How to Treat Osteoarthritis and Relieve its Symptoms
Osteoarthritis is by far the most common form of arthritis, a progressive, debilitating disease that involves inflammation of joints and requires medical attention. Although it has no ultimate cure, with the right treatments its potentially crippling effects can be halted and even reversed. Besides osteoarthritis, other common forms of arthritis include rheumatoid arthritis and gout.
If you are over 65, odds are even that you are suffering from some form of arthritis. It may be nothing more than just mild stiffness in the hands or knees or, in more advanced stages, may plague you with several painfully swollen and severely inflamed joints. Besides old age, it is defects in the immune system, infections and genes that are suspected as the culprits in some forms of the disease. Past joint injuries and the natural deterioration of joints over a lifetime also make a person more vulnerable.
Many people ignore the symptoms of arthritis or dismiss them as signs of growing older. Others take painkillers instead of seeking medical treatment. Some try unproven remedies such as copper bracelets. However, none of these strategies is adequate. Patients with arthritis need professional medical help.
Osteoarthritis: The Most Common Form of Arthritis
Osteoarthritis, the most common type of arthritis and the only form directly related to age, is a progressive, degenerative joint disease that originates from natural wear and tear of the body’s joints. It is estimated that half of all adults over 65 have osteoarthritis and the disease is even more common after age 75.
Osteoarthritis is characterized by the breakdown of the firm, rubbery material that cushions the surface between the bones in a joint, called cartilage, and the thickening of adjacent bone and soft tissue. As cartilage ages, it begins splitting. Bone surfaces in the affected joint can then make direct contact with each other during movement, causing pain. The cartilage gradually loses its elasticity and wears away completely, leaving the surfaces of the bones entirely unprotected.
Generally, only one or two joints get affected by osteoarthritis. The knee, hip, hand and spine are most vulnerable. Osteoarthritis initially causes only mild pain and stiffness but as the condition progresses, fluid, which lubricates and nourishes the cartilage, begins to accumulate and the joint becomes swollen. Osteoarthritis rarely results in serious deformity. But, it can eventually limit a person’s mobility if they do not make necessary changes in their lifestyle and do not use medications to relieve symptoms.
Several factors are thought to be implicated in causing osteoarthritis. Genetics or heredity, excess weight, previous injuries and overuse of joints in sports or work-related activities can all encourage development of osteoarthritis.
Symptoms of osteoarthritis that last longer than two weeks should be reason enough to see your primary care physician. The doctor will conduct a thorough physical exam and may order x-rays or magnetic resonance imaging scans to look for bone and joint changes typical of osteoarthritis. Blood tests may be used to rule out the presence of other conditions whereas joint fluid analysis can determine whether there is inflammation in your joints and whether the pain is not caused by gout. However, the major criteria confirming a diagnosis of osteoarthritis or any other form of arthritis are simply pain and limitation of motion.
Although no ultimate cure for osteoarthritis exists, treatments, such as joint protection, physical therapy and medications, can significantly improve its symptoms. For example, overweight patients usually benefit from weight reduction whereas others may gain relief and improvement from muscle strengthening exercises. Canes and walkers can also be used efficiently to relieve the pressure on affected joints. There are some useful tricks for standing up, sitting down and getting in and out of bed that can make a patient’s life much easier. These tricks can be learned from any physical or occupational therapist.
The Role of Exercise in Treating Osteoarthritis
Exercise is a vital component of therapy for osteoarthritis. Regular physical activity keeps joints from becoming stiff and relieves the stress on affected joints by strengthening muscles around the joints and maintaining bone and cartilage tissue. Remember, exercise can not only help to decrease pain but also the need for medication. By contrast, a sedentary lifestyle allows osteoarthritis to progress. However, not just exercise but proper exercise is key. Any osteoarthritis exercise program should focus on three major areas: weight-bearing cardiovascular exercises, muscle strengthening exercises and flexibility exercises. Swimming, walking, stationary bikes and treadmills are typically recommended. The secret is to start small and then gradually stretch the activity bit by bit. Pain helps you to gauge a safe amount of exercise. Do not ignore this message but do not overreact either. Correct posture also helps to prevent irritation of arthritic joints. Keep your back reasonably straight when standing, lying, walking or lifting and change positions frequently to prevent stiffness.
Patients with osteoarthritis should stay as close as possible to their recommended weight. From midlife onward, a woman’s greatest risk factor for osteoarthritis of the knee is her excess weight. Overweight older women (and men too) who reduce their weight by just 10% can significantly lessen pressure on arthritic joints. The key to losing weight is to eat fewer calories and increase physical activity. Although no diet can cure osteoarthritis, a well-balanced diet low in saturated fats, sugar, red meat and cholesterol certainly contributes to overall good health and helps you to shed some excess pounds.
Medications for Relieving Osteoarthritis Symptoms
Several types of medications are used to alleviate the symptoms associated with osteoarthritis such as pain and swelling. A mild over-the-counter product called paracetamol (also known as acetaminophen which you can find in a variety of products such as Tylenol) remains the safest choice for older adults with mild symptoms. This OTC drug reduces the pain but it has no effect on the underlying inflammation and swelling of the joint. In addition to paracetamol, some over-the-counter ointments can provide short-term relief of minor arthritis pain but they do not reduce swelling and should not be used long-term. Other commonly used drugs include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and reduce inflammation when symptoms of osteoarthritis become increasingly more severe. These drugs block the production of prostaglandins, the body’s own substances that cause inflammation and pain. Some NSAIDs require a doctor’s prescription while others do not. NSAIDs are generally divided into salicylates and non-salicylates. Both groups of drugs have similar pain-relieving effects but their potential side effects are somewhat different.
