I was declared to be disabled due to mild to severe Osteoarthritis throughout my body on April 6, 2006. I continued to work as much as I could part time until I finally had to quit in May of 2008. My spine is full of moderate arthritis. I had to have the disc at C4 replaced because I had lost feeling in my right arm and hand. I have several bulging discs, but the worst seems to be at the tail bone where the arthritis is severe. I was having pain management shots that actually deadened the nerve there for 6 months to 2 years. I can't stand for more than a few minutes without doubling over in pain without the shots. Both of my knees need to be surgically replaced, but my chronic bronchitis and asthma are keeping me from having surgery. On X-Rays, I have what looks like a second big toe on my right foot, but is actually a bone spur that causes a great deal of pain. Surgery to remove it is very risky. In most cases the patient loses balance and the ability to walk -per the Pediatrist who treated me- so few people have the surgery to relieve the pain. And I am allergic to all NSAIDS. Alleve made me break out in hives. Naproxen sent me into anaphylaxis shock. Which is terrible because I felt so much better after taking Naproxen for three days.
Right now I'm on a roll. I'm losing weight instead of gaining weight. I'm doing my physical therapy at home now. I'm eating better and keeping active on a daily basis ... most days. I'm taking Cymbalta for pain and depression. I'm using Fentanyl patches on a daily basis and rarely resorting to Percocet for breakthrough pain. My pulmonary specialist says no surgery yet, but I'm doing my breathing exercises and trying to get my lung capacity where it needs to be to get off the oxygen. ~ Sandi
What Is Osteoarthritis?
Learn about the symptoms, effects and causes of this common joint disease.
Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA) is the most common chronic condition of the joints, affecting approximately 27 million Americans. Although it occurs in people of all ages, osteoarthritis is most common in people older than 65.
In osteoarthritis, there is a breakdown in the cartilage covering the ends of bones where they meet to form a joint and allow movement. As the cartilage wears away, the bones become exposed and rub against each other. The deterioration of cartilage also affects the shape and makeup of the joint so that it no longer functions smoothly. You may notice a limp when you walk, or you may have trouble going up and down stairs because those movements put additional stress on the joint.
Other problems can occur inside the joint as cartilage breakdown affects the joint components. Fragments of bone or cartilage may float in joint fluid, causing irritation and pain. Spurs, or osteophytes, can develop on the ends of the bones, damaging surrounding tissues and causing pain. Fluid inside the joint may not have enough of a substance called hyaluronan, which may affect the joint’s ability to absorb shock. And although inflammation is not a main symptom of osteoarthritis, it can occur in the joint lining in response to the cartilage breakdown.
In osteoarthritis, there is a breakdown in the cartilage covering the ends of bones where they meet to form a joint and allow movement. As the cartilage wears away, the bones become exposed and rub against each other. The deterioration of cartilage also affects the shape and makeup of the joint so that it no longer functions smoothly. You may notice a limp when you walk, or you may have trouble going up and down stairs because those movements put additional stress on the joint.
Other problems can occur inside the joint as cartilage breakdown affects the joint components. Fragments of bone or cartilage may float in joint fluid, causing irritation and pain. Spurs, or osteophytes, can develop on the ends of the bones, damaging surrounding tissues and causing pain. Fluid inside the joint may not have enough of a substance called hyaluronan, which may affect the joint’s ability to absorb shock. And although inflammation is not a main symptom of osteoarthritis, it can occur in the joint lining in response to the cartilage breakdown.
What Are the Symptoms of Osteoarthritis?
Symptoms of osteoarthritis vary, depending on which joints are affected and how severely they are affected. However, the most common symptoms are stiffness, particularly first thing in the morning or after resting, and pain. The most commonly affected joints are the lower back, hips, knees and feet. When those joints are affected you may have difficulty with such activities as walking, climbing stairs and lifting objects.
Other commonly affected joints are the neck and fingers, including the thumb base. When finger and hand joints are affected, osteoarthritis can make it difficult to grasp and hold objects, such as a pencil, or to do delicate tasks, such as needlework.
Other commonly affected joints are the neck and fingers, including the thumb base. When finger and hand joints are affected, osteoarthritis can make it difficult to grasp and hold objects, such as a pencil, or to do delicate tasks, such as needlework.
What Causes Osteoarthritis?
Like other chronic conditions, osteoarthritis has no single, specific cause. Instead, there are several factors involved in the disease, including heredity and lifestyle. While osteoarthritis was long believed to be a simple mechanical process in which joints wore out, researchers now view it as a disease of the joint. The following factors may contribute to osteoarthritis:
Genes: One possibility is that certain people may have a defect in the gene responsible for the body’s production of collagen, the protein that makes up cartilage. This somewhat rare genetic defect might lead to abnormally weak cartilage that wears down after just a few decades of normal activity, causing osteoarthritis as early as age 20.
Genes: One possibility is that certain people may have a defect in the gene responsible for the body’s production of collagen, the protein that makes up cartilage. This somewhat rare genetic defect might lead to abnormally weak cartilage that wears down after just a few decades of normal activity, causing osteoarthritis as early as age 20.
Other genetically based traits may result in slight defects in the way the bones and joints fit together so that cartilage wears away faster than usual. The inherited trait known as joint laxity, or double-jointedness, in which the joints bend farther than the usual angles, may also increase the risk for osteoarthritis. Simply inheriting a gene that makes you more susceptible to osteoarthritis doesn’t mean you will get the disease, however. Your lifestyle – that is, the way you eat, exercise, sleep and whether you have bad habits such as smoking – has a tremendous impact on whether you will develop OA.
