JOINT pain becomes more common as we grow older, but it should not be dismissed as a consequence of ageing.
Consultant rheumatologist Dr Lee Kar Hoo at Sunway Medical Centre Damansara (SMCD) says the term “arthritis” is a broad description for a group of conditions that affect the joints, causing pain, stiffness and swelling.
Generally, arthritis can be divided into inflammatory and mechanical forms. Inflammatory arthritis occurs when the joint becomes painful and swollen.
He notes that it can arise from infections, autoimmune diseases, chemical or drug-related reactions, and certain metabolic or hormonal disorders.
Mechanical arthritis – also called osteoarthritis – develops through changes in the cartilage, bone and other structures within a joint. Ageing is a risk factor, but previous injuries, excess body weight, joint alignment, genetics and repetitive loading may also be contributory.
Dr Lee says controlling the underlying inflammation early may prevent or limit permanent joint damage in inflammatory arthritis.
For mechanical arthritis, the treatment generally focuses on relieving symptoms, improving function and addressing the mechanical factors contributing to the problem.
The pattern of symptoms can provide important clues to assist diagnosis, says Dr Lee.
“For inflammatory arthritis, symptoms are worse after resting, while mechanical-type joint pain worsens as the day progresses.
“Swollen or warm joints and involvement of multiple joints suggest inflammatory disease, whereas mechanical arthritic joints improve with rest and deteriorate with activity.”
Inflammatory arthritis often extends beyond the joints.
Depending on the underlying disease, patients may experience persistent fatigue or involvement of the skin, eyes, lungs, heart, kidneys and other organs.
Family history and occupational history may be important, says Dr Lee.
To diagnose, blood tests can help identify inflammation and markers associated with particular autoimmune diseases, while uric acid, and sometimes, analysis of fluid taken from a swollen joint can assist in diagnosing gout.
Imaging such as X-rays, ultrasound and MRI may reveal cartilage loss, bone changes, inflammation or structural damage.
He adds that making the correct diagnosis early is important.
Medications to stop the inflammation and relieve the pain are fundamental.
Once controlled, specific treatment will be prescribed to address the cause. When treatment is started promptly and disease activity is well controlled, irreversible joint damage – and consequently, the need for future surgery – may be reduced, he says.
The good news is not everyone with arthritis requires surgery.
Medication, exercise, physiotherapy, weight management where appropriate, and pain control, can help many remain active for years.
SMCD consultant orthopaedic trauma, arthroplasty and robotic surgeon Dr Juzaily Fekry Leong emphasises: “Surgery is always the last resort. It becomes necessary only when conservative treatment is not adequate.”
According to him, joint surgery is needed to reduce or eliminate pain, and correct deformity so that patients can resume their normal daily living.
Also, surgery does not always mean replacing the joint.
Joint-preserving procedures may be appropriate in some, especially younger ones, particularly when damage is localised or when abnormal joint alignment is contributing to the problem.
Procedures such as osteotomy can redistribute forces across the joint and potentially delay replacement. However, when a joint is extensively damaged, arthroplasty, or joint replacement, may offer more reliable relief.
Hip and knee replacements are among the most common, replacing damaged joint surfaces with artificial components designed to restore movement, relieve pain and improve function.
Joint surgery has evolved considerably, with robotic-assisted surgery and artificial intelligence (AI)-assisted computer navigation being increasingly utilised, says Dr Juzaily.
“Such technologies help surgeons plan operations and
position implants with a high degree of precision, although technology remains a tool that complements, rather than replaces, the surgeon’s expertise.”
Age does not determine whether someone is suitable for surgery.
“We consider the severity of joint damage, symptoms, overall health, activity level, expectations and whether non-surgical treatments have been adequately explored.
“There isn’t a ‘too young, too old’ cut-off. As long as the patient is fit for the surgery, there are no limits,” he notes.
Ultimately, both specialists stress the importance of seeking a proper diagnosis rather than self-treating persistent joint pain.
“Many Malaysians assume their joint pain is osteoarthritis or gout and treat themselves. You need an accurate diagnosis so that the underlying cause can be treated before permanent joint damage, or other complications, occur,” advises Dr Lee.
Patients should also not automatically fear surgery, adds Dr Juzaily.
“With modern surgical techniques and tools, hospital stays have become considerably shorter. Some patients undergoing joint replacement may be discharged within a few days, while carefully selected patients may even be suitable for same-day surgery.”
Arthritis care has one ultimate goal: preserving mobility and quality of life for as long as possible.
