Osteoarthritis
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.
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.
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.
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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.
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.
 |
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
 |
Mechanical Devices
 |
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.
 |
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.