Weight: Your hips and knees bear the brunt of your body’s weight. Being overweight puts additional pressure on these joints. For every pound you gain, your knees gain three pounds of added stress; for your hips, each additional pound translates into six times the pressure on these joints. Many years of carrying extra pounds can cause the cartilage that cushions your joints tends to break down. Obesity may lead to osteoarthritis on its own, or it may combine with other factors such as genetic susceptibility to produce the disease and worsen its symptoms.
Some research has shown a link between being overweight and having an increased risk of osteoarthritis in the hands, but the reason for that connection is unclear. One theory is that excess fat tissue itself produces inflammatory chemicals that travel throughout the body and are capable of causing damage in places other than weight-bearing joints.
Weight: Your hips and knees bear the brunt of your body’s weight. Being overweight puts additional pressure on these joints. For every pound you gain, your knees gain three pounds of added stress; for your hips, each additional pound translates into six times the pressure on these joints. Many years of carrying extra pounds can cause the cartilage that cushions your joints tends to break down. Obesity may lead to osteoarthritis on its own, or it may combine with other factors such as genetic susceptibility to produce the disease and worsen its symptoms.
Some research has shown a link between being overweight and having an increased risk of osteoarthritis in the hands, but the reason for that connection is unclear. One theory is that excess fat tissue itself produces inflammatory chemicals that travel throughout the body and are capable of causing damage in places other than weight-bearing joints.
Injury and overuse: Sometimes repetitive movements or serious injuries to joints (such as a fracture or surgery) can lead to osteoarthritis down the road. Some full-time athletes, for example, repeatedly damage certain joints, tendons and ligaments, which speeds cartilage breakdown. Even joints such as shoulders (which don’t bear much weight and are unlikely to have osteoarthritis) can develop the disease after injuries or repeated stressful activities.
The constant knee bending required by some types of work, such as landscaping, can make cartilage wear away more quickly than moderate use of those joints.
The constant knee bending required by some types of work, such as landscaping, can make cartilage wear away more quickly than moderate use of those joints.
Others: Several other factors may contribute to osteoarthritis. These factors include other bone and joint disorders like rheumatoid arthritis and certain metabolic disorders such as hemochromatosis, which causes the body to absorb too much iron, or acromegaly, which causes the body to make too much growth hormone.
How Is Osteoarthritis Diagnosed?
What are the signs, symptoms and tests that might result in a diagnosis?
The diagnosis of osteoarthritis begins with a medical history, or information about your health background. Because certain conditions can be inherited, your doctor will ask which conditions run in your family. Your doctor will also want to find out about the symptoms that prompted you to seek medical attention.
Information your doctor may need to help diagnose osteoarthritis includes:
• a description of your symptoms
• details about when and how the pain or other symptoms began
• where you are feeling pain, stiffness or other symptoms
• how the symptoms are affecting you
• whether you have other medical problems that could be causing these symptoms
The next important part of the diagnostic process is the physical exam. During the exam your doctor will look at your joints and touch those you’ve described as painful. He or she will be looking for areas that are tender, painful or swollen as well as indications that the joints may be damaged.
To find out how arthritis is affecting your body, your doctor may ask you to stand up and move certain joints. This will show the range of motion in your joints or how well you can move each joint through its full capabilities. The doctor will examine the position and alignment of your neck and spine. He or she may ask you to walk around the office a bit to see how you are able to move your hips and knees.
The final part of the diagnosis of osteoarthritis may involve laboratory tests to confirm the diagnosis your doctor suspects based on your medical history and physical exam. Blood tests are usually not helpful in making a diagnosis; however, the following tests may help confirm a diagnosis of osteoarthritis:
Joint aspiration: For this laboratory test, your doctor will administer a local anesthetic, then insert a needle into the joint in order to withdraw fluid. The fluid is then examined for evidence of crystals or joint deterioration. This test can help rule out other medical conditions or other forms of arthritis.
X-ray: Imaging techniques like X-rays can show the physical effects of osteoarthritis to confirm the diagnosis. X-rays use radiation to penetrate the body’s soft tissues and show internal structures like bones. The images can show damage and other changes in cartilage and bones that can occur with osteoarthritis.
MRI: Magnetic resonance imaging (MRI) uses magnetic fields to produce an image of a specific area of the body. The test is more expensive than X-rays, but it does not involve the radiation risk of X-rays. And MRIs provide a two-dimensional view that offers better images of soft tissues, as cartilage, to detect early abnormalities typical of osteoarthritis.
• a description of your symptoms
• details about when and how the pain or other symptoms began
• where you are feeling pain, stiffness or other symptoms
• how the symptoms are affecting you
• whether you have other medical problems that could be causing these symptoms
The next important part of the diagnostic process is the physical exam. During the exam your doctor will look at your joints and touch those you’ve described as painful. He or she will be looking for areas that are tender, painful or swollen as well as indications that the joints may be damaged.
To find out how arthritis is affecting your body, your doctor may ask you to stand up and move certain joints. This will show the range of motion in your joints or how well you can move each joint through its full capabilities. The doctor will examine the position and alignment of your neck and spine. He or she may ask you to walk around the office a bit to see how you are able to move your hips and knees.
The final part of the diagnosis of osteoarthritis may involve laboratory tests to confirm the diagnosis your doctor suspects based on your medical history and physical exam. Blood tests are usually not helpful in making a diagnosis; however, the following tests may help confirm a diagnosis of osteoarthritis:
Joint aspiration: For this laboratory test, your doctor will administer a local anesthetic, then insert a needle into the joint in order to withdraw fluid. The fluid is then examined for evidence of crystals or joint deterioration. This test can help rule out other medical conditions or other forms of arthritis.
