What is Osteoarthritis?

Osteoarthritis is a disease that causes the breakdown of the cartilage in joints. It also called degenerative arthritis. Cartilage is the joint's cushion. It covers the ends of bones and allows free movement. If it becomes rough, frays, or wears away, bones grind against each other. As a result, the joint becomes irritated and inflamed. Sometimes the irritation causes abnormal bone growths, called spurs, which increase swelling. The disease normally affects the feet, knees, lower back, hips, and fingers. Usually only one or maybe a few joints are affected at one time.

Osteoarthritis is 3 times more common in women than in men. It usually begins after the age of 40. By age 60, most people have some osteoarthritis, although it may be too mild to cause symptoms.

How does it occur?

Osteoarthritis is caused by excessive wear on joints. Obesity, bad posture, old injuries, and overuse can all cause extra wear on joints. Heredity also appears to play a role.

What are the symptoms?

The symptoms of osteoarthritis include:

·         mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time.

·         creaking or grating sound in the joint

• swelling, stiffness, limited movement of the joint, especially in the mornings
• weakness in muscles around the sore joint from lack of use
• deformity of the joint.

How is it diagnosed?

Your health care provider will review your medical history and examine you. Your health care provider may also order blood tests and x-rays. A sample of fluid in the joint may be taken with a needle to confirm the diagnosis.

How is it treated?

The aim of treatment is to keep the joint working by reducing strain on the joint and by relieving pain, stiffness, and swelling.

Most of the time, acetaminophen is the best medicine to use to relieve pain. It has fewer side effects than other pain relievers when used for a long time.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are other drugs used to treat pain. Aspirin, ibuprofen, and naproxen are NSAIDs that you may buy with or without a prescription. Adults over the age of 65 should not take NSAIDs for more than 5 days without their health care provider's approval. NSAIDs help reduce pain and swelling but can cause kidney and stomach problems.

COX-2 inhibitors such as celecoxib (Celebrex) are prescription NSAIDs. COX-2 drugs may cause fewer stomach problems than other NSAIDs.

Rubbing anti-inflammatory or deep-heat creams over the arthritic joint can provide short-term relief. Putting an ice pack on the joint once or twice a day can also help relieve pain.

Your health care provider may inject steroids into the painful joint to help relieve pain.

If you are overweight, your provider may recommend that you lose weight. This may be done by eating fewer calories, by increasing your physical activity, or both. This helps reduce strain on the joint.

Canes and splints offer protection. Physical therapy helps relieve pain and muscle spasms, and maintains joint range of motion. Regular gentle exercise is very important to help you control osteoarthritis.

Sometimes severely damaged hips and knees may be surgically replaced.

How long will the effects last?

There is no cure for osteoarthritis. Once you are diagnosed with it, you will have it for the rest of your life. It can worsen over time. Avoiding repeated injury to your joints can help, but damaged cartilage cannot repair itself.

How can I take care of myself?

No one yet knows how to prevent osteoarthritis, but you can help reduce symptoms by following these guidelines:

• Keep your joints in good working order. Stay fit. Do any exercises recommended by your health care provider or physical therapist for posture, muscle strength, and joint mobility. Daily moderate exercise is much better for your joints than occasional strenuous exercise. Walk a little each day if you can. Be sure to wear comfortable, well-cushioned walking shoes. Otherwise, you can exercise while sitting down or go swimming. The water in a warm swimming pool can help support your weight while you exercise, and the warmth helps improve joint movement.
• Protect your joints by doing warm-up exercises before strenuous activity.
• Use a knee pad to protect your knees when you are kneeling.
• Take the medicine your health care provider recommends for controlling your osteoarthritis.
• Keep your body healthy by eating a healthy, varied, low-fat diet.
• Follow your health care provider's recommendations for weight control.

But if you have joint pain, exercise may be the last thing you feel like doing. Aphysical medicine and rehabilitation (PM&R) physician can help.

A PM&R physician is a medical doctor who treats conditions that can cause pain or limit function. Also called physiatrists, PM&R physicians provide a full spectrum of nonsurgical care to restore maximum health and quality of life.

For help in overcoming arthritis, PM&R physicians:

·         Are uniquely qualified to prescribe therapeutic exercise; they are trained in exercise physiology, ergonomics, and the latest research-based treatments.

·         Help patients modify their activities to minimize pain and maximize their ability to do the things they want and need to do.

