The consultation: where should you go, who should you see and why?

Osteoarthritic flare-ups reflect structural changes and destruction of the cartilage surface, with the production of debris.
At first, the thickness of the cartilage is preserved and X-rays are normal. The debris and degradative enzymes released are very irritating to the joints. As a result the latter manufacture a larger amount of synovial fluid (which normally exists in small quantities) to enable diluting irritant substances and lubricate the damaged joint. 

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During an osteoarthritic flare-up these lesions persist and worsen if the joint is left untreated and/or not rested either completely or partially, by using a cane, for example for weight bearing joints. In this case, the cartilage no longer having its normal resistance, irritant substances continue their action of cartilage degradation and the slow healing process cannot be completed properly. The painful flare-up continues.

By resting your joints during flare-up episodes they can finally "self cleanse" and heal: the cartilage regains its firm surface. Although it looks thin on the X-ray, it functions normally. After a few days you can thus resume your normal activities.  

The evolution is thus a succession of painful flare-ups separated by intervals of variable duration, up to the stage of cartilage ulceration. At this stage, the cartilage has disappeared and part of the bone is exposed so the pain may intensify. Sometimes the episodes slow down or even disappear, replaced by pain proportional to the time of walking and standing.  Twenty years may go by between the beginning of the first flare and the total destruction of the cartilage. However, the pain caused during osteoarthritic flare-ups is not always very pronounced, so that some people neglect their osteoarthritis with the risk of it being discovered at an advanced stage. 
 
Thus, you need to know that it is not normal to suffer regularly from a painful joint. It is essential that you go and see your doctor as early as possible. He will prescribe the standard X-rays that will serve as a basis for regular monitoring. If they are normal, they will serve as a reference for this monitoring. 

Your GP, general practitioner

He or she knows you and is best placed to organise your care. Indeed, a general practitioner considers the patient as a whole and the affection from he or she suffers as the result of physiological, human and environmental factors. Hence, he or she has a special relationship with each patient.

In addition, if necessary he or she will refer you to a specialist (Rheumatologist, Radiologist, Physiotherapist, etc.), and/or will prescribe additional tests needed to confirm the diagnosis, drain an effusion and ensure you get the appropriate treatment.

 

The rheumatologist

With their training and knowledge, is the specialist for pain and diseases of bones, joints, muscles and tendons. He is the privileged partner, like other specialists, of your GP. Your doctor will refer you to a rheumatologist if necessary.

If you are suffering from one or more joints and have some of the symptoms mentioned in this section, you should go and see your general practitioner.

All of these measures will help make you a real player in your health issues rather than just a passive patient This partnership with your doctor will help you to build a more effective anti-osteoarthritis strategy.

The measures outlined will enable you to better manage and control the evolution of your arthritis. Participating in your medical care is essential in the management of your arthritis.

It is very important that you:

• Do not hesitate to go and see your doctor if an aspect of your self evaluation shows a change for the worse.
• You will go for an X-ray which, as you will remember, is used for monitoring osteoarthritis in a concrete way. The frequency of radiological monitoring is guided by your symptoms.
• Follow your prescribed treatment to the letter. The latter is not only medication: often physical exercise or physiotherapy will be offered in addition to drug treatment.
• Learn the name and dosage of the drugs prescribed by your doctor. Each individual reacts differently to the same speciality. You will never annoy your doctor if you inform him or her:

1. of a delay lasting too long for a limited effectiveness,

2. unexpected reactions.

Be patient and calm!

Sedating an osteoarthritic flare-up or cooling a damaged joint takes time.

By following the tips provided as much as possible, you can help to slow down the evolution of your osteoarthritis.