X-ray: Imaging techniques like X-rays can show the physical effects of osteoarthritis to confirm the diagnosis. X-rays use radiation to penetrate the body’s soft tissues and show internal structures like bones. The images can show damage and other changes in cartilage and bones that can occur with osteoarthritis.
MRI: Magnetic resonance imaging (MRI) uses magnetic fields to produce an image of a specific area of the body. The test is more expensive than X-rays, but it does not involve the radiation risk of X-rays. And MRIs provide a two-dimensional view that offers better images of soft tissues, as cartilage, to detect early abnormalities typical of osteoarthritis.
When Should I See a Doctor?
Most people have some joint aches and pains as they age, and often pain can be managed with over-the-counter medications and self-care techniques such as warm baths and cold packs, massaging the affected joint or resting it when pain is at its worst. But if self-care techniques don’t sufficiently relieve your pain, a doctor may be able to prescribe other medications or treatments that will help.
It’s also important to see your doctor if you experience symptoms that might indicate your joint pain is not from osteoarthritis but a problem that requires more immediate medical attention. These symptoms include:
• Sudden swelling, warmth, redness along with pain in any joint(s).
• Joint pain accompanied by a fever and/or rash
• Severe pain that prevents you from using the joint
It’s also important to see your doctor if you experience symptoms that might indicate your joint pain is not from osteoarthritis but a problem that requires more immediate medical attention. These symptoms include:
• Sudden swelling, warmth, redness along with pain in any joint(s).
• Joint pain accompanied by a fever and/or rash
• Severe pain that prevents you from using the joint
How Will Osteoarthritis Affect You?
You have a diagnosis. Now what’s your prognosis with OA?
By Susan Bernstein
After years of increasing pain and stiffness in your joints, after ordinary tasks like making your bed in the morning had become almost impossible, you finally spoke to your doctor. When you heard that your problem had a name – osteoarthritis, or OA – you weren’t surprised. In fact, you were a bit relieved.
But now you want to know what OA will do to your body, to your lifestyle, and how this disease may affect your future. You want to know what you can do to make yourself feel better, and to keep your OA from getting worse.
What is Osteoarthritis?
Osteoarthritis the most common form of arthritis, affecting about 27 million Americans. OA symptoms usually include pain, stiffness and swelling in and around the joints. OA can make daily activities more difficult. Your fingers may feel stiff when you try to grasp a pen. Your lower back may ache as you lean over to open a drawer. Your knees may hurt when you bend down to pick up your morning newspaper.
Where Does Osteoarthritis Strike?
OA affects joints, places where bones come together and move in various directions. OA typically affects the following joints:
- Neck
- Spine
- Hips
- Hands
- Knees
- Ankles
Other joints may be affected as well. Just because you have OA in one particular joint doesn’t mean you’ll develop it in others. But osteoarthritis symptoms may worsen – increasing your pain and decreasing your ability to perform daily tasks – if you don’t address them with treatment and prevention strategies. Luckily, there are many osteoarthritis treatments available to manage pain and stiffness and improve flexibility. You are in charge of your OA prognosis.
What Happens in Osteoarthritis?
OA occurs when parts of a joint, including cartilage, bones, fluid or its membrane lining (synovium), change and break down, usually over years. Cartilage and joint fluid cushion and lubricate a joint, easing the motion of bones. When these joint components break down, movement becomes difficult or painful. In OA, joints can feel stiff. Each movement can be painful. Joints can swell, further hindering movement.
As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may even chip off and float around in the joint cavity. Synovial fluid can diminish in amount or quality.
In the final stages of OA, cushioning cartilage erodes, inflaming the lining of your joint. As a result, chemicals called cytokines (inflammatory proteins) or enzymes are released, causing more pain, swelling and damage.
Finally, bones may rub against bones with each movement of the joint. Even at rest, OA-affected joints can hurt terribly, affecting your sleep and your overall well-being.
What Causes Osteoarthritis?
The factors that lead to OA are varied and may or may not be things you can control or prevent:
- Aging
- Excessive or strenuous movements (sports or hard physical labor)
- Repetitive movements (sports or work)
- Heredity
- Obesity
- Injuries or accidents
- Muscle weakness
How Will Osteoarthritis Affect Your Lifestyle?
Because OA is a common disease, too many people shrug off its seriousness. Or, they think its effects are inevitable, so they don’t bother doing anything to manage it. Don’t make these mistakes. OA symptoms can hinder your ability to live and work normally if you don’t take steps to prevent further joint damage, manage your pain and increase your flexibility.
OA pain, swelling or stiffness may make it difficult to perform ordinary tasks at work or at home. Simple acts like tucking in your bed sheets, opening a box of food, grasping a computer mouse, or driving a car can become nearly impossible. OA pain, stiffness and immobility can affect your ability to perform your job, and can put a strain on your relationships.
What Can You Do About Osteoarthritis Symptoms?
While there are items (called assistive devices) to help you perform daily tasks if you have OA, and ways to get around performing tasks the typical way (calledadaptive living), you can take steps to prevent your OA from worsening.
Simple stretching and regular, easy exercises can reduce OA pain, lower joint-straining weight, and increase your joint’s flexibility. Numerous osteoarthritismedications are available, either with a doctor's prescription or over-the-counter, to help reduce OA inflammation or pain. There are arthritis supplements available that may help control OA symptoms and make you feel better. Surgical techniques, including arthroplasty or total joint replacement, can replace joint components damaged by OA, restoring mobility and reducing pain.
You’ve taken the most important first step: Getting an osteoarthritis diagnosis from your doctor. Now, speak with your doctor and other health-care professionals, such as physical therapists or nurse practitioners, to develop an OA management plan tailored to your lifestyle and needs. The Arthritis Foundation has resources available both locally and online to help you put your plan into action.
OA, for now, isn’t curable, but it is manageable. You are the manager of your OA, and your doctor and other health-care professionals are key members of your team. You can take control of the way OA affects your body over time through physical activity, diet, medications and supplements, surgery, and most of all, a positive attitude about how you will keep living fully as a person with osteoarthritis.
Managing Osteoarthritis Symptoms
Tactics for keeping OA pain, stiffness and swelling in check, and restoring mobility.
By Susan Bernstein
Osteoarthritis, or OA, is a common disease affecting as some 27 million Americans, causing pain, stiffness and swelling in joints. OA reduces your joints’ mobility, interfering with your ability to work and live your life normally.
There is no cure for OA at this time. It will progress and damage your joints further unless you intervene now. Luckily, there are many ways to manage OA symptoms.
Long-Term Management
As a person with osteoarthritis, you’ll need to take a long-term view of your health. OA can’t be bested in one day or with a single pill. You’ll have to take a comprehensive approach to your health.
You have a team to help you, including your arthritis doctor and other health care professionals, your family and friends, and your local Arthritis Foundation office. But you are the manager of that team. You must make a commitment to making healthy changes and choices and sticking with the OA management plan that you and your doctor will devise.
Top Tactics for Tackling OA
Your plan for taking on OA should include:
- Managing OA symptoms, like pain, stiffness and swelling
- Improving joint mobility and flexibility
- Keeping your weight in check
- Maintaining better fitness through physical activity
That sounds like a big project, but start by slowly making changes to your current routine, not trying everything all at once. Here are tips for managing your OA, and resources to help you.
Stretch Yourself. Slow, gentle stretching of joints may improve flexibility, lessen stiffness and reduce pain. Morning is a great time to stretch to get joints ready for the day’s tasks. The Arthritis Foundation offers stretching routines, including yoga- and tai chi-based moves, approved for people with OA on DVD or in live classes in your area. First, speak to your doctor to gauge your level of fitness and any special considerations.
Get Moving. Physical activity is a proven way to manage OA symptoms. Before you groan about hating exercise, just pledge to progress from dedicated couch-sitter to regular mover. Simple activities like walking around the neighborhood or taking a fun, easy land or water exercise class approved for people with OA can reduce pain and extra weight, which only worsens OA.
Get Stronger. Aerobic activity, the kind that makes you sweat, isn’t the only sort of workout that helps OA symptoms. Strengthening exercises build muscles around OA-affected joints, easing the burden on those joints and reducing pain. Your doctor or health-care professional can suggest moves for you, or check out these easy moves.
Keep Weight in Check. Excess weight adds additional stress to weight-bearing, OA-affected joints like the hips, knees, feet and back, increasing pain. Obesity has been cited as a possible cause for developing OA in the knees. If you are overweight, you may not want to exercise because you don’t like the way you look or because you tire easily. But losing weight can help people with OA reduce pain and limit further joint damage. Speak to your doctor about a weight-management plan and healthy food choices.
Manage With Medications. Many prescription (only available from your doctor) or over-the-counter (available at your pharmacy or online) medicines treat OA symptoms. Common OA medications include NSAIDs (nonsteroidal anti-inflammatory drugs, which target inflammation – a potential cause of pain and swelling), analgesics (which treat pain only), topical treatments (which are rubbed onto the skin in the affected area to temporarily ease pain or swelling), and injectable treatments, like hyaluronic acid therapy. Injectables are given by your arthritis doctor in the office, and aim to replace joint fluid depleted by OA.
Explore Surgery. Your arthritis doctor may also suggest surgery to repair or replace OA-damaged joints, especially hips or knees. If you are eligible for surgery, your doctor will refer you to an orthopaedic surgeon to perform the procedure. After surgery, you must commit to rehabilitating the joint, maintaining a healthy weight and continuing to engage in physical activity.
Investigate Alternatives. Many people with OA use natural or alternative therapies to address symptoms and improve their overall well-being. Nutritional supplements like glucosamine or chondroitin sulfate are available over the counter and purport to treat OA by restoring cartilage. Other alternative therapies used by some to treat OA include acupuncture, massage techniques, hydrotherapy, and external tools like copper bracelets. Scientific research on these methods does not show proven effects, so consult your doctor before purchasing or trying any treatment.
Grab Some Gadgets. People with OA may have painful, stiff joints that don’t perform as they should, making everyday tasks difficult. Items called assistive devices can help. These include supportive items like scooters, canes, splints, shoe orthotics or walkers, or helpful tools like jar openers or car steering wheel grips.Some tools and adapted products may be easier to use. Consider adaptive livingtechniques too, modifying the way you perform tasks to ease strain on joints. Your doctor, or physical or occupational therapist can help determine what is right for you.
Stay Positive. Managing OA symptoms is a lifelong task. It’s important to stay positive about your goals when you feel pain or stiffness. Think about the benefits of sticking with your stretching or physical activity routine, and how much better you will feel when your joints are more flexible and less painful. Focus on the good things in your life, like your family or hobbies, and how much more you’ll enjoy them when you’re managing your OA symptoms. You are not alone. Get in touch with others like you at local programs. Most of all, stick to your plan, and you will successfully manage your OA.
Osteoarthritis Medications
What medications are used to treat osteoarthritis?
