact on your life, health and occuption.


As a full time orthopaedic surgeon at Mediclinic Cape Town, Doctor Jason Crane offers advanced orthopaedic care in a state-of-the-art medical facility on the slopes of Table Mountain.


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location Mediclinic Cape Town, Suite B105, 1st Floor (Doctors Block)
21 Hof Street, Oranjezicht, Cape Town, South Africa