·         Work with a team of health professionals to provide an individualized treatment plan and the tools that enable patients to take control of their health.

·         Prescribe medication and provide treatments such as injections to help patients avoid surgery.

·         Help achieve a successful recovery when surgery is necessary, by working with patients and their surgeons before and after the surgery.

A PM&R physician can provide a multi-faceted treatment approach to osteoarthritis that might include:

Weight management. Excess weight can accelerate joint deterioration. PM&R physicians can help you identify safe, effective ways to achieve your healthiest weight.

Therapeutic exercise. PM&R-prescribed exercise focuses on stretching, strengthening, and range-of-motion exercises to help your joints work more easily and efficiently. PM&R treatment approaches:

·         Build strength in muscles surrounding the joints.

·         Modify the way you do a particular activity through use of gait and ergonomic analysis.

·         Change the mechanical properties of your exercise by prescribing appropriate equipment, such as support braces.

Medications and supplements. A PM&R physician can help determine which prescription and non-prescription products are right for you.

·         Pain medications. Options include acetaminophen; nonsteroidal anti-inflammatory drugs, such as ibuprofen; and, for more severe symptoms, prescription pain medications.

·         Corticosteroid injection therapy. Steroids are applied directly to the joint for pain relief.

·         Nutritional supplements. Some patients find pain relief with glucosamine and chondroitin sulfate. The benefits of these supplements are still being studied.

Other nonsurgical treatments. A PM&R physician may also prescribe:

·         Injections of visco-lubricants to build up cartilage and lubricate joints.

• Heat and cold therapy to provide temporary pain relief.

                                          Rheumatoid Arthritis:

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints, usually in a symmetrical pattern (if one hand has it, the other one will also). In RA, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments. RA can also cause inflammation in the blood vessels and the outer lining of the heart and lungs.

About 2.1 million Americans have RA.

Common sites for RA include:

• Hands
• Wrists
• Elbows
• Shoulders
• Neck
• Hips
• Knees

Causes of Rheumatoid Arthritis?

No one knows exactly what causes RA, but there are many thoughts about what might contribute to it.

Heredity, or the genes you get from your parents, may be a factor in determining who gets rheumatoid arthritis.

Some researchers think certain infections or chemicals might cause the disease. Many studies are being done to see if this can be determined.

Some people think hormones may play a role. But this, too, is still uncertain, even though women are more apt to suffer from RA than are men.

RA is an autoimmune disease, which means your own immune system starts to attack some of your tissues.

Symptoms of Rheumatoid Arthritis?

Symptoms of Rheumatoid arthritis can come and go.

The most common symptoms of RA are pain, swelling and stiffness in one or more joints. The pain may be similar to a headache or toothache. In some people, the joints can feel hot. Some people may have a fever. You may become anemic—you may have a lower number of red blood cells than normal.

On days when RA acts up, some people may lose their appetites, be tired, and have trouble sleeping.

Sometimes lumps of tissue develop near the affected joint, usually near the elbow joint. These are called rheumatoid nodules.

Occasionally, RA sufferers will develop inflammation of the lining that surrounds the heart and lungs. Also common are dry eyes and a dry mouth due to inflammation of tear glands and saliva glands.

Treatment options:

The main goals in treating RA are to relieve pain, reduce swelling, slow down the damage to the joints, and improve the person's ability to function.

While there is no cure for rheumatoid arthritis, some drugs can help control the disease. A rheumatologist will often suggest:

• Nonsteroidal anti-inflammatories can be used and include:
  • Acetylsalicylic acid (aspirin)
  • Ibuprofen
  • Indomethacin
  • Naproxen
  • Tolmetin

Corticosteroids can also help ease pain and swelling and help slow the damage to the joints. Drugs that are corticosteroids include prednisone and cortisone.

There are also a group of drugs know as disease modifying antirheumatic drugs. These are also called DMARDs and they take much longer to act than the NSAIDs. Sometimes it can take weeks or months to begin to notice a change. But, the DMARDs may help slow the progress of the arthritis, too. There are more side effects to these drugs though and you will need to check with your doctor often.

DMARDs include:

• Antimalarial drugs
• Gold compounds
• Penicillamine
• Sulfasalazine

Surgery, such as joint replacement, may be an option for some people.

Rest and exercise are also important. For many people, support groups may also help. You can contact the National Arthritis Foundation at 800.283.7800 to find some groups near you. Or find the chapters near you by visiting their Web site at http://www.arthritis.org/offices/