There are no medications yet that treat the underlying disease process. Instead, the goal of medical treatment for osteoarthritis (OA) is to reduce pain and stiffness and make it easier to remain active.
The most commonly used medications for osteoarthritis are:
Analgesics are drugs that relieve pain. These medicines do not reduce inflammation or swelling. But if pain relief is your main concern, these drugs tend to have fewer side effects than drugs that reduce inflammation.
The most commonly used analgesic is acetaminophen, which the American College of Rheumatology recommends for the treatment of mild or moderate pain caused by osteoarthritis. Acetaminophen is available over the counter as generic and store brands or the name brand Tylenol, Anacin (aspirin-free), Excedrin caplets andPanadol. Acetaminophen can be taken in doses of 325 to 1,000 mg every four to six hours, but no more than 4,000 mg should be taken per day. This drug can interact with alcohol. Check with your doctor before using acetaminophen if you consume more than three alcoholic drinks per day.
If you have severe pain, your doctor may prescribe a stronger analgesic. Examples include propoxyphene hydrochloride (Darvon, PC-Cap and Wygesic), acetaminophen with codeine and tramadol (Ultram). Often, these drugs are used only for short periods because the carry the risk of dependence.
Topical analgesics – These are creams, rubs and salves that are applied directly to the painful area. One of them, Voltaren Gel, is a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, and is available only by prescription. The rest are available over the counter. Their effects come from one or more of a variety of active ingredients. The most common ingredients are:
Capsaicin – A highly purified natural ingredient found in cayenne peppers, capsaicin works by depleting the amount of a neurotransmitter called substance P that is believed to send pain messages to the brain. For the first couple of weeks of use, the ingredient may cause burning or stinging. Capsaicin is available under the product names Zostrix, Zostrix HP, Capzasin-P and others. Menthacin includes both capsaicin and counterirritants.
Counterirritants – Like stepping on your toe to take your mind off a headache, counter-irritants stimulate or irritate the nerve endings to distract the brain’s attention from musculoskeletal pain. Counterirritants encompass such substances as menthol, oil of wintergreen, camphor, eucalyptus oil, turpentine oil, dihydrochloride and methlnicotinate and are found in products such as ArthriCare, Eucalyptamint, Icy Hot and Therapeutic Mineral Ice.
Salicylates – Like the salicylates found in many oral pain relievers, these compounds may work by inhibiting prostaglandins. They primarily work topically as counterirritants, themselves stimulating or irritating nerve endings. Brand name examples of topical analgesics containing salicylates include Aspercreme, Ben-Gay, Flexall, Mobisyl and Sportscreme.
The most commonly used medications for osteoarthritis are:
Analgesics are drugs that relieve pain. These medicines do not reduce inflammation or swelling. But if pain relief is your main concern, these drugs tend to have fewer side effects than drugs that reduce inflammation.
The most commonly used analgesic is acetaminophen, which the American College of Rheumatology recommends for the treatment of mild or moderate pain caused by osteoarthritis. Acetaminophen is available over the counter as generic and store brands or the name brand Tylenol, Anacin (aspirin-free), Excedrin caplets andPanadol. Acetaminophen can be taken in doses of 325 to 1,000 mg every four to six hours, but no more than 4,000 mg should be taken per day. This drug can interact with alcohol. Check with your doctor before using acetaminophen if you consume more than three alcoholic drinks per day.
If you have severe pain, your doctor may prescribe a stronger analgesic. Examples include propoxyphene hydrochloride (Darvon, PC-Cap and Wygesic), acetaminophen with codeine and tramadol (Ultram). Often, these drugs are used only for short periods because the carry the risk of dependence.
Topical analgesics – These are creams, rubs and salves that are applied directly to the painful area. One of them, Voltaren Gel, is a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, and is available only by prescription. The rest are available over the counter. Their effects come from one or more of a variety of active ingredients. The most common ingredients are:
Capsaicin – A highly purified natural ingredient found in cayenne peppers, capsaicin works by depleting the amount of a neurotransmitter called substance P that is believed to send pain messages to the brain. For the first couple of weeks of use, the ingredient may cause burning or stinging. Capsaicin is available under the product names Zostrix, Zostrix HP, Capzasin-P and others. Menthacin includes both capsaicin and counterirritants.
Counterirritants – Like stepping on your toe to take your mind off a headache, counter-irritants stimulate or irritate the nerve endings to distract the brain’s attention from musculoskeletal pain. Counterirritants encompass such substances as menthol, oil of wintergreen, camphor, eucalyptus oil, turpentine oil, dihydrochloride and methlnicotinate and are found in products such as ArthriCare, Eucalyptamint, Icy Hot and Therapeutic Mineral Ice.
Salicylates – Like the salicylates found in many oral pain relievers, these compounds may work by inhibiting prostaglandins. They primarily work topically as counterirritants, themselves stimulating or irritating nerve endings. Brand name examples of topical analgesics containing salicylates include Aspercreme, Ben-Gay, Flexall, Mobisyl and Sportscreme.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a large group of medications used to help reduce joint pain, swelling and inflammation. NSAIDs are available over the counter and by prescription. For patients with knee osteoarthritis who experience moderate or severe pain and signs of inflammation, the American College of Rheumatology recommends NSAIDs as an alternate initial therapy to acetaminophen. Aspirin is the most common NSAID. Other examples of NSAIDs are ibuprofen (Advil, Motrin IB), ketoprofen (Actron, Orudis KT, Oruvail), naproxen (Naprosyn, Naprelan) and naproxen sodium (Anaprox, Aleve).
