Living with osteoarthritis

Your joints – all 100-plus of them – are living, constantly self-renewing machines enabling you to bend, twist, run, stretch, jog, walk, skip and jump. These machines, for the most part, work perfectly and do their job unnoticed for half a century or more. It’s only when things go wrong that the taken-for-granted joint gets any attention.

Osteoarthritis (OA) is the silent assailant that attacks joints without mercy. More than one in every five Canadians over age 50 is affected with OA and, over age 75, the odds shoot up to a 50 per cent chance of developing OA. By the year 2020, well over 60 million North Americans will suffer stiff knees or painful hips. Small wonder that medical researchers are focusing on relief of osteoarthritis pain and on discovering ways to prevent joint damage and deformity. Fortunately, science has made much more progress than many patients realize.

What’s in a joint like this?
Ever examined bones for soup? Or cut up a raw chicken? Then you’ve probably noticed a shiny blue-white covering on the ends of bones. That’s cartilage. And that’s where, in humans, osteoarthritis starts. In osteoarthritis, that “cap” of cartilage vering the bones erodes over time, fraying, splitting and perhaps even partly disappearing.

Also, the bones themselves deteriorate, often forming spurs (bony projections) which narrow the joint space. The more numerous the spurs, the more cartilage has been lost, preventing bones from gliding smoothly over each other and sometimes causing bone to rub against bone.

At first, the pain of OA is mild. It worsens over time, though, if the disease is ignored and if the joint is forced to perform exactly as it did when healthy.  But what makes cartilage deteriorate in the first place? While scientists still can’t pinpoint the exact cause, they do know cartilage has an extremely exacting job to do over the course of a lifetime.

For instance:
If you put weight on your knee, fluid is squeezed out of the cartilage and the cartilage flattens. Shift your weight, and fluid moves back in. And this shock-absorbing action occurs thousands of times a day, every day.
· OA is most likely to attack joints that bear the heaviest loads: knees, hips and the spine – but particularly the knees.
· Fingers can also be affected.

Though OA mainly strikes people over 45, scientists now believe more than simple wear and tear is to blame. Researchers predict that soon, we’ll identify at the cellular level, the basic biochemical malfunction which attacks cartilage.

Fighting back
Treatment for OA is three-pronged:
1. Medication
2. Physical therapy when needed
3. A prescribed, regular exercise routine.

No single therapeutic regimen suits everyone – what helps one patient may prove useless to another. But the good news is that OA (unlike rheumatoid arthritis) seems to be a local, mechanical problem, limited to joints and their surrounding tissue. With up-to-date treatment, OA is no longer the crippler it was generations ago.

Medication for pain
As for medication:
· Non-prescription acetaminophen (e.g. Tylenol) may be all some people with mild OA need for relief.
· Prescription drugs may be any number of non-steroid anti-inflammatory drugs (or NSAIDs). ASA, ibuprofen and naproxen are the most commonly used NSAIDs for arthritis treatment.
· Some physicians recommend codeine for chronic pain. Studies show that the main drawback of codeine is constipation, so it’s wise to drink eight glasses of water a day if you take it regularly.
· Corticosteroids, injected directly into the joint, provide quick (if short-term) relief when a joint becomes suddenly painful and swollen.

The “COX” drugs
Now available for treating OA is an entirely new class of NSAIDs with a fancy name: COX-2 inhibitors (or COX-1-sparing anti-inflammatory drugs). These medicines control inflammation and pain with far fewer gastrointestinal side effects (e.g. stomach pain and inflammation) than other NSAIDs.

· One of these “COX” drugs (celecoxib, or Celebrex) has become the fastest-selling prescribed medicine in history.
· A similar COX drug (rofecoxib, or Vioxx) works like Celebrex, except it doesn’t affect a certain enzyme which helps protect the stomach lining. Like celecoxib, rofecoxib seems to be as effective as the old traditional NSAIDs and patients need take just one pill daily.

Be sure to consult your doctor before taking any off-the-shelf medicine in addition to any prescribed medication. It’s especially unwise to take over-the-counter NSAIDs (say ASA or ibuprofen) as well as a prescribed drug, for extra pain relief. And tell your doctor if your medicine isn’t working and/or pain relief is inadequate.

Joint injections
At the Canadian Rheumatology Association meeting last March in Alberta, several rheumatologists presented the benefits of Syn-Visc injections. The goal of this treatment is to restore normal joint lubrication by directly injecting into the knee one of the components of synovial fluid (the clear fluid that normally fills the joint space).

This technique is called viscosupplementation and some specialists now view it as “first line” treatment for mild OA. Dr. Wojcieck Olszynski, professor of rheumatology at the University of Saskatchewan in Saskatoon, has been successfully employing viscosupplementation for eight years. In his view, 75 per cent to 80 per cent of patients benefit, including some with advanced disease.

Physical therapy
Partnering medicines for pain relief can be beneficial, but a “one size fits all” approach won’t work.
· Some patients find heat helps, such as hot or warm baths for finger pain.
· Other patients prefer hot water bottles, heat pads or electric blankets.
· For those with hot, swollen joints, cold packs may reduce swelling and cool the joint. (A two-pound bag of frozen peas or kernel corn makes an excellent, and reusable, ice pack when moulded around the painful joint.)
· For neck OA, massage by a trained therapist, traction and deep heat treatment via ultrasound can provide relief.

Keep moving
Immobility harms joints. Exercise – with the advice of a physical therapist or occupational therapist – helps, but you need a workout program tailored specifically for you.

Therapeutic exercise strengthens the muscles supporting the joints and helps maintain joint flexibility. And it needn’t hurt either. In fact, a regular exercise program can be easy, sociable – and fun.

If medication, physical treatments and an exercise regimen all fail, then joint replacement (hip or knee) is a viable option. The procedure can dramatically decrease pain and improve motion, and more than 115,000 hip replacements are performed in the U.S. alone, with almost uniformly good results.

Today, OA needn’t turn anyone into a sofa spud. With new treatment strategies and new sociable ways to exercise, people with arthritis can live more active lives than our grandparents ever dreamed possible.