Osteoarthritis

Fall 2006 CSANews Issue 60  |  Posted date : May 30, 2007.Back to list

Although there are many forms of arthritis, including rheumatoid arthritis, lupus and gouty arthritis (each of which requires very specific medical treatment), osteoarthritis is the common condition which we are all interested in managing ourselves until more aggressive medical or surgical interventions are needed. The recent scare concerning the use of certain arthritis medications and their relationship to increased risk of heart disease makes it necessary for us to consider not only what works and what doesn’t work, but also what is safe and what is not.

Osteoarthritis is a condition characterized by a breakdown in the cushioning properties of cartilage, a tough elastic material that protects the bony surfaces of joints. As the cartilage deteriorates, the bony surfaces are no longer protected, the surfaces become thickened and rough and inflammation occurs.

Pieces of cartilage can actually break off, aggravating the joint malfunction. Projections of bone (spurs) can occur, and these can cause increased pain, inflammation and impairment. The common results of such processes are increasing problems with stiffness, pain, deformity and impaired function. When it occurs in the weight-bearing joints such as the hips, knees, feet and spine, the most common sites, there can be difficulty moving about and keeping fit. With inactivity, muscle mass can lessen, which worsens the joint function. Osteoarthritis can also affect other joints such as fingers, elbows and shoulders, which can be associated with difficulties in daily living such as dressing, homemaking, bathing, hobbies and sports.

Diagnosis is usually made by the patient who has suffered increasing discomfort and stiffness in a joint or joints for some time. Medical examination is necessary to rule out the more infrequent causes for such symptoms. Blood tests and simple X-rays, along with the physician’s history and physical examination are usually enough to confirm the diagnosis. As the condition deteriorates, in spite of modest treatment, more sophisticated tests such as MRI or arthroscopy (visual examination of the joint and joint surfaces by a surgeon) may be necessary, especially if surgery is indicated.

In spite of all the research, the cause of osteoarthritis remains a mystery. However, there are many well-known factors that increase the risk of developing the condition, some of which may be preventable or may, at least, delay the onset of more severe disease. As noted, risk increases with age, but it is also far more common in persons who are overweight, especially affecting the weightbearing joints, the hips and the knees. There appears to be a hereditary factor and repeated stress or injury to certain joints may increase the risk to that particular joint. For example, those who regularly participated in long-distance running in their earlier years are at greater risk for hip problems later in life.

As with many of the conditions which afflict us as we age, osteoarthritis is often preventable and can certainly be reduced in severity through healthy living choices. Excess weight requires particular attention because, in addition to adding stress to the joints, other conditions such as heart disease, hypertension and type 2 diabetes have been proven to be additional threats. Inactivity is often the result, which compounds the challenge of reducing weight and decreasing the risk of these other complications. Obesity and diminished activity may also have an effect on increasing the risk of osteoporosis (a decrease in bone mass and density) and fractures of the hip. Daily brisk, but comfortable, walks are the easiest for most in reducing these risks. However, when arthritis has already affected the feet, knees or hips, brisk walks may not be the exercise of choice. In such cases, dietary caloric reduction and participation in other forms of activity such as aqua therapy are indicated. Snowbirds have the advantage of increased access to such activity because of their yearround presence in warmer climates.

Osteoarthritis Treatement

Medications and Supplements
Although there is no cure for osteoarthritis, there are many forms of treatment which can be helpful in reducing the symptoms of the disease. Initial home treatment in milder forms may simply be a mild pain medication, most commonly acetaminophen along with external application of heat or “arthritic creams.” Daily acetylsalicylic acid use may cause gastrointestinal symptoms in some and if using acetaminophen, be sure to not exceed daily recommended doses as liver damage can result if maximum limits are exceeded. Other non-prescription drugs that help some individuals include over-the-counter doses of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. NSAIDs cause gastrointestinal symptoms in some people, in which case the NSAIDs should be stopped and the symptoms reported to your physician. If acetaminophen alone does not work, it can be purchased in Canada without prescription, containing a small amount of codeine for more relief. Judicious use of the affected joint(s) and attention to any weight problem may assist in the long run.

There are many choices of other non-prescription products available, some with proven success and many with no scientific value. In this day of commercialized medical “sales” in the media, one has to be particularly careful to not succumb to products or treatments that may be useless, expensive or risky to your health. Do your own research and consult with your personal physician, if in doubt.

