Arthritis Treatment

Each year thousands of medics utilize their surgical instruments to perform surgery for treating osteoarthritis, however, a recent study published in the New England Journal of Medicine (NEJM) found that surgery wasn’t any better than conventional treatments for treating the disorder.

Arthroscopic surgery is a widely accepted minimally invasive surgical procedure, wherein surgeons insert medical instruments including an arthroscope in the knee to remove cartilage fragments, thus smoothening the joint surface to provide relief.

However, the recent study by scientists at the Robarts Clinical Trials at the University of Western Ontario in London concluded that patients with arthritic knees benefited equally well with non-surgical treatments viz. pharma drugs and physical therapy.

The research lasting 8 years, from 1999 to 2007 is based on the observation of 178 osteoarthritis (OA) patients. Of which 86 were treated with medicines and physical therapy. And at the end no additional benefits of surgery were found.

Despite the results, the health care industry experts suggest that knee arthroscopy is beneficial in the treatment of many abnormal medical conditions affecting the knee, viz meniscal repair, resection.

Osteoarthritis (OA), or degenerative arthritis, is a clinical syndrome in which low-grade inflammation results in swelling, pain, and stiffness in the joints. The disorder is a consequence of wear and tear within the joint. It’s also the most common type of arthritis that affects 27 million Americans and 10% of the Canadians.

Although simple arthroscopic procedures might not have proven to be better than conventional treatments in this study, experts believe that for patients with severe arthritis, “knee replacement surgery” serves as an option.

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Osteoarthritis is the most prevalent rheumatic disease. There is an enormous disability and loss of productivity associated with this condition; osteoarthritis is second only to cardiovascular diseases. The prevalence and severity of osteoarthritis increases with age. The degree of osteoarthritis is almost universal after 75 years of age; if someone lives long enough, they will have some form of osteoarthritis. Women are more affected than men in osteoarthritis, especially in nodal osteoarthritis.

Osteoarthritis is primarily a disease of the joint cartilage. The cartilage is the low-friction surface covering bone ends which functions in lubrication during movement, shock absorbency, load support and joint stability. Th cartilage is mainly composed of water, chondrocytes (controls synthesis and degradation of cartilage), collagen (proteins involved in tensile strength and maintenance of shape) and proteoglycans (provides the “stuffing material” for the cartilage). The failure of the chondrocytes to maintain the balance between cartilage formation and destruction exposes the underlying bone, leading to microfractures and osteophytes.

The major symptoms of osteoarthritis are pain, and to a lesser extent stiffness. Loss of mobility and function ensue. Instability of the weight-bearing joints and limited motion can also present as symptoms of osteoarthritis. As there are no proven cure for osteoarthritis, the underlying goals of treatment are to reduce pain, improve function, and prevent associated disability.

The pain experienced during osteoarthritis is usually a deep, aching pain. The pain worsens on motion and weight-bearing, but improves with rest. On the other hand, the other symptom of osteoarthritis, stiffness, resolves with motion but recurs with rest. This stiffness usually lasts for about 30 minutes or less in duration.

The sources of pain in osteoarthritis are multiple, and includes structures within and around the joint as well as psychosocial factors. The focus in osteoarthritis research has been on articular cartilage, and clinically this is monitored by joint-space narrowing on X-ray. However, the articular cartilage contains no neural or vascular structures.

Intra-articular sources of pain include periosteum and osteophyte formation, subchondral bone engorgement and microfractures, intra-articular ligament degeneration, capsular distension with effusions, and synovitis. Periarticular sources can include inflammation of tendon, fascia or bursa, muscle spasm, and nerve pressure. Psychosocial aspects can contribute, with lower education levels and depression both being associated with greater pain and disability in patients with osteoarthritis.

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Osteoarthritis (OA) is the most common form of arthritis and affects more than 20 million Americans. Commonly associated with aging, OA affects weight-bearing areas of the musculoskeletal system such as the neck, low back, hips, and knees. It also affects joints that are highly mobile such as the base of the thumb and the big toe joint.

