Coping with osteoarthritis (OA) is no simple thing. The resulting pain can make it difficult to handle basic daily activities, including work. Yet, it’s possible to manage and treat OA—and in many instances reduce the inflammation and pain. Understanding the disease and taking the right actions is paramount.
Nathan Wei, MD, director of the Arthritis Treatment Center in Frederick, Md., suggests that osteoarthritis patients take a proactive approach to managing and treating the disease.
What is osteoarthritis?
Dr. Wei: Osteoarthritis is the most common form of arthritis. It’s what we think about when we hear the word “arthritis.” It’s the older person who limps along and complains about hip and knee pain. OA is a disease of the cartilage. It affects joints, mostly in weight bearing areas. When the cartilage begins to wear away, patients develop pain, swelling, and stiffness. Eventually, if it’s left untreated, it results in a lack of function.
What is the cause of OA?
Dr. Wei: The most common causes of osteoarthritis are genetic factors. However, long-term overuse of joints can lead to OA. It’s more common as we grow older. About 70 percent of adults between ages 55 and 80 suffer from it. Studies show that excessive weight is an aggravating factor, particularly for the knees and lower back. Inactivity also worsens osteoarthritis.
How does OA impact a person and what does he or she experience?
Dr. Wei: As tissue begins to degrade, inflammation and pain follow. Most people who suffer from OA experience stiffness in their joints and the problem is usually worse the first 30 minutes after waking up in the morning. Once the joint loosens up the pain usually subsides. Some patients experience swelling, cracking sounds and have limited range of motion in the joint. As the joint further degrades they may experience bone spurs and more severe pain.
How does a doctor diagnose OA?
Dr. Wei: We look at where it hurts and whether the problem occurs in a weight-bearing joint or a non-weight-bearing joint. We ask questions. Does the pain last more than 30 minutes in the morning? With rheumatoid arthritis it’s not uncommon to have two hours or more of morning stiffness. How much joint swelling is involved? Then a doctor launches into diagnostic tests. These typically consist of X-rays and MRIs.
How can individuals with OA manage the disease on their own?
Dr. Wei: A lot depends on how far the disease has progressed. Weight loss is often the easiest remedy for the pain. If this is not an issue for the patient, and the OA is caught early on and it isn’t severe, over-the-counter analgesics or anti-inflammatory medicines can help. Exercise is also important, including swimming, riding a stationary bike and possibly using an elliptical trainer. Exercise is crucial. It can help strengthen muscles and aid in weight loss, which greatly relieves OA symptoms. In fact, in some cases, weight loss can also lead to some restoration of cartilage. Hot and cold wraps are another effective treatment. And some patients take dietary supplements such as glucosamine and chondroitin sulfate. Some studies indicate that these supplements are effective and there are no serious side effects associated with them.
What if the disease is more serious?
Dr. Wei: It might be necessary to use a brace to unload a weight-bearing surface such as a knee. A doctor might also prescribe stronger pain medication, including opioids and use corticosteroid injections to relieve inflammation, including joint swelling. Another approach is the use of hyaluronic acid derivatives through injection. These provide additional lubrication, but they are expensive and there is no evidence that they are more effective them less expensive treatments like NSAIDs. Some patients also benefit from physical therapy.
At what point does surgery enter the picture?
Dr. Wei: If other treatments don’t work or the disease has progressed to an extreme state it might be necessary to resurface or realign a joint. A person is a candidate for a joint replacement when there’s bone on bone. But it’s important to recognize that highly effective therapies exist and, as long as the osteoarthritis hasn’t progressed to an extreme stage, it’s often possible to manage it without surgery.
What is the typical recovery period?
Dr. Wei: Typically, there’s a six-to-eight-week recovery for a joint replacement surgery. The potential for complications is relatively low. Nonetheless, it’s an expensive procedure—often in the $30,000 to $40,000 range after you factor in all the costs, including physical therapy. Of course, there are risks associated with any kind of major operation and sometimes a joint replacement doesn’t help.
Is there any promising research in the OA field?
Dr. Wei: There is a lot of research going in the field of stem cells—particularly autologous stem cells that are harvested from a patient’s own bone marrow. Doctors are using these stem cells for some experimental procedