Osteoarthritis (OA) is the most common form of arthritis worldwide and a leading cause of joint pain (joint and bone conditions page) and disability in Singapore. Its significance is evident in recent studies, where it is estimated that about 11% of Singaporean adults have symptomatic knee osteoarthritis, with the prevalence increasing to nearly 20% among those aged 60 and above.

Often described as "wear-and-tear" arthritis, OA develops when the protective cartilage that cushions our bones gradually wears away. As this degeneration progresses, joint pain, stiffness and reduced mobility become more pronounced, especially in frequently stressed joints like the knees, hips, hands and spine.

Unlike immune-related forms of arthritis, OA is a degenerative condition that unfolds gradually over time. That is why early recognition and effective management are crucial if we are to preserve mobility and maintain quality of life well into later years.

What are the types of Osteoarthritis?

The condition can be classified in different ways depending on what triggered the joint damage and how many joints are involved. These include:

• Primary osteoarthritis – this is the most common form and develops gradually as part of the natural ageing process. Over years of use, cartilage begins to thin and wear away, even without a specific injury or underlying medical problem.
• Secondary osteoarthritis – the joint damage is linked to an identifiable cause such as a previous injury, obesity, congenital joint abnormalities or diseases that accelerate cartilage breakdown. The wear and tear may develop earlier and progress more rapidly than in primary OA.
• Localised osteoarthritis – only one or a small number of joints are affected. For example, OA may be limited to the knee or the hip.
• Generalised osteoarthritis – multiple joints across the body are involved, such as both knees, hips and the spine. This wider pattern can have a greater impact on mobility and daily activities.

What causes Osteoarthritis?

Osteoarthritis often develops due to a complex interplay of mechanical stress, cartilage breakdown and the body’s reduced ability to repair joint tissue. Some of the main mechanisms include:

• Bone changes – as cartilage deteriorates, the bone underneath thickens and forms bony growths called osteophytes, which can further restrict movement.
• Cartilage wear and tear – repeated joint use gradually erodes the smooth cartilage surface, leading to friction between bones.
• Inflammatory response – low-grade inflammation in the joint lining contributes to pain, swelling and ongoing cartilage loss.
• Loss of elasticity – ageing cartilage becomes less flexible and more prone to damage.

What are the symptoms of Osteoarthritis?

The symptoms usually develop gradually and become more severe over time. Some of the common complaints include:

• A grating or crackling sensation when moving the joint
• Loss of flexibility and reduced range of motion
• Persistent joint pain that worsens with activity and improves with rest
• Stiffness, especially in the morning or after long periods of inactivity
• Swelling and tenderness around the joint
• Visible enlargement or deformity in advanced stages

Who is at risk of Osteoarthritis?

While osteoarthritis can affect anyone, certain factors increase the likelihood of developing it. These risks are linked to how the joints are used, how the body changes over time and underlying health conditions. These may include, but are not limited to:

• Age – as we grow older, cartilage gradually loses its strength and elasticity. The body’s natural ability to repair small areas of joint damage also slows down, which makes the joints more prone to wear and tear.

• Gender – women are more likely to develop osteoarthritis than men, particularly after menopause. Hormonal changes are thought to reduce the protective effect of oestrogen on cartilage, leaving joints more vulnerable to degeneration.

• Genetics – a family history of osteoarthritis can increase the likelihood of developing the condition. Certain inherited traits, such as the shape or alignment of joints, may predispose cartilage to break down more quickly.

• Other health conditions – metabolic disorders such as diabetes, as well as inflammatory conditions like gout or rheumatoid arthritis, can damage joint tissues directly or increase inflammation, which in turn makes cartilage more fragile.

• Joint injury – past injuries such as ligament tears, cartilage damage or bone fractures can disrupt the smooth functioning of a joint. Even if the injury heals, it can leave the joint unstable or unevenly loaded, accelerating the breakdown of cartilage.

• Repetitive stress – jobs or activities that involve frequent kneeling, squatting, heavy lifting or twisting motions place repeated mechanical stress on joints. Over time, this ongoing strain increases the chance of cartilage wearing out.