While OA was considered to be primarily a condition affecting the elderly, it is now believed that OA can begin early- within the second decade of life. OA is a disease that affects cartilage, the gristle that lines the ends of long bones.

Cartilage consists of a matrix that is composed of a mixture of collagen and proteoglycans. Within this matrix, cells that make new cartilage, called chondrocytes, sit much like grapes inside jello.

Biochemical changes occur that lead to alterations in the matrix of cartilage making it more susceptible to early degeneration. As a result, the cartilage begins to wear away prematurely. Small cracks- called fissures- begin to form. The fissures eventually grow to the point that the cartilage actually flakes away. At the same time, inflammation develops and this accelerates the wearing away of cartilage.

It is difficult to estimate the number of people who have OA but who are not yet symptomatic. However, as we learn more about this disease, it is clear that cartilage changes and symptoms do not necessarily go hand-in-hand.

The treatment of OA then needs to take into consideration both the symptoms of pain that occur along with the biochemical changes that lead to cartilage deterioration.

A number of investigators have devoted much time and effort towards developing medicines called disease-modifying osteoarthritis drugs or DMOADS.

Unfortunately, DMOAD discovery is extremely difficult since cartilage damage is hard to quantitate. Scientists have used many different methods to measure cartilage thickness in response to drugs including magnetic resonance imaging, ultrasound, standard x-ray, and arthroscopy. Arthroscopic retrieval of cartilage specimens offers the most hope as far as a definitive marker of effect but is technically difficult.

Currently, the treatment of osteoarthritis is primarily symptomatic. Rheumatologists generally start with non-drug therapies including patient education, dietary counseling, and specific exercises.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (eg, Advil) or naproxyn (eg, Aleve) and analgesics such as acetaminophen (eg, Tylenol) sometimes are effective.

Most patients with more than mild OA will require prescription medications such as prescription NSAIDS (Motrin, Naprosyn, Lodine, Relafen, Daypro, Mobic, and Celebrex, to name a few.) These medicines are usually effective but also carry with them potential side-effects including damage to the gastrointestinal system, kidney damage, and an increased risk of cardiovascular events such as heart attack and stroke.

A food-based anti-inflammatory compound called flavocoxib (Limbrel) appears to be effective for some patients and appears to be safer than traditional NSAIDS.

Prescription analegesics such as tramadol (Ultram) may be useful. However, the use of stronger narcotics sometimes is called for in severe cases.

Topical agents such as Myorx (an OTC preparation), Voltaren gel, and patches such as Flector (a patch containeing Voltaren) and Lidoderm (a patch containing lidocaine, a local anesthetic) can also be useful adjuncts.

Since OA tends to affect weight-bearing joints the most, the hip and knee are often the symptomatic areas that bring patients in to see the rheumatologist.

Injections of corticosteroid (cortisone) or viscosupplements (lubricants derived from rooster combs or other sources… examples being Hyalgan, Supartz, Synvisc, Euflexxa)) can be helpful for symptomatic relief.

The most exciting and promising therapy aimed at both pain relief as well as cartilage regeneration appears to be the use of combined treatment using stem cells and platelet rich plasma. The technique involves the use of autologous stem cells, meaning cells that are harvested from the patient, and given back to the patient therefore mitigating the ethical concerns associated with fetal stem cells.

Stem cells are harvested using a biopsy needle from the iliac crest (pelvic bone) of the patient. At the same time, blood is drawn and the blood is spun down to produce platelet rich plasma. Platelets are cells in the blood that contain many growth and healing factors. A small gauge needle is then inserted into the joint (knee or hip) using local anesthetic and the area of concern (cartilage, bone spur, and tendon attachments) are mildly irritated with the needle. The stem cells and platelet rich plasma are then injected into the joint.

Preliminary results appear very promising not only for symptom relief but also for chondrocyte and cartilage regeneration.

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Treating Osteoarthritis should be a joint effort between the patient and their physician that takes into account the patient’s personal needs and medical condition. If you think you may have osteoarthritis, the best thing you can do for yourself is to take a pro-active role in your health.

