Experts still aren’t sure why cartilage, the shock-absorbing tissue that normally coats the ends of bones, sometimes breaks down. When it does, it causes those typical arthritis symptoms: stiffness and pain.
What is arthritis?
Arthritis literally means inflammation of a joint. The term comprises more than 100 different rheumatic diseases that cause pain, swelling, inflammation, and impaired movement in joints and connective tissue throughout the body. Most are chronic—once you develop arthritis, you have it for life—and your genes may add to your risk. But aggressive treatment can help you manage your arthritis and prevent pain, disability, and deformity. That’s why the sooner the condition is diagnosed, the better. If you experience any joint or muscle pain, stiffness, or swelling that lasts more than a few weeks, see your doctor.
The most common type of arthritis is osteoarthritis (OA), which afflicts about 1 in 10, or 3,000,000 Canadians. The condition develops as protective cartilage—the rubbery cushioning material that covers the ends of bones at the joint—gradually wears away. The joint’s inner bone surfaces eventually are exposed and rub together, causing pain and damage to the joint.
Who is at risk for arthritis?
As arthritis is a degenerative disease, its causes are varied. Your family history may bear some responsibility: Your genes set the stage for a defect in the production of collagen, a protein crucial to cartilage. Perhaps you were injured (even decades ago), or you are overweight, or use a certain joint repetitively (maybe on the job).
Osteoarthritis is most common in people over age 45.
Rheumatoid arthritis (RA) is a more serious disorder and can strike people of any age. It is an autoimmune disease in which the immune system runs amok, attacking joints and connective tissue as if they were foreign invaders. It can cause inflammation throughout the body.
Treatment for arthritis
If you have arthritis, you probably have “good days” and “bad days.” If it’s a bad day, start by taking a painkiller (acetaminophen, an OTC NSAID, or a COX-2 inhibitor). You’ll probably feel better in a couple of hours. Self-care remedies are also useful: Hot or cold packs, liniments, stretching, and natural methods of relaxing help control arthritis pain. The supplements glucosamine and chondroitin may prevent cartilage deterioration. It’s important to know that you can control your situation by making changes in your lifestyle. You can prevent arthritis flare-ups, for example, by keeping your weight down, exercising regularly, and using doctor-recommended aids (shoe wedges, walking aids, braces). A physical therapist can provide specialized procedures. Ask your doctor for a referral so insurance will cover the cost.
Good medical options for arthritis are also available. If swelling gets very bad, your doctor may use a syringe to drain fluid from around a joint, such as the knee. Steroid or hyaluronic acid injections can also bring relief. Overall, the odds are small that you’ll need surgery to replace your affected joint, but it’s reassuring that success rates for such procedures are very high. Surgeons often urge active people with arthritic knees to try low-impact aerobic activities—such as biking, walking, or using an elliptical trainer, rather than knee-stressing ones like running or skiing—before they consider joint replacement surgery.
Medications for arthritis
No medicine can cure your arthritis, but many can ease pain and stiffness, making life comfortable again. Reach first for acetaminophen (Tylenol, Anacin-3, Panadol). If you’re just a little achy and stiff, it might well do the trick, and it’s very safe. Acetaminophen can’t calm inflammation, so if discomfort persists or there’s actual swelling, add a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen (Motrin or Advil), or naproxen (Naprosyn). NSAIDs, available over the counter or by prescription in stronger versions (familiar brands include Voltaren, Arthrotec, Relafen, Feldene), block the body’s creation of prostaglandins, substances that trigger inflammation. If your arthritis is a constant problem, these drugs might cause some digestive side effects. Although generally quite safe, NSAIDs can irritate your stomach lining, causing queasiness, abdominal pain, and even bleeding. Along with NSAIDs, try a liniment (pain-relieving cream, rub, or spray). The popular ones (capsaicin cream and methyl salicylate products) must be applied four times a day for several days before you get results.