NSAIDs also include the class of drugs called COX-2 inhibitors, which are much like traditional NSAIDs but formulated to be safer for the stomach. At present, the only COX-2 inhibitor available is celecoxib (Celebrex). Two others were removed from the market when they were found to increase the risk of cardiovascular events.
NSAIDs work by stopping the production of chemicals called prostaglandins that occur naturally in the body and are involved in inflammation.
Corticosteroid injections – Corticosteroids are drugs related to the naturally occurring hormone in your body called cortisone. In some cases your doctor may inject these drugs into a painful joint for fast, targeted relief. When fluid builds up in a knee with osteoarthritis, the doctor may drain fluid from the knee and then inject a corticosteroid medication. The American College of Rheumatology (ACR) recommends corticosteroid injections as an alternate initial therapy for patients who have moderate to severe knee pain and signs of inflammation and who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.
Hyaluronic acid therapy – Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint it may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc andHyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid.
According to ACR guidelines, Hyaluronic acid therapy may be helpful to patients who have inadequate response to NSAIDs or COX-2 drugs, or who have experienced adverse side effects from these drugs. Clinical trails have shown that the injections may provide pain relief for people with mild to moderate osteoarthritis of the knee. It is not know whether the injections are helpful for other joints.
NSAIDs also include the class of drugs called COX-2 inhibitors, which are much like traditional NSAIDs but formulated to be safer for the stomach. At present, the only COX-2 inhibitor available is celecoxib (Celebrex). Two others were removed from the market when they were found to increase the risk of cardiovascular events.
NSAIDs work by stopping the production of chemicals called prostaglandins that occur naturally in the body and are involved in inflammation.
Corticosteroid injections – Corticosteroids are drugs related to the naturally occurring hormone in your body called cortisone. In some cases your doctor may inject these drugs into a painful joint for fast, targeted relief. When fluid builds up in a knee with osteoarthritis, the doctor may drain fluid from the knee and then inject a corticosteroid medication. The American College of Rheumatology (ACR) recommends corticosteroid injections as an alternate initial therapy for patients who have moderate to severe knee pain and signs of inflammation and who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.
Hyaluronic acid therapy – Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint it may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc andHyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid.
According to ACR guidelines, Hyaluronic acid therapy may be helpful to patients who have inadequate response to NSAIDs or COX-2 drugs, or who have experienced adverse side effects from these drugs. Clinical trails have shown that the injections may provide pain relief for people with mild to moderate osteoarthritis of the knee. It is not know whether the injections are helpful for other joints.
Will I Need Surgery?
Most people with osteoarthritis will not need surgery, but if you have severe joint damage, extreme pain that isn’t helped by other treatments or very limited motion as a result of osteoarthritis, surgery may be necessary.
Surgical procedures can provide several benefits, including the following:
Improved movement – If the constant wearing away of cartilage makes it difficult for you to move, making it difficult to your to get around and stay independent, replacing the damaged joint with a synthetic one can make it easier for you to move and continue activities that you enjoy.
Pain relief – If osteoarthritis causes severe, constant pain that isn’t relieved by treatments such as medications, exercise or physical therapy, surgically replacing the painful joint or removing growths that are causing pain, for example, can relieve pain.
Improved joint alignment – In some cases, osteoarthritis can keep a joint to become misaligned so that it no longer functions as it should and it looks unusual. In the knees, surgery can correct or improve this misalignment. But appearance should not be the main reason for having surgery; improved appearance should be a bonus of surgery that is performed to improve movement and relieve pain.
Surgical procedures can provide several benefits, including the following:
Improved movement – If the constant wearing away of cartilage makes it difficult for you to move, making it difficult to your to get around and stay independent, replacing the damaged joint with a synthetic one can make it easier for you to move and continue activities that you enjoy.
Pain relief – If osteoarthritis causes severe, constant pain that isn’t relieved by treatments such as medications, exercise or physical therapy, surgically replacing the painful joint or removing growths that are causing pain, for example, can relieve pain.
Improved joint alignment – In some cases, osteoarthritis can keep a joint to become misaligned so that it no longer functions as it should and it looks unusual. In the knees, surgery can correct or improve this misalignment. But appearance should not be the main reason for having surgery; improved appearance should be a bonus of surgery that is performed to improve movement and relieve pain.
25 Treatments for Arthritis Hip and Knee Pain
Guidelines recommend combining drugs with non-medicinal remedies.
When it comes to treating osteoarthritis in your knees and hips, you may have more options than you realize. In February 2008, the Osteoarthritis Research Society International (OARSI), a nonprofit organization dedicated to promoting osteoarthritis research and treatment, published its first evidence-based recommendations for treatment of osteoarthritis of the hip and knee. The goal was to eliminate inconsistent treatment approaches by creating simple guidelines that would enable health care providers to determine which therapies would be most useful for an individual patient.
The committee took the scientifically proven commonalities it found in the international literature, evaluated the level of scientific evidence, proposed a strength of recommendation for each modality, and then condensed them into a comprehensive “playbook” of 25 treatment recommendations. The first of the 25 recommendations is to combine drug and non-drug treatments for optimal results. The remaining 24 fall into three categories: non-drug, drug and surgical. Following are the 25 recommendations with updates and links to further reading by Arthritis Today.
1. Drug and non-drug treatments. The optimal osteoarthritis (OA) treatment program should consist of both medications and non-drug treatments.
Non-drug treatments
2. Education and self-management. The initial focus of treatment should be on what patients can do for themselves, rather than on passive therapies delivered by a health professional.
3. Regular telephone contact. The best evidence for the benefit of phone contact came from a study of 439 OA patients in which monthly phone calls from lay personnel promoting self-care were associated with improvements in joint pain and physical function for up to a year.