Patients are often unaware that they have osteoarthritis, since the symptoms develop gradually, only to be discovered when joints swell or there is discomfort and pain after a period of inactivity.

Osteoarthritis or degenerative joint disease is a wear and tear disease of the joints typically seen in the older adult (usually over 60 years of age). Osteoarthritis, or degenerative joint disease, affects the elderly in various parts of the body such as the knees, hips, hands and even the spine.

Currently osteoarthritis treatment is limited because no medications are capable of preventing or retarding the disease process. Very often the doctor will, if osteoarthritis is found, make various recommendations to the patient that will help them to cope with both the pain and maintenance of the disease.

But whether you suffer from osteoarthritis (“wear and tear” of the joints), rheumatoid arthritis (inflammation in the joints) or gout (excess uric acid that accumulate in the joints), relief from your arthritis pain is available.

Osteoarthritis Pain Relief

Although there are effective pain relief drugs prescribed for osteoarthritis, natural pain relief if safer and just as effective. Glucosamine and Chondroitin Sulphate combined together are excellent supplements in the fight against arthritis pain: they are said to increase mobility, reduce osteoarthritis pain and form the building blocks for cartilage growth.

Silicon can prevent joint deterioration and heal cartilage. Good sources of Silicon that calcifies and strengthen bones are wholegrain cereals, oats, barley, and root vegetables. Alternate medication, home remedies, liniments, gels, and creams used to help lessen pain require patience and belief.

Prevention

Prevention of the disease can help. If osteoarthritis runs in the family, the best preventive measure would be to follow a healthy lifestyle and a regular exercise program. Medication has to follow the course of the disease.

Sportspersons are more predisposed to osteoarthritis because they tend to put too much of pressure on particular parts of their bones and joints. Playing sport uses a lot of repetitive movements which can, in time, ‘wear out’ the joint.

Diagnosis

Don’t try and diagnose yourself. If you have any pain in the joints visit your doctor. There are different types of arthritis which need different treatment and medication.

There are several methods your doctor or rheumatologist will use to diagnose your type of arthritis. For instance, knee osteoarthritis is diagnosed through physical and pathological examinations of joints on either side of knee including hip joints and checking on posture and gait.

Other Options

Once the disease sets into the advanced mode, hip replacement surgery or arthroplasty is advised to help cure the pain and improve mobility.

The Future

Increasing levels of this disease mean that within two decades it is possible that around 20% of aged people in the US will be suffering with this condition. As the baby boomers age, more and more people will be experiencing symptoms of osteoarthritis. To offset this, more and more is becoming known about natural arthritis medication and natural arthritis treatments.

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Six months earlier, my dad started complaining of knee pain every night when he went to bed. He would wake up alright every morning with no signs of any disability or pain, go to office, do a little bit of exercise and perform his real life role of a great father to perfection. But, it’s the bed time he feared the most. Every night he would ask me or my mom to give him a little massage so that he can go to sleep easily. He also ignored to give the doctor a visit. But, I realized that something was wrong and took him to an orthopedic surgeon. He asked us to go for an X-ray imaging of the knees and it was diagnosed as Osteoarthritis.

Incidence of osteoarthritis has been on the rise. The disease primarily affects persons over the age of 60 years but it can also occur a decade early as in the case of my dad. It mainly affects the joints of knees, hips, hand and the cervical and lumbar spine. The main problem with this condition is the high rate of disability associated with it.

Osteoarthritis (OA) is a degenerative process affects the different joints of our body and the primary pathology associated with it is the loss of articular cartilages. A joint has many components- joint capsule, ligaments, muscles, tendons, synovium, synovial fluid, sensory nerves carrying impulses from the joints, articular hyaline cartilage and underlying bone. These components of the joint act as a unit to maintain the integrity of the joint and function as protectors of the joint from damage. For example, cartilages at the ends of bones forming the joint act as cushion during movement at the joint and the synovial fluid secreted from the synovium acts as a lubricant allowing frictionless movement. Any malfunction in the protective mechanisms sets in a complex interplay of molecular action at the joint leading to inflammation and damage to the joint resulting in OA.