At one time, if you had side effects from NSAIDs or were at risk for an ulcer, your doctor might have suggested switching to prescription NSAIDs, also known as COX-2 inhibitors, introduced in the late 1990s. Celecoxib (Celebrex) and valdecoxib (Bextra) once commanded 60% of the $6.6 billion arthritis-drug market. Recent studies, however, indicate that heart attack risk is four times greater than traditional pain relievers, and side effects as extreme as death have been linked to certain COX-2s. Vioxx was voluntarily pulled from the market by its drug manufacturer, but Celebrex, the more popular of the two, remains and is under FDA investigation. Clinical trials of Bextra indicate that a higher risk of stroke and heart attack can occur, especially in those with heart problems. Talk with your doctor if you are taking COX-2 inhibitors to discuss risks and alternatives to consider.
If your arthritis pain is severe, opioids such as tramadol (Ultram) or codeine are worth considering. Aim for the lowest effective dose so you can minimize the risk of becoming dependent (especially with codeine) or suffering side effects such as constipation, nausea, or drowsiness.
When your joints creak and ache, it seems counterintuitive to exercise, but exercise is one of the best arthritis remedies around. Done properly (good form is crucial), exercise can keep your pain and stiffness from veering out of control. You’ll get the biggest payoff by doing resistance training with weights designed to strengthen and tone muscles. Such exercises stabilize joints and make them more flexible. Ask a physical therapist to show you exercises that will benefit your condition. Only after focusing on actions that build muscles should you add aerobics. Low-impact aerobic exercises (swimming, biking, walking) stimulate blood flow and ease joint stress by keeping your weight down. They also boost your mood. Working up a sweat can even make you feel less sensitive to pain. In time, tack on stretching and range-of-motion exercises, such as yoga and tai chi, to enhance flexibility and your sense of control over the pain.
You may be amazed at the strides you can make with exercise. An intriguing 2002 study found that knee osteoarthritis patients who regularly lifted weights or exercised aerobically were much more likely to dress, bathe, and move from a bed to a chair independently than those who simply read information on disease management. While exercise is crucial, so is giving your joints a rest. Listen to your body. A little soreness the day after working out is normal, but if the pain keeps nagging you, ease up a bit.
Ask your doctor about joint protectors (splints, braces, neck collars, crutches, canes). They can support tender areas and are especially good for lightening the strain on lower body joints. Check out physical or occupational therapy catalogs or stores for supplies. For people with hand arthritis, special grip devices make opening jars easier. Foam pads attached to handles on garden and household tools also help. Arthritis pain in your knee or hip can be rectified with orthopedic shoes or footwear outfitted with shock-absorbing soles or wedge-shaped insoles. By distributing your weight evenly and correcting for improper alignment, such simple aids can make a big difference. For knee problems, try in-shoe heel wedges to lessen the lateral thrust on the joint. They allow many to postpone joint replacement surgery. Knee support with taping or a Velcro brace also helps.
For rapid relief from pain or stiffness without drugs, try hot and cold treatments. If there’s no acute inflammation, apply warm compresses and heat lamps, or take hot showers or baths to ease stiffness. Hot wax or paraffin treatment kits do wonders for arthritic hands. When your joints are inflamed, ice is the way to go. A commercial cold pack or bag of frozen peas placed on the joint really works. You might want to alternate between hot and cold. Either way, 20 minutes will do it (less if your skin gets very red). Avoid direct skin contact by using a towel or other buffer.
Excess weight adds stress to your weight-bearing joints (knees, hips, feet). So diet and exercise to drop any extra pounds you may have gained over the years. A healthy diet also perks you up—chronic pain can wear out even the hardiest souls—and a high-fiber content can counter pain-medication–related constipation. Plan to eat lots of cold-water fish (salmon, herring, sardines), which are rich in omega-3 fatty acids, a natural anti-inflammatory. Or swallow a daily tablespoon of omega-3 fatty-acid-rich fish oil, evening primrose oil, or flaxseed oil. Getting lots of calcium and vitamin D will help keep your bones strong and better able to support your joints.