4. Physical therapy. Studies consistently support the usefulness of an evaluation by a physical therapist and instruction in appropriate exercise to reduce pain and improve function. Physical therapists can also provide assistive devices to make daily tasks easier.
5. Aerobic, muscle-strengthening and water-based exercises. A roundedexercise program can promote muscle strength, improve range of motion, increase mobility and ease pain.
6. Weight loss. Maintaining your recommended weight or losing weight if you are overweight can lessen your pain by reducing stress on your affected joints. Weight loss specifically helps ease pressure on weight-bearing joints such as the hips and knees.
7. Walking aids. Canes and crutches can reduce pain in hip and knee or OA. If both hips and/or knees are affected wheeled walkers may be preferable.
8. Footwear and insoles. If osteoarthritis affects the knee, special footwear and insoles can reduce pain and improve walking.
9. Knee braces. For osteoarthritis with associated knee instability, a knee brace can reduce pain, improve stability and reduce the risk of falling.
10. Heat and cold. Many people find the heat of a warm bath, heat pack or paraffin bath eases OA pain. Others find relief in cold packs. Still others prefer alternating the two.
11. Transcutaneous electrical nerve stimulation (TENS). A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It has been shown to help with short-term pain control in some patients with knee or hip arthritis.
12. Acupuncture. A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been touted as a treatment for osteoarthritis pain. A recent trial of 352 patients with knee osteoarthritis showed small but statistically significant improvement in pain intensity two and four weeks after a course of acupuncture.
Drug treatments
13. Acetaminophen is part of a group of pain-treating medications calledanalgesics. At a dosage of up to 4 grams per day, acetaminophen (Tylenol), can be an effective initial treatment for osteoarthritis pain. The American College of Rheumatology (ACR) recommends acetaminophen as the initial treatment for osteoarthritis of the hip and knee.
14. Nonsteroidal anti-inflammatory drugs. Despite cardiovascular and gastrointestinal concerns about this class of drugs, the committee concludes NSAIDs can be useful for OA pain, but advises using at the lowest effective dosages and avoiding long-term use if possible. In people at high risk of gastrointestinal side effects, the committee recommends a COX-2 inhibitor or a traditional NSAID along with proton pump inhibitor or other stomach-protective drug.
15. Topical analgesics (NSAIDs and Capsaicin). Topical NSAIDs and capsaicin, an analgesic derived from chili peppers, can be used along with or instead of oral analgesics or NSAIDs for OA pain. One of them, Voltaren Gel, is a topical formulation of the NSAID diclofenac, and is available only by prescription.
16. Corticosteroid injections. Injecting corticosteroid compounds directly into affected joints can be useful when there is localized inflammation and/or moderate to severe pain that doesn’t respond to oral pain relievers. The ACR recommends corticosteroid injections as an alternate initial therapy to acetaminophen for patients who have moderate to severe knee pain and signs of inflammation and who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.
17. Hyalruonic acid injections. A series of injections of hyaluronic acid, meant to supplement a natural substance that gives joint fluid its viscosity, may be useful in treating the pain of hip and knee arthritis, according to the experts. However, a recent study published in Arthritis & Rheumatism found a single intraarticular injection of hyaluronic acid for the treatment of hip osteoarthritis was ineffective in achieving significant pain relief in comparison to placebo.
18. Glucosamine and/or chondroitin for symptom relief. Treatment with one or both of these supplements may provide symptomatic benefit for some people with knee osteoarthritis. However, the experts advise discontinuing them if you don’t notice any relief within six months.
19. Glucosamine sulfate, chondroitin and/or diacerein for possible structure-modifying effects. There is some evidence that glucosamine or chondroitin may not only ease symptoms but may slow or halt cartilage breakdown in osteoarthritis. Similar effects have been seen with the osteoarthritis medication diacerein. (Diacerein is not approved in the U.S.)
20. Opioid and narcotic analgesics. The use of weak opioids and narcotic analgesics can be considered for patients who cannot tolerate other medications or for whom other medications are not effective, according to recommendations. Stronger opioids should be used only for the management of severe pain in “exceptional circumstances.”
21. Joint replacement surgery. When symptoms of knee or hip OA are not controlled with drug and non-drug treatments, replacing the joint with a prosthesis is often effective.
22. Unicompartmental knee replacement. Approximately 30 percent of people with knee osteoarthritis have disease that is largely restricted to one area of the joint. In these cases, unicompartmental knee replacement (also called partial knee replacement) may offer the same improvement and function as total knee replacement but with less trauma and better range of motion.
23. Osteotomy and joint-preserving surgery. For young, active people with hip or knee osteoarthritis, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement by years.
24. Joint lavage and arthroscopic debridement. The roles of joint lavage (flushing the joint with a sterile saline solution) and arthroscopic debridement (the surgical removal of tissue fragments from the joint) are controversial. Some studies have shown short-term relief; however, a 2008 Cochrane Review by the Cochrane Collaboration – an international not-for-profit organization, providing up-to-date information about the effects of health care – shows that in people with osteoarthritis arthroscopic debridement probably does not improve pain or ability to function compared to placebo (sham surgery).
25. Joint fusion when replacement has failed. When knee replacement fails, joint fusion (a procedure in which the bones that form the joint are surgically prepared and then held in place with screws, pins or plates until they fuse into a single rigid unit) can be considered a salvage procedure.
Exercising With Osteoarthritis
Physical activity is the best non-drug treatment for improving pain and function.
While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, research shows that people can and should exercise when they have osteoarthritis. Exercise is considered the most effective non-drug treatment for reducing pain and improving movement in osteoarthritis.