• Obesity – carrying excess weight adds continuous pressure to weight-bearing joints like the knees, hips and spine. The additional force speeds up cartilage breakdown and can trigger inflammation that worsens joint damage.

What are the complications of Osteoarthritis?

When osteoarthritis progresses unchecked, the damage within the joint does not remain confined to discomfort alone. The gradual loss of cartilage and the resulting changes in bone structure can interfere with simple movements, limit independence and affect overall quality of life.

Some of the potential complications include:

• Chronic pain that affects mobility and independence
• Development of bone deformities or joint instability
• Increased risk of falls and related injuries due to impaired mobility
• Severe stiffness leads to difficulty walking, climbing stairs or using hands
• Sleep disturbances due to pain at night

How is Osteoarthritis diagnosed in Singapore?

Because joint pain and stiffness can be caused by many different conditions, a careful evaluation is necessary to confirm osteoarthritis and rule out other possibilities. The diagnosis is usually a combination of the following steps:

• Medical history – the consultation begins with a detailed discussion of symptoms, such as the nature and timing of the pain, morning stiffness or difficulty with certain movements. Dr James Tan will also review daily activities, past joint injuries and any family history of arthritis, all of which provide important clues about underlying risk factors.

• Physical examination – the joint is then examined for signs such as tenderness to touch, visible swelling or a reduced range of motion. Our doctor may listen and feel for creaking or grinding sensations, which suggest cartilage loss and assess whether the joint feels unstable.

• Imaging – X-rays remain the mainstay for diagnosing osteoarthritis, as they can reveal narrowing of the joint space, bone spurs and changes in bone shape. A magnetic resonance imaging (MRI) may be recommended to give a clearer picture of the cartilage, ligaments and other soft tissues that do not show up well on X-rays.

• Laboratory tests – although there is no specific blood test for osteoarthritis, lab investigations can help rule out other conditions that mimic its symptoms, such as rheumatoid arthritis, gout or infections. For example, blood tests and joint fluid analysis may be performed if another type of arthritis is suspected.

How is Osteoarthritis graded?

Doctors often use the Kellgren-Lawrence grading scale, based on X-ray findings, to classify osteoarthritis severity. The classifications are:

• Grade 0 – normal joint with no signs of OA
• Grade 1 – doubtful narrowing of joint space and possible small bone spurs
• Grade 2 – Definite bone spurs and mild joint space narrowing
• Grade 3 – multiple bone spurs, definite narrowing, some deformity and possible cysts
• Grade 4 – severe joint space narrowing, large bone spurs, significant deformity

How is Osteoarthritis treated in Singapore?

Although there is no cure for osteoarthritis, there are many treatments that can relieve symptoms, improve function and slow progression. Depending on the severity of your condition, treatment typically involves a combination of approaches:

Conservative treatment

• Assistive devices – braces, supportive footwear or walking aids to reduce stress on joints.
• Lifestyle modification – weight loss, reduced high-impact activity and joint-friendly exercises.
• Pain management – heat or cold therapy, activity pacing and over-the-counter pain relievers.

Non-surgical treatment

• Medications – non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics for pain and inflammation.
• Injections – corticosteroid injections for flare-ups, hyaluronic acid injections to improve lubrication, or platelet-rich plasma (PRP) injections to stimulate healing and tissue repair.
• Physiotherapy – strengthening muscles around the joint, improving flexibility and restoring mobility.

Surgical treatment

• Arthroscopy – minimally invasive procedure to smooth cartilage or remove loose fragments (best in select cases).
• Osteotomy – bone realignment surgery to shift weight away from the damaged joint area.
• Joint replacement (arthroplasty) – replacing severely damaged joints, particularly hips and knees, with prosthetic implants.

Summary

Osteoarthritis may be a long-term condition, but it does not have to define the way you live your life. With early diagnosis, thoughtful lifestyle changes and the right medical or surgical support, many people can stay active, reduce pain and continue enjoying the activities they love.

If you have been noticing persistent stiffness, discomfort or difficulty moving your joints, it is important not to brush these signs aside. Reaching out for help early can make all the difference. Contact us today to schedule an appointment with Dr James Tan and take the first step towards protecting your joint health and restoring your quality of life.