Associated risk factors-

Age- With increasing age the capacity of the joint to repair any damage sustained is reduced and the joint is at increased risk of developing OA.

Women are at higher risk.

Genetic influence- If any of the parent is having the disease then the children are at increased risk of developing the disease in future.

Previous history of ligament tear, major injury to the joint or fractures involving the joint.

Any deformities of hands or legs.

Weakness of muscles around the joint due to any muscular or nervous disease.

Obesity is a major risk for the disease to develop.

Continuous

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Osteoarthritis is the most common type of arthritis and the leading cause of chronic musculoskeletal pain and limited mobility in older people worldwide.Since it is so common, many treatments have been advocated. Some treatments work and others dont. However, the sheer number of claims of efficacy can be overwhelming to both physicians as well as patients.A new set of treatment recommendations for knee and hip osteoarthritis have been released by a scientific organization, the Osteoarthritis Research Society International (OARSI).The goals of the committee were (1) to review all of the published national and international treatment guidelines together with the more recent evidence from clinical trials and (2) to produce a single set of up-to-date, evidence-based recommendations for the worldwide treatment of knee and hip osteoarthritis.The first of OARSIs 25 evidence-based recommendations was that that best treatment requires both non-drug and drug modalities. The remaining 24 recommendations fall into three categories non-drug, drug, and surgical.Non-drug These 11 recommendations include education and self-management (97%); regular telephone contact (66%); referral to a physical therapist (89%); aerobic, muscle strengthening and water-based exercises (96%); weight reduction (96%); walking aids (90%); knee braces (76%); footware and insoles (77%); thermal modalities [heat or cold] (64%); transcutaneous electrical stimulation (58%); and acupuncture (59%).Surgical These five recommendations include total joint replacement (96%); unicompartmental knee replacement (76%); osteotomy and joint preserving surgical procedures (75%); joint lavage and arthroscopic debridement in knee OA (60%); and joint fusion as a salvage procedure when joint replacement had failed (69%).In recent years, there has been a drop in the use of NSAIDs by physicians because of concerns related to the potential for causing gastrointestinal side effects and the possible cardiovascular risks associated with these drugs.The guideline committee was made up of experts from six countries, including 11 rheumatologists, two primary care physicians, one orthopedic surgeon, and two experts on evidence-based medicine.For example, research into osteoarthritis is constantly advancing and newer types of therapies exist for which there is still insufficient evidence to say whether they are effective or not.Second, one therapy, arthroscopic debridement for the knee has much evidence supporting its use, yet payers such as CMS (Medicare) will not pay for it citing the very few studies that dont show benefit as their evidence.Finally, there are cutting edge therapies such as stem cells and the use of platelet rich growth factors which show a lot of promise but for which it is much too early to know how effective they will be.

So… stay tuned!

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Osteoarthritis is the most common form of arthritis. The breakdown of joint cartilage caused by osteoarthritis may affect any joint in your body. Joints affected may include:

Fingers

Hips

Knees

Lower back

Feet

At first osteoarthritis may affect only one joint, but if your fingers are affected, multiple hand joints may become arthritic.

There are available treatments for osteoarthritis, but no cure. The available treatments can relieve pain and help you remain active.

Some people may not experience symptoms because the disease often develops slowly. Signs and symptoms of osteoarthritis may include:

Pain in a joint during or after use, or after a period of inactivity

Discomfort in a joint before or during a change in the weather

Swelling and stiffness in a joint, particularly after using it

Bony lumps on the middle or end joints of your fingers or the base of your thumb

Loss of joint flexibility

Areas in which osteoarthritis typically affects include:

Fingers: Bony knobs can enlarge your finger joints and create a gnarled appearance. Early in the disease, your joints may feel painful or stiff and numb. The pain eventually often subsides, but leaves bony nodes that affect the mobility of the joints at the end of your fingers. The nodes run in families and affect women more than men.

Spine: As the disk slowly deteriorate between the bones along your spine, back and neck pain and stiffness may occur.

