managing osteoarthritis

Aches and pains are all too familiar for anyone getting older or for those who work out with high intensity. Sometimes this discomfort subsides or disappears altogether. But if osteoarthritis is at play, you are left with progressive pain and having to manage the degenerative condition.

What Is Osteoarthritis?

It’s estimated that more than 30 million U.S. adults suffer from overall “wear and tear” of the joints, otherwise known as osteoarthritis. If you think you may be suffering, read on to learn how to obtain a proper diagnosis, identify ways to lessen the pain and continue with your activities. We will explore all options in treating this type of arthritis.

Our bones throughout our body naturally are protected by cartilage allowing comfortable movement and a full range of motion in the joints. When cartilage begins to thin out and break down, redness, swelling, tenderness, and pain often are the result. The most common areas affected by osteoarthritis are hands, knees, hips, and spine.

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The Breakdown of Cartilage

Cartilage is composed of a gel-like substance (matrix), two types of proteins (collagen and proteoglycans), and cells known as chondrocytes that are contained within the matrix. Collagen is a familiar structural protein found in tissue. It’s the foundation of cartilage itself and creates a framework for the other components of cartilage. Water makes up a large part of healthy cartilage. It helps it to form a “gel-like” matrix, thereby serving as the “shock absorber” for the joint. In diseases like osteoarthritis, cartilage loses a lot of its water content.

Proteoglycans are complex molecules made up of protein and sugar combinations that are entwined in the matrix of cartilage, trapping large amounts of water in cartilage. Chondrocytes are highly complex multifunctional cartilage cells. They produce collagen, proteoglycans, and enzymes, all of which help healthy cartilage grow.

Once the cartilage dissipates, it does not grow back. A release of inflammatory products causes irritation of the joint lining. The otherwise firm, rubbery, and slippery tissue no longer is capable of providing cushion between bones.

I see many of my patients suffering from this condition and the percentages are not going down. In fact, the CDC predicts an estimated 78 million adults aged 18 years or older (more than a quarter of the US population) to be diagnosed with some form of arthritis by 2040.

Adults who are overweight or obese are diagnosed with arthritis more often than those with a lower body mass index (BMI). However, when a patient loses or maintains a healthy weight, it can relieve pain, improve mobility, as well as slow the progression of osteoarthritis.

Often people suffering from arthritis suffer from other comorbidities, which contribute to poor health. A comorbidity means a person has more than one disease or condition at the same time. Comorbid conditions typically are chronic or long-term such as diabetes, heart disease, and obesity. In 2013–2015, the CDC reported a prevalence of arthritis among adults who also had these three conditions:

  • Obesity (31 percent had arthritis).
  • Diabetes (47 percent had arthritis).
  • Heart disease (49 percent had arthritis)

Additional trends in joint pain prevalence among arthritic adults, according statistics from 2002 to 2014 in the United States, found pain:

  • Higher among women (29.2 percent) than men (22.7 percent)
  • Highest among adults aged 45 to 64 years (30.7 percent)
  • Highest among non-Hispanic Blacks (42.3 percent), followed by Hispanics (35.8 percent), and non-Hispanic whites (23.1 percent).

Symptoms of Osteoarthritis

Typically arthritis forms over time. Whether from trauma, overuse in physical activity, or aging, osteoarthritis by definition is the wearing down of the cartilage between joints. If your doctor suspects osteoarthritis, imaging and lab tests may be ordered. This will be in the form of an x-ray or MRI after a full examination and review of the patient’s medical history.

If you experience any of the following symptoms, consult with your physician. They may refer you to a joint specialist known as an Orthopedist or Sports Medicine Physician.

  • Pain: Throbbing or ache felt during physical activity or normal range of movement.
  • Tenderness: Discomfort can be felt if pressure is applied to the area even gently.
  • Heat: Due to the inflammatory nature of the condition, the area could feel warm to the touch that may worsen with increased activity.
  • Stiffness: Felt mostly in the morning or after a period of activity that goes away with over-the-counter anti-inflammatory medication.
  • Declined flexibility: This is a decrease in one’s ability to contract and extend the hips, hands, knees, and legs.
  • Grinding sensation: Just as it sounds, the bones can make a grating or otherwise audible sound when in use if the condition has advanced to the point of the dissolution of all cartilage.
  • Bone spurs: Bones can formulate a lump or spur that feels like an extension of the original bone. This can cause a deformity and further aggravate the affected joint. This is more common at an advanced stage of the disease.