Related procedures for arthritis
If you have persistent arthritis pain, especially in the knee, a steroid injection may make you feel better. You can’t have these shots more than once every three months, but you may enjoy about a three-week vacation from pain. Injections of a synthetic derivative of hyaluronic acid (Hyalgan or Synvisc) may give you longer-lasting relief. This gooey joint lubricant is a component of synovial fluid, which normally eases and cushions joints. Many people with osteoarthritis have paltry amounts of it, and injections help replenish the supply. After three to five weeks of injections, you may enjoy several months of pain-free movement. One study found it as potent as high-dose Tylenol.
If you still have pain and trouble moving, surgical joint repair using endoscopic techniques (called arthroscopy) is another option. After making two or three small incisions around the joint, the surgeon fishes out bits of bone and damaged cartilage. So-called “knee scraping” has gotten some negative press lately, however. In a widely reported 2002 study, patients were just as likely to say their knee felt better two years after sham surgery as they were after a pricey arthroscopic procedure. So talk it over with your doctor. Osteotomy may be an option if you have early-stage arthritis in one knee and no inflammation. By surgically reshaping the shinbone or thighbone, a surgeon can often improve the alignment, repositioning the joint so that your knee can once again move freely and carry your weight evenly. The knee won’t look symmetrical, but it may not hurt as much. Osteotomy can also slow further joint deterioration.
Unicompartmental knee arthroplasty may also ease pain and delay total knee replacement. It works best if you’re over age 60, are not obese, have no real inflammation, and the anterior cruciate ligament (ACL) at the back of your knee is intact. The surgeon removes diseased bone and puts in an implant. Joint motion and function are good because healthy parts of the knee are preserved. It’s cheaper and less likely to cause complications than osteotomy, and recovery is short. As a last resort, if your arthritis pain is overwhelming and the joint is misshapen, consider a total joint replacement (arthroplasty). Success rates are high, and techniques improve all the time.
Alternative therapies for arthritis
Certain alternative therapies can be quite helpful for arthritis, but every person is different. What works for your neighbour may not be good for you—and vice versa. You may also need to be patient. It may be several weeks before you feel any true benefit.
Many people report arthritis relief when they routinely take glucosamine and chondroitin, two dietary supplements widely advertised to help cartilage. Glucosamine sulfate is extracted from shellfish; chondroitin sulfate from cattle.
Relaxation therapies are a useful add-on treatment for arthritis. Stress and anxiety can tighten muscles around joints, worsening pain. Relaxation helps blunt this pain—and your perception of it—and enhances your capacity to cope. For biofeedback and hypnosis, an experienced therapist can show you several techniques to do on your own. Deep breathing relaxes you through the process of inhaling deeply and rhythmically. It’s often taught in yoga classes. During meditation, you focus on awareness of what you feel, and what comes into your mind, at a given moment. The gentle kneading of massage can loosen and stretch tight muscles, improving your flexibility.
Acupuncture is another method used for pain relief. This ancient therapy has been practiced in China for 2,500 years. Western scientists think strategically inserted needles prompt the body to generate compounds that relieve pain and reduce inflammation. Just be sure your practitioner uses sterile, throwaway needles.
Living with arthritis
If you suffer with Arthritis, here are a few tips to help you out:
• Go to class. Studies show that being actively involved in managing your own osteoarthritis can dramatically lessen your pain. There are classes led by osteoarthritis sufferers specially trained to share tips on treatments, exercise, and strategies for relaxation and coping.
• Toss the heels. Twice as many women as men suffer from knee osteoarthritis, and Harvard researchers have a clue as to why. When walking in heels two inches or higher, the torque—the rotational force—applied around the inside of the knee is 23% greater than when barefoot. This is enough torque to destroy cartilage and cause arthritis. So opt for low-heeled or flat shoes, and keep the high heels for special occasions.
• Get on the ball. Try squeezing a tennis ball to relieve stiffness and strengthen your forearms and hands. Make a two- to three-inch cut in the ball for light resistance, and a one-inch cut to create moderate resistance.
• Be hip on hips. Don’t just settle for a standard replacement hip. Ask your doctor about the procedure most appropriate for your age, condition, and lifestyle.
Adapted from Looking After Your Body: An Owner's Guide to Successful Aging, Reader's Digest; Know Yo