Three kinds of exercise are important for people with osteoarthritis: exercises involving range of motion, also called flexibility exercises; endurance or aerobic exercises; and strengthening exercises. Each one plays a role in maintaining and improving your ability to move and function.
Speak with your doctor or physical therapist about exercising with osteoarthritis and the specific exercises that are best for you.
Range of motion/flexibility: Range of motion refers to the ability to move your joints through the full motion they were designed to achieve. When you have osteoarthritis, pain and stiffness make it very difficult to move certain joints more than just a little bit, which can make even the simplest tasks challenging.
Range-of-motion exercises include gentle stretching and movements that take joints through their full span. Doing these exercises regularly – ideally every day – can help maintain and even improve the flexibility in your joints.
Aerobic/endurance: These exercises strengthen your heart and make your lungs more efficient. This conditioning has the added benefit of reducing fatigue, so you have more stamina throughout the day. Aerobic exercise also helps control your weight by increasing the amount of calories your body uses. Furthermore, this type of exercise can help you sleep better and improve your mood.
Three kinds of exercise are important for people with osteoarthritis: exercises involving range of motion, also called flexibility exercises; endurance or aerobic exercises; and strengthening exercises. Each one plays a role in maintaining and improving your ability to move and function.
Speak with your doctor or physical therapist about exercising with osteoarthritis and the specific exercises that are best for you.
Range of motion/flexibility: Range of motion refers to the ability to move your joints through the full motion they were designed to achieve. When you have osteoarthritis, pain and stiffness make it very difficult to move certain joints more than just a little bit, which can make even the simplest tasks challenging.
Range-of-motion exercises include gentle stretching and movements that take joints through their full span. Doing these exercises regularly – ideally every day – can help maintain and even improve the flexibility in your joints.
Aerobic/endurance: These exercises strengthen your heart and make your lungs more efficient. This conditioning has the added benefit of reducing fatigue, so you have more stamina throughout the day. Aerobic exercise also helps control your weight by increasing the amount of calories your body uses. Furthermore, this type of exercise can help you sleep better and improve your mood.
How much should you exercise? Current recommendations for
150 minutes of moderate-intensity aerobic exercise per week
OR
75 minutes of vigorous-intensity aerobic exercise per week
OR
an equivalent combination of moderate and vigorous exercise
Strengthening: Strengthening exercises help maintain and improve your muscle strength. Strong muscles can support and protect joints that are affected by arthritis.
Does stress affect OA?
Yes, having a chronic disease like osteoarthritis can be stressful. Stress, in turn, can make dealing with a disease like osteoarthritis more difficult – and painful.
That’s because when you feel stressed, your body becomes tense. This muscle tension can increase pain, making you feel helpless and frustrated because the added pain may limit your abilities. This, in turn, can depress you. Stress, depression and limited and lost abilities can all contribute to pain, which then perpetuates the cycle. If you understand how your body reacts physically and emotionally to stress and learn how to manage stress, you can break the destructive cycle.
That’s because when you feel stressed, your body becomes tense. This muscle tension can increase pain, making you feel helpless and frustrated because the added pain may limit your abilities. This, in turn, can depress you. Stress, depression and limited and lost abilities can all contribute to pain, which then perpetuates the cycle. If you understand how your body reacts physically and emotionally to stress and learn how to manage stress, you can break the destructive cycle.
How will losing weight help?
Excess body weight is a risk factor for the both the development and progression of osteoarthritis. For every pound of body weight you gain, your knees gain three pounds of added stress; for hips, each pound translates into six times the pressure on the joints. After many years of carrying extra pounds, the cartilage that cushions the joints tends to break down more quickly than usual.
Conversely, losing weight can reduce additional stress on joints that can cause cartilage to wear away. Easing the pressure on joints by shedding extra pounds can also reduce pain in osteoarthritis-affected joints, which will help you feel and move much better.
Conversely, losing weight can reduce additional stress on joints that can cause cartilage to wear away. Easing the pressure on joints by shedding extra pounds can also reduce pain in osteoarthritis-affected joints, which will help you feel and move much better.
Can OA be prevented?
Although you can’t do anything about the genes you inherit from your parents, you can and should take extra care in minimizing your other risk factors – primarily excess weight and joint injuries.
By maintaining a healthy body weight you avoid putting additional stress on your joints. This stress can wear away at cartilage more quickly than usual and lead to osteoarthritis in weight-bearing joints such as the knees.
Injuries from routine falls or severe bangs and bumps during athletic activities can cause major damage to the cartilage. These injuries can cause cartilage tears, or they can permanently alter the way your joints move so that they wear down cartilage more than usual. You can avoid injuries that may lead to osteoarthritis by taking care of your body. Warming up and stretching before athletic activity and exercise can help you prevent serious injury. If you do injure yourself, see your doctor to receive proper treatment. Injuries left untreated may heal improperly, which could lead to further damage later on.
By maintaining a healthy body weight you avoid putting additional stress on your joints. This stress can wear away at cartilage more quickly than usual and lead to osteoarthritis in weight-bearing joints such as the knees.
Injuries from routine falls or severe bangs and bumps during athletic activities can cause major damage to the cartilage. These injuries can cause cartilage tears, or they can permanently alter the way your joints move so that they wear down cartilage more than usual. You can avoid injuries that may lead to osteoarthritis by taking care of your body. Warming up and stretching before athletic activity and exercise can help you prevent serious injury. If you do injure yourself, see your doctor to receive proper treatment. Injuries left untreated may heal improperly, which could lead to further damage later on.
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