Weight-bearing joints: The hips, knees and feet are more susceptible to osteoarthritis because they bear the majority of your bodys weight. Over the years cartilage slowly deteriorates and chronic pain or varying amounts of discomfort when you stand and walk can occur. Swelling especially in the knees may also occur.

Treatment for osteoarthritis

Your doctor may recommend a combination of treatment that includes medication, self-care, physical therapy and occupational therapy. Surgical procedures may also be necessary in some cases.

Medications may include:

Topical pain relievers such as Aspercreme or Sportscreme, Icy Hot and Ben-Gay.

Acetaminophen like Tylenol and others can relieve pain but does not reduce inflammation

NSAIDs: Nonsteroidal anti-inflammatory drugs work to relieve pain and fight inflammation. They range from OTC aspirin, ibuprofen like Advil, Motrin IB and others to prescription strength

Cox-2inhibitors: Are considered as effective as other NSAIDs for managing pain and inflammation without the same stomach-damaging effects. Other side effects of Cox-2inhibitors may include fluid retention, exacerbating high blood pressure and links to increased risk of heart attack and stroke

Tramadol: Available only by prescription, has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects such as stomach ulcers and bleeding. Tramadol may cause nausea and constipation. It is generally used for short-term treatment of acute flare-ups.

Antidepressants: Tricyclics especially can help reduce chronic pain. They can treat sleep disturbances that can accompany arthritis. Some antidepressants used for arthritis pain and nonrestorative sleep include amitriptyline and nortriptyline.

Injections of pain relievers: Corticosteroid injections into a joint space can offer some pain relief and reduce inflammation.

Surgical or other procedures used to treat osteoarthritis include:

Joint replacement

Arthroscopic lavage and debridement

Repositioning bones

Fusing bones

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Osteoarthritis (OA) is one of the most common conditions leading to disability and impaired quality of life in the Western world.

Ironically, while more effective disease-modifying therapies have been developed for rheumatoid arthritis, particularly within the last 10-15 years, rheumatologists still treat osteoarthritis with symptomatic and supportive therapies.

As a result, the inexorable progression of this disease results in the performance of more than half a million joint replacements annually in the United States. While joint replacement surgery has made gigantic strides, it is still a major surgical procedure.

Risk factors for the development of OA include: genetic factors, obesity, joint injury, surgery, and the presence of associated metabolic disease.

It is clear from the research that OA is a disease that involves not only the cartilage- the gristle that caps the end of long bones and cushions the joint, but also the synovium- the tissue lining the joint- as well as the bone that underlies cartilage.

While genetic factors play a significant role in the incidence of osteoarthritis, the damage that occurs is a result of a complex interaction of inflammatory messengers. Among these are cytokines, prostaglandins, nitric oxide, growth factors, and proteases.

These substances, which are produced by chondrocytes (cartilage cells) that are subjected to abnormal forces lead to a situation where there is premature aging and destruction of cartilage substance.

The production of these inflammatory proteins also contributes to inflammation of the synovium and excessive amounts of bone growth.

Present therapies, as issued by guidelines proposed by the Osteoarthritis Research Society International (OARSI), are clearly aimed at symptom relief. These treatments include: analgesics, non-steroidal-anti-inflammatory drugs (NSAIDS), topical agents (rubs), and joint injections with either glucocorticoids (cortisone), or hylauronic acid lubricants.

Current research has been aimed at finding the triggers that cause inflammation to start and also to identify specific markers that might identify those patients who are at greatest risk for rapid progression of disease. These markers would also be useful in measuring improvement once newer drugs that can slow down disease progression in OA can be discovered.

However, all of these investigations are futile unless and until specific disease-modifying osteoarthritis drugs (DMOADS) drugs that slow down the rate of cartilage loss- can be developed.

Drugs aimed at inhibiting cytokine and protease function show some promise but it is still too early to tell whether they will have the desired effect. Examples of these drugs include: matrix metalloproteinase inhibitors, drugs that block interleukin 1, bisphosphonates, calcitonin, as well as nutritional supplements such as glucosamine and chondroitin.

