Osteoarthritis - Those Achy Brachy Joints

Osteoarthritis (OA), known as degenerative joint disease, is the most common of all arthritis conditions. This so-called "wear and tear" arthritis typically affects middle-aged and older adults. Weight-bearing joints are usually affected - the hips, the knees, and the spine -- but also the finger joints.

What causes osteoarthritis?

Little is known about the exact cause of this type of arthritis. Although it is not inevitable like death and taxes, about 85 percent of Americans have some degree of OA by age 75. The most common risks are being overweight, having a family history of OA, and having a congenital defect (e.g., hip dysplasia). People who repeatedly injure their joints, such as runners who have spent 20 or so years pounding the pavement in pursuit of healthy bodies, may begin to develop OA in their knees as they move into their 40's.

OA is a condition that affects the cartilage ("gristle") in joints. In a healthy joint, the smooth, elastic cartilage that cushions the ends of the bones does not have its own blood supply. It receives oxygen and nutrients from the synovial fluid that surrounds and bathes the joint.

Over the years, cartilage can become thin, fray, split, and wear away completely. THe ends of the bones at the joints then beging to grate on each other. This causes pain, stiffness, and limited joint movement. Unlike rheumatoid arthritis, there is little inflammation (i.e., swelling, redness) in the joints.

How can osteoarthritis be managed?

If you have arthritis, treatment you are using or considering should be aimed at relieving your pain, maintaining or improving your joint function, preventing disability, and improving your quality of life.

Traditional self-care and home treatments

Weight loss (if needed)

Regular rest and sleep

Heat and cold treatments(talk with your health practitioner)

Regular (gentler) exercise, such as walking and swimming, water aerobics, and range-of-motion exercise for affected joints (i.e., bending and moving joints as far as they will go normally without pain).

Over-the-counter pain relievers

Acetaminophen is generally considered the first choice because it usually costs less and has fewer side effects than the anti-inflammatory pain relievers, such as ibuprofen and aspirin. Acetaminophen overdoses can be toxic to your liver, and alcohol enhances its toxic effects. Ibuprofen should be avoided if you're allergic to aspirin or have asthma, heart failure, kidney problems, or ulcers. Aspirin should be avoided if you have asthma, a history of ulcers, or a bleeding disorder, or if you're taking a blood thinner.

Supportive devices to help you maintain your activities, including canes, crutches, splints, walkers, and special shoes.

Traditional medical treatments

Physical and occupational therapy to learn how to correctly use canes, walkers, and so on as well as when to use heat versus cold therapy.

Prescription pain relievers

The latest prescription drug for arthritis pain is a group of anti-inflammatories called COX-2 inhibitors, which include the new drugs, celecoxib (Celebrex) and rovecoxib (Vioxx). These nonsteroidal anti-inflammatory drugs (NSAIDs) are easier on the stomach than aspirin or ibuprofen. The most commonly reported side effects for Vioxx are diarrhea, headache, insomnia, edema, and upper respiratory infection.

Corticosteroids injected directly into painful joints (usually limited to one or three injections per affected joint) have been a long-standing treatment for arthritis. They may negatively effect other medical problems, and may lower your resistance to infections. Common side effects include increased appetite, indigestion, nervousness or restlessness, and trouble sleeping. There is also the possibility for more severe side effects.

Skin creams

Capacian is rubbed into the skin over the affected joint. The main ingredient is an extract from hot peppers, it appears to relieve joint pain in some people.

Surgery(almost always a last resort)

This includes osteotomy (removing a wedge of bone from an affected knee or hip joint); total hip or knee replacement; small joint replacement in the hands; and the rarely used fusion for OA in neck, spine, hip, knee, and other joints.

Alternative treatments

The hottest - and some woudl say more controversial - treatment for OA is glucosamine. This aminosugar is a naturally occurring chemical in the body that helps stimulate the production of collagen, one of the main components of cartilage.

There is increasing evidence that glucosamine relieves the OA pain in some people. Summarizing the research on this supplement as treatment, an Arthritis Foundation publication reported that more than a dozen European studies show that glucosamine provided some pain relief in about half of the participation with mild to moderate OA. Chondroitin, another nutritional supplement, was included in these studies of glucosamine (Arthritis Today 12, no. 5 (September-October 1998): 448-451).

According to Drug Research(41, 1991), glucosamine is safe and nontoxic. Stomach upset and nausea have been reported as infrequent side effects.

Although glucosamine is not a "cure" for OA - and neither are more traditional drugs - both alternative and mainstream medicine acknowledge that more research is needed on the role of glucosamine in slowing or reversing cartilage degeneration. Some researchers point out that while elsewhere in the world, glucosamine is used as frontline therapy for OA, in the United States, it is not ("Complementary/Alternative Therapies in Select Populations: Elderly Persons." Complementary/Alternative Medicine, An Evidence-Based Approach. Edited by J. Spencer and J. Jacobs. (St. Louis, MO: Mosby, 1999) 340:348).

Boswellian serrata(Indian frankincense), an herb used in combination with other herbs and zinc, was also known to significantly reduce pain and disability in a small study of OA ("Complementary/Alternative Therapies," 403).

While Western medicine is concerned about the unregulated potency, purity, and doses of nutritional supplements and herbs for treating OA, the literature shows enthusiasm for research into their promise, particularly glucosamine.

Frances Alves, M.P.H., is a health writer and editor who has been writing for consumers for more than 20 years.

Types of Arthritis

There are moe than 100 different types of arthritis that affect the joints and connective tissues of over 40 million Americans. Most times, we do not clearly understand what causes arthritis. It tends to be chronic and usually cannot be cured. But it can be managed with home and alternative treatments. Common types of arthritis (the first three are the most common) include:

Osteoarthritis (OA), the most common of all arthritic conditions.

Rheumatoid arthritis (RA), which affects the whole body so that RA patients often feel as if they have a virus. The membranes lining joints become inflamed, causing pain, warmth, redness, and swelling. Involved joints - typically wrists, knuckles, knees, and joints of the balls of fee - can become mis-shapen and misaligned. RA usually begins in middle age, affects joints on both sides of the body, such as both wrists (unlike OA, which can affect just one knee or one hip), and is much more common in women than in men.

Fibromyalgia, a condition involving generalized muscle pain, fatigue, and poor sleep. Tender spots (when pressed) on muscles are the hallmark of this condition.

Juvenile rheumatoid arthritis (JRA), a completely different condition in children with at least three major subtypes that affect single joints, multiple joints, or the entire body. In most children, the disease completely disappears over time.

Gout, a type of arthritis characterized by attacks of sudden, severe pain in body joints. The joint most often affected is at the base of the big toe. Gout can also affect knees, ankles, feet, and (less commonly) joints in the arms. The pain is caused by a buildup of uric acid crystals in the joints.

Systemic lupus erythematosus (lupus, SLE), an autoimmune disorder. That is, antibodies (that your body produces) attack other parts of your body. A red skin rash may be present; about half of SLE patients have arthritis in their joints; but not to the degree of intensity and disability as RA patients. Lupus is a very individual condition; some people aren't aware they have it; but others have a major illness.

Ankylosing spondylitis, a genetic disease -- more than half the people who develop it have a family member with the condition. It is known as attachment arthritis because tendons and muscles that attach to bones become inflamed. The typical site is the bottom of the spine (sacrum) where pelvin bones connect. Low back pain is the hallmark of this condition.

Reprinted with permission AIM Partners Magazine, October, 1999

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