Aspirin (also Bufferin, etc.) is the most popular over-the-counter salicylate, while ibuprofen (Advil, Genpril, IBU, Midol, Motrin, Nuprin) and naproxen (Aleve, Anaprox, Naprosyn, etc.) are the most common non-salicylates. A more tolerable NSAID called meloxicam (Mobic) offers another alternative for those who either find no relief or experience disturbing side effects from the older NSAIDs. Other NSAIDs that can be prescribed to treat pain and inflammation in the joints include diclofenac (Voltaren), piroxicam (Feldene) and sulindac (Clinoril).
While NSAIDs provide much-needed pain relief, they can, in some people, cause serious side effects, including gastrointestinal disorders such as nausea, vomiting, heartburn, stomach pain, diarrhea or even stomach ulcer. Occasionally, gastrointestinal bleeding can occur, characterised by black or bloody stools. Less frequently, NSAIDs can cause dizziness, blurred vision and headaches. An anti-ulcer drug called misoprostol (Cytotec) can be prescribed to treat serious stomach disorders and prevent ulcers in arthritis sufferers, taking NSAIDs. Taking NSAIDs with food also helps to reduce stomach distress.
COX-2 selective inhibitors such as celecoxib (Celebrex) and valdecoxib (Bextra) offer another solution to those prone to stomach distress. COX-2 inhibitors are a new type of NSAIDs with the same painkilling effects as the older drugs but without as many gastrointestinal side effects. Unlike older NSAIDs, COX-2 selective inhibitors directly target a natural enzyme called COX-2 responsible for inflammation and pain without interfering with a similar substance, called COX-1, which exerts a protective effect on the stomach lining. Therefore, these newer NSAIDs are less likely to cause bleeding and ulcers during sustained use.
Corticosteroids such as dexamethasone (Decadron), prednisone (Deltasone) and methylprednisolone (Medrol) can effectively fight inflammation caused by osteoarthritis. These potent drugs closely resemble cortisone, a natural hormone produced by the body. They are available in oral form or they can be injected directly into an inflamed, swollen joint for fast-acting relief. Although corticosteroids offer fast relief from pain, redness and swelling, they often produce serious side effects. They can lower resistance to infection and cause a number of other health problems such as mood disorders, blurred vision, indigestion, cataracts, weight gain, loss of muscle mass and strength, diabetes and high blood pressure.
Glucosamine sulphate – over-the-counter supplements containing glucosamine sulfate or glucosamine in combination with chondroitin sulfate, have been shown to provide many osteoarthritis sufferers with pain relief. Glucosamine and chondroitin are both naturally occurring components of cartilage and it is believed that their synthetic forms may slow the breakdown of cartilage in the joints. Side effects resulting from the use of these supplements appear to be minimal.
Estrogen replacement therapy – while not prescribed specifically for arthritis or osteoarthritis, many women taking estrogen also report pain relief. Though not exactly known why this occurs, many studies have confirmed a link between female hormone levels and the severity of arthritis.
Hyaluronic acid injections – are yet another remedy based on the body’s own natural chemistry. Hyaluronic acid is a joint lubricant that is known to be depleted by inflammation. This treatment, marketed as Hyalgan or Synvisc, provides pain relief for osteoarthritis, particularly of the knee (though some doctors use this therapy also on other joints such as the hip and ankle), with minimal side effects. However, patients allergic to eggs may not take this drug.
Other pain medications – During an arthritis flare, when pain is particularly acute, doctors may prescribe a narcotic pain reliever from the class of opioids such as codeine or tramadol (Ultram) or some antidepressant from the category of serotonin-norepinephrine reuptake inhibitors such as duloxetine (Cymbalta). However, opioids and antidepressants should be used for treating osteoarthritis pain only if NSAIDs or paracetamol, together with lifestyle measures, cannot offer satisfactory relief. Since older patients often take multiple medications, each additional prescription increases their chances of a serious drug interaction.
Joint Replacement Surgery
Joint replacement surgery is typically recommended for patients with stubborn pain that cannot be managed by any other combination of therapies and for those with a true loss of function that cannot be regained through physical therapy. In fact, arthritis accounts for approximately 90% of all knee replacement operations whereas knee replacement happens to be the most common joint replacement.
Although replacements are available for all major joints, hip and knee replacements are known to have the best track record for reducing pain and restoring mobility. Unsurprisingly, patient satisfaction rates for hip and knee replacements are very high, though the operations are not without risk. Statistically, about 5% of patients undergoing joint replacement will experience a significant problem during or following surgery.
Another option for some patients with osteoarthritis is the arthroscopic surgery where damaged tissue is removed without replacing the whole joint. This procedure involves the insertion of a special instrument called arthroscope through a small incision, which enables the surgeon to view the joint and repair any damage. Arthroscopic surgery typically has a good record of success with quick recovery.
Where to Find Related Information: Arthritis Foundation