And it may not be enough to find drugs that simply slow disease progression.

The holy grail is still the treatment(s) that will rebuild cartilage. The type of therapy that shows the greatest promise to date is the use of autologous stem cells. These are stem cells harvested from the patient and reintroduced into the affected joint along with a specific matrix to which the stem cells can adhere and grow.

Early results look promising. For more information about stem cell treatment for osteoarthritis of the knee, contact the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.

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Osteoarthritis (OA) is the most common form of arthritis, affecting anywhere from 30 to 50 million Americans. It is a disease that is due to disordered metabolism in cartilage, the gristle that caps the ends of long bones within a joint. The disordered metabolism leads to a cycle of cartilage deterioration accompanied by inflammation within the joint capsule leading to more deterioration of cartilage.

The primary symptoms associated with OA are pain, stiffness, and swelling.

Unlike rheumatoid arthritis, osteoarthritis is a disease for which there are no revolutionary biologic therapies that are available to put it into remission. No treatments prevent osteoarthritis or reverse or block the disease process once it begins.

Current treatments relieve only the symptoms. Researchers are looking for drugs that can prevent, slow down, or reverse joint damage. One antibiotic drug, doxycycline, may stop certain enzymes from damaging cartilage. The drug has had mixed reviews in clinical trials, but more studies are needed.

Researchers are also studying growth factors or other natural chemical messengers. These potential medicines may be able to stimulate cartilage growth or repair.

Acupuncture has received a lot of press recently. In acupuncture, fine needles are inserted into the skin at various points on the body.

Scientists think that the needles stimulate the release of natural, pain-relieving chemicals produced by the brain or the nervous system. Findings suggest that traditional Chinese acupuncture is effective in some patients as an additional therapy for osteoarthritis, reducing pain and improving function. Still acupuncture is a symptomatic therapy and is not designed to reverse or slow down cartilage loss.

Anesthetic patches containing lidocaine are currently being studied as an adjunctive treatment for the pain of OA. Preliminary studies look promising.

Nutritional supplements are often reported as helpful in treating osteoarthritis.

Glucosamine and chondroitin sulfate are components of normal cartilage. Scientific studies on these two nutritional supplements have come up with conflicting conclusions. Most European studies have demonstrated that this combination of nutritional supplements is effective not only for pain relief but also apparently slows down the rate of cartilage deterioration. However, a recent clinical trial conducted by The National Center for Complementary and Alternative Medicine at NIH failed to demonstrate any benefit in patients with mild OA but did appear to show that there was some possible benefit for patients with moderate OA.

There is interest in the role of vitamins for OA. Apparently, progression of the disease appears to be less in patients with high levels of vitamin D or C intake. More studies are needed to confirm these reports.

Injecting hyaluronic acid into the knee joint provides long-term pain relief for some people with osteoarthritis. Hyaluronic acid is a natural component of cartilage and joint fluid. It lubricates and absorbs shock in the joint. The Food and Drug Administration (FDA) has approved a number of these types of preparations (also called viscosupplements) for patients with osteoarthritis of the knee if they do not get relief from exercise, physical therapy, or simple analgesics. Researchers are studying whether hyaluronic acid can slow down the progression of osteoarthritis.

Tissue Engineering is a technology that involves removing cells from the body and replacing them to improve certain body functions. There are three major types of tissue engineering for use in treating osteoarthritis.

Enzyme engineering. Certain body chemicals called enzymes may help cartilage to break down. Scientists are working to genetically engineer cells that would inhibit these enzymes and prevent the damage they cause. Cells are removed from the body, genetically changed, and then injected back into the affected joint. They protect the joint from damaging enzymes.

Cartilage cell replacement. Researchers remove cartilage cells from the patients own joint, clone or grow new cells using tissue culture and other laboratory techniques, and inject the newly grown cells into the patients joint. The cells are kept in place with a biodegradable mesh. Patients with cartilage cell replacement have decreased osteoarthritis symptoms. Actual cartilage repair is limited, however. The procedure is also arduous in that the patient must go at limited weight-bearing for six months.