Risk Factors of Osteoarthritis

Although the risk of osteoarthritis increases primarily with age, there are populations and certain lifestyles that make some people more vulnerable. Women, for example, are at a higher risk for developing the majority of arthritis conditions, particularly after 50 or menopause. Men, however, are more prone to developing gout (a specific form of arthritis). Other than age and gender, additional risk factors include:

  1. Overuse—Ongoing bending of the knees, elbows, or any repetitive stress on other joints, can yield damage increase the risk of osteoarthritis. Also, if you have injured an area on your body and continually use those joints (think tennis elbow or warehouse employee), the pain will increase and condition progress faster since there is no rest or treatment of the joints.
  2. Obesity—Extra weight puts more stress on joints, particularly weight-bearing ones like the hips and knees. This stress increases the risk of osteoarthritis. Obesity could have metabolic effects that increase the risk, too.
  3. Genetics—People who have family members with osteoarthritis are more likely to develop it. People who have hand osteoarthritis are more likely to develop it in the knee. People born with specific genes are more likely to develop certain types of arthritis, such as rheumatoid arthritis, systemic lupus erythematous, and ankylosing spondylitis. These genes are called HLA (human leukocyte antigen) class II genotypes. These genes can also make your arthritis worse.
  4. Race—Osteoarthritis is most common in Hispanics, Non-Hispanic Blacks, and Non-Hispanic Caucasians. Some Asian populations have lower risk for osteoarthritis, however.
  5. Heredity—Individuals born with other diseases, including autoimmune disorders or Paget’s disease, are more likely to develop osteoarthritis.

Even if you are at risk, the good news is that you can change behaviors and decrease your risk or the progression of the condition. If osteoarthritis is your diagnosis, there are several options in treating the disease — from conservative to surgical.

Treatment of Osteoarthritis

Weight Loss

It seems like a simple solution, but anyone who has tried to shed the pounds knows it’s a marathon and not a race. For every one pound lost above the idea body weight, joints experience four times additional force. That means if you’re 20 pounds overweight, the body experiences 80 pounds of additional force across the joint. If you aim to hit your daily recommended 10,000 steps each day, consider the 800,000 pounds of additional force placed on the joints every single day! Shedding unwanted pounds improves all bodily functions and systems, so if you are outside of your healthy range for your age, height, and gender, talk to your doctor or a nutritionist about how to lose the pounds safely and permanently.

Exercise

Most of us know the science behind the benefits of exercise. Whether you have weight to lose or not, moving your body keeps it from becoming stiff and lethargic. It’s important to choose the right level of activity for your body. Especially if you already have arthritis. Participate in joint-friendly, low impact physical activities such as walking, biking, dancing, and swimming. In doing so, you will improve your pain, mood, and quality of life. A body in motion stays in motion.

Being physically active can also delay the onset of arthritis-related disabilities, as well as decrease the risk of diabetes, heart disease, and obesity. Learn how you can increase your physical activity safely. Current recommendations are 150 minutes per week of moderate-intensity activity. You should combine cardiovascular exercise with resistance training using weights or the body itself. Sporadic, little exercise will not be effective and too much can be counterproductive. Always consult with a health care professional before starting or changing your level of fitness.

Physical Therapy

For acute attacks, apply ice/heat to the area, rest, and take an over the counter NSAID or prescription medication for immediate relief. Your doctor may prescribe physical therapy in addition to at home remedies. Therapists work individually with clients to develop a customized plan for pain relief and an increase in balance and mobility. Physical therapy uses gentle therapies to help patients gain control of and reduce stress in their lives. This include a treadmill, in pool, or going through range of motion exercises.

