Reasons to measure Osteoarthritis
Why should you measure your Osteoarthritis? If you want to reduce the pain it is important to have a record of how severe the pain is before you make each change. How effective was that tablet I took last year? Did losing weight make any difference? Did red wine help me? It is also useful to understand how to diagnose osteoarthritis.
You need a system to measure the severity and impact of your pain on that date. It has to be easy to do and it has to give you some meaningful information. (As you are now becoming a citizen scientist this will be called your Data)
How to measure?
This is a question that many clever people have tried to answer. Dr Nicholas Bellamy led a group that compiled a set of questions measuring the effect of osteoarthritis. This is the Western Ontario and McMaster Universities Osteoarthritis Index and became known all around the world as WOMAC. Lots of people have continued to study it and to make refinements. It has been translated into many languages and each time it has been translated it has then been tested to make sure that it still works and is reliable in that language.
How reliable is WOMAC?
WOMAC has 24 questions and is relatively easy to use. Each time you use it it gets easier. Time is our most valuable resource and answering the WOMAC does take significant time. However,if you make the effort and understand what each of the questions is trying to do it will become easier and more accurate. This will be of much more value to you. For more information read this post “How to use WOMAC“
Answer all the questions. Take your time. Read the explanatory notes. Ask for help. Each time you do it you will become more accurate and more reliable. Always remember that you are doing this for your own information. So be honest with yourself. If you are going to stop eating bread, drinking alcohol or going for a walk every day you want to know “Does it really make any difference?” and “how important is this change?” The real question is not “how reliable is WOMAC” but “How reliable are you?”
You can make your own short version of WOMAC?
Is there a shorter version of WOMAC? Yes there is. Is it any good? Absolutely! This is your personal version and relates specifically to you. First you answer all the questions. The next day you answer them all again. Then look back at you answers to each question. Was that an accurate answer? It is unlikely that you will never be 100% satisfied with your answers but as you develop a better understanding they will become more accurate, more repeatable. This is your baseline and forms your point of reference. “Since I started walking has my score improved in comparison to my reference score?”
Custom WOMAC
Now you look at all the questions and decide which ones are important for you. Which ones most closely relate to me. Then if you discard all the least important questions you will have your own short version. This is valuable because you will be able to get a reasonable assessment of your function on any day with little effort. Tracking changes will be easier. If you are worried about accuracy sit down and answer all 24 questions.
If you don’t measure before you make a change your interpretation of your improvement will be clouded and unreliable.
Are there other measuring forms?
Yes. WOMAC is best used for knee OA. There is another questionnaire for knees called the Knee Osteoarthritis Outcomes Score (KOOS). This one is free. If your OA is mainly in your hips you can use the Hip Osteoarthritis Outcomes Score (HOOS). The shortest measure is the VAS pain score. It is quick and easy to use. It has been studied extensively and is reliable. A change of 1 is significant (Minimal clinically important difference – MCID). If your VAS is 33 or less this is acceptable pain control after surgery. But, it only tells you about pain. It doesn’t record function. Can you move, walk or run? Print VAS Pain chart here
Do x-rays measure Osteoarthritis?
Yes, but not very well. X-rays cannot ‘see’ the cartilage. A guess is made that because the bones are closer together the cartilage that normally holds them apart must have been lost. Osteophytes and bone sclerosis is easy to see and these are indicators of the changes that have happened to your bones because of osteoarthritis. X-rays are graded according to the Kellgren and Lawrence scale looking at how close the bones are and whether osteophytes and bone sclerosis are present.
CAT scans ‘see’ the cartilage
CAT scanning has allowed us to see the cartilage on the surface of the bone. When the cartilage is lost you are said to be ‘bone on ‘bone’. Surprisingly this is often not painful and may be completely asymptomatic. We do not know why some people with minimal changes on x-ray and CAT scan can have severe pain and disability while others who are obviously ‘Bone on Bone’ have no symptoms. This leads to two important points. First x-rays cannot be the only guide to treatment. Second treatment to remove pain and stiffness can allow complete return to full function. Dancing, running and jumping can all happen again while you are still ‘Bone on Bone’.
This patient has been able to grow new cartilage after treatment with a stem cell mixture (His own Adipose SVF). The bright white area is synovial fluid. New cartilage is the grey area next to the synovial fluid. There is a strip of dense cartilage next to the new cartilage. This is seen as a black line. Not everyone is able to grow new cartilage and this is why you need to measure your osteoarthritis using another tool.