Although there is some question as to the value of food supplements, many individuals find relief by taking chondroitin and glucosamine. Available without prescription, these products can be purchased in health food stores and pharmacies. Chondroiten is derived from animal cartilage and glucosamine from lobster, crab or shrimp shells. Scientific research has not yet proven the effectiveness of these supplements. If there is no relief after several weeks, you’re probably wasting your money. Inform your physician if you’re taking any of these over-the-counter products along with prescribed drugs.

If your symptoms are not controlled satisfactorily, your doctor will probably prescribe more potent medication in the class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Two such drugs found to have a suspected relationship to increased heart disease were being prescribed in large numbers in Canada until 200 . Since then, one company withdrew its product from distribution and the other drug is being used more commonly when other choices are not available. The more potent NSAIDs available by prescription may be more effective, but the risk of side-effects may be greater. Occasionally, local joint injection with cortisone may provide temporary relief. However, repeated use of this drug, whether given orally or by injection, is associated with a long list of health risks.

A newer form of treatment that is proving to be of some benefit in certain cases of affected knee joints is the injection of hyaluronic acid. This lubricating liquid injected over a series of treatments has yet to be fully researched.

Physical and Mental Therapies
A number of approaches focusing on improving physical and mental health are helpful to some. Physiotherapy helps in teaching how to strengthen muscle groups around affected joints. If the joints are not exercised, muscle wasting occurs and the joint becomes stiffer and loses function. Various exercises such as walking, stationary bicycling and aqua-aerobics improve muscle strength and flexibility and may relieve pain. Tai Chi exercises promote balance, flexibility, relaxation and stress reduction. In addition to many classes in Canada and the U.S., home exercise books for seniors are available. Massage therapy may be useful for some for temporary relief and relaxation, but should only be done gently around involved joints by a trained professional. Acupuncture provides some short-term relief in some individuals, but there is no evidence that it has any effect on the progression of the disease.

Mechanical Devices
Over decades, various mechanical devices were marketed to be applied to the body in the home or office by various “professionals,” who alleged that the device would “cure” the patient. The search for such effective treatment of arthritis and various other ailments continues. The latest is low-intensity laser therapy. Not yet proven to be effective in helping arthritis sufferers, there are some health-care workers who are providing such treatments and there are some patients who find relief. The same can be said for electrotherapy, which uses machines to electrically stimulate the peripheral nervous system in order to achieve pain relief. Treatments can be expensive and are not covered by provincial health plans. As with other alternative forms of care, be sure that you only continue if you are getting improvement.

Surgery
When conservative measures no longer control the pain and/ or function, surgery to repair or replace the affected joint becomes an option. Arthroscopy involves the exploration of the joint with a scope, at which time the surgeon may make a more definitive diagnosis and may be able to remove debris or spurs in the joint. This procedure is used most frequently with knees.

Although hip replacements have been performed for several decades now, knee replacements (developed later) now surpass hip replacements annually Although the success rate of such surgery is very high and patients are often able to return to activities which they had abandoned, certain risks are associated with all major operations and joint revision may be required after a number of years. Total hip replacement involves removal of the damaged parts of the bone and replacement with plastic and metal ball-and-socket parts. As prostheses and surgical skills improve, what used to involve long incisions, lengthy surgery and hospitalization can now involve an incision only several inches long and much less trauma to surrounding muscle, allowing for quicker rehabilitation.

Knee replacements involve the replacement of the damaged bony surfaces with a prosthesis. Although slightly more involved and requiring more rehabilitation, knee joint replacement has proven to be of benefit to more than 85% of those undergoing this treatment.

A newer form of hip surgery is being performed with promising results in various teaching centres in Britain, the U.S. and Canada. Hip resurfacing, initially attempted 30 years ago, failed at that time. Newer resurfacing implants appear to be more stable and, because the surgery involves less bone loss and trauma, recovery may be quicker. Long-term studies to measure success outcomes will have to be done before more orthopedic surgeons choose this procedure over total hip replacement.

Much important research is focusing on a cure for cartilage breakdown and prevention of osteoarthritis, as well as newer forms of treatment. Meanwhile, there are many choices for you if you have osteoarthritis and, in partnership with your health professionals, there will be opportunities for you to enjoy less pain and more function in your affected joints.