Support devices

Depending on how often and for what purpose, people may find that devices help to stabilize and support their activity. Crutches, canes, joint braces, and shoe inserts may help damaged joints. Yet, devices should be used in moderation and under the guidance of a physical therapist, physician, or other specialist. Typically these devices should be transitional, because too much support can actually worsen the problem and weaken the muscles or impair proper body gait mechanics.

Diet

Proper nutrition can help or hinder our health. In order to optimize our health and aid in reducing inflammation in the body – such as osteoarthritis – an anti-inflammatory diet rich in essential fatty acids, vitamins, fiber, and protective nutrients can only benefit the body by reducing stress, increasing energy and helping to reduce inflammation in the body. Often it can include supplements believed to naturally aid in reducing or blocking pain. Turmeric, green tea, Omega-3, and glucosamine-chondroitin do not adversely interact with oral non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen, naproxen) and may be a safe option for managing pain.

An example of this diet is Dr. Weil’s, which can be found at drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid.

Medications

As mentioned previously, sudden or acute pain can be treated with over the counter medications such as Tylenol (although this has no effect on inflammation reduction) and NSAIDs. However, ongoing use of these medications can damage the liver and have known side effects. Topical creams and ointments are another alternative for relief. Various analgesic patches, sprays, rubs, and ointments may be applied directly to the skin of the affected area.  Duloxetine, or Cymbalta, normally used as an antidepressant has been approved to also treat chronic pain. It’s important to talk to your physician about the proper prescription and dosage for your overall health.

Injections/Surgery

When all else has failed or no relief is found from moderate attempts in managing your osteoarthritis, guided injections and even surgery may options. Although more invasive, it swiftly and successfully addresses the origin of pain more directly. Still, injections and surgery may not be for you. Discuss the options with your provider for best results.

Steroid injections: These are potent anti-inflammatory medicines that are injected directly into the joint to help decrease pain and return function however, they are limited to approximately three to four a year since the medication can worsen joint damage over time with repetitive use.

Viscosupplemental injections (erg., Euflexxa, Synvisc): These are manufactured from a natural source of hyaluronic acid, believed to help cushion, lubricate, and protect joints. Hyaluronic acid is a component naturally found in joint fluid.

Platelet-Rich Plasma injections: Also called PRP or ACP (autologous conditioned plasma), these attempt to take over the blood’s natural healing properties. Growing evidence indicates this form of injection is a safe, effective choice. During the procedure, the PRP uses the patient’s blood and isolates the platelets which have the ability to secrete growth factors in order to stimulate tissue regeneration and promote healing.

Stem Cell injections: Young cells have the ability to formulate different kinds of tissues. Typically obtained through bone marrow or fat, it has shown success in its role for pain relief from osteoarthritis.

Joint Replacement or Realignment: Also called arthroplasty, a surgeon replaces the damaged joint with plastic and metal parts. Sometimes, these new parts become worn over time and need to be replaced down the road. If osteoarthritis only damages one side of the knee, for example, a surgeon may cut across the bone to remove or add a wedge of bone to shift the body weight away from the worn-down area.

As with most chronic illness or disease, the best way to maintain your health is by maintaining a healthy weight. Also make exercise a part of your lifestyle, refrain from smoking or excessive alcohol, eat a healthy diet, and keep your annual visits with your provider. If osteoarthritis is part of your daily life, combining treatment and relief options can slow progression. It will also improve the quality of your life, function, and mobility depending on its stage and your underlying health factors. If your condition worsens or does not improve, talk to your doctor about the next steps.

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About UPMC Pinnacle

UPMC Pinnacle is a nationally recognized leader in providing high-quality, patient-centered health care services in south central PA. and surrounding rural communities. UPMC Pinnacle includes seven acute care hospitals and over 160 outpatient clinics and ancillary facilities serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams, and parts of Snyder counties. These locations care for more than 1.2 million area residents yearly, providing life-saving emergency care, essential primary care, and leading-edge diagnostic services. Its cardiovascular program is nationally recognized for its innovation and quality. It also leads the region with its cancer, neurology, transplant, obstetrics-gynecology, maternity care, and orthopaedic programs.

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