Stem cell transplantation. Stem cells are primitive cells that can transform into other kinds of cells, such as muscle or bone cells. They are usually taken from bone marrow. Researchers are able to insert stem cells into cartilage where they make new cartilage. If successful, this process could be used to repair damaged cartilage and avoid the need for surgical joint replacements with metal or plastics.

Platelet rich plasma grafting techniques are attracting interest. The patient has 20 ccs of blood drawn and the blood is spun down in a centrifuge. The layer containing platelets (a type of blood cell) is selectively removed. The cartilage in the joint is then teased to bleed using a special needle. Stem cells may be inserted and then the platelet rich plasma, which contains an abundant amount of growth factors is added. Cartilage cells are stimulated to grow. The attraction of this approach is that the procedure is not nearly as invasive as cartilage cell transplantation and the patient does not have to go at extreme limited weight-bearing.

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What is this condition?

Osteoarthritis, the most common form of arthritis, is an ongoing process that breaks down cartilage around a bone, then causes new bone to grow around and under the affected joint. It usually occurs in the hips and knees. Osteoarthritis is widespread and affects both sexes after age 40. It can be disabling and usually gets worse as the person ages, ranging from minor dysfunction of the fingers to severe hip or knee problems.

What causes it?

Osteoarthritis, a normal part of aging, results from many metabolic, genetic, chemical, and mechanical factors. One form of osteoarthritis results from a specific event, such as a fall, an inherited deformity, or obesity that leads to degenerative changes.

What are its symptoms?

The most common symptom of osteoarthritis is deep, aching joint pain, which occurs particularly after exercise or other joint stress. The pain goes away when the person rests. Other symptoms include stiffness in the morning (again, relieved by rest), aching during changes in weather, “grating” of the joint during motion, and tight muscles that hamper movements. These symptoms are worse if the person has poor posture or job stress or is obese. When it affects the hands, osteoarthritis changes the shape of the joints and can eventually make them red, swollen, tender, and numb.

How is it diagnosed?

The doctor can assess obvious changes in the person’s joints and use X-rays to see such signs as joint deformity, bony deposits, and joint fusion. There is no lab test specific for osteoarthritis, but tests can rule out other inflammatory joint problems.

How is it treated?

The doctor will prescribe medications to relieve pain and minimize stiffness. Medications include aspirin (or other nonnarcotic pain relievers), Butazolidin, lndocin, Nalfon, Advil or Motrin, or Darvon and, in some cases, injections of corticosteroids. Such injections, given every 4 to 6 months, may delay the development of new deposits in the person’s hands. The person will also be taught specific exercises to promote flexibility.

Other treatments

The doctor may put the person in a brace or traction, suggest a cane or crutches for walking, and encourage other supportive measures such as massage, steam baths, paraffin (wax) dips for the hands, and exercise. Surgery is reserved for people who have severe disability or uncontrollable pain.

What can a person with osteoarthritis do?

Pace yourself. Plan rest periods during the day and be protective about getting a good night’s sleep. Because osteoarthritis is not a disease of your whole body, concentrate on therapy that improves your flexibility and comfort.

Specific treatments

Hand: Hot soaks and paraffin dips can relieve pain.

Lower and middle back: Use a firm mattress (or bed board) to decrease morning pain.

Neck: Check the tightness of your cervical collar; watch for redness after prolonged use.

Hip: Use moist heat pads to relieve pain (usually with prescribed antispasmodic drugs) and do stretching and strengthening exercises. You may need to inspect your braces or a walker for proper fit.

Knee: Regularly exercise to maintain flexibility, muscle tone, and strength. Consider a brace or an elastic wrap for support.

More good moves

Take your medication exactly as prescribed, and report side effects immediately.

Avoid overexertion, and learn to stand and walk without stressing joints. Be especially careful when stooping or picking up objects.

Wear well-fitting supportive shoes; don’t allow the heels to become too worn down.

Install safety devices at home, such as hand rails in the bathroom .

Maintain your proper weight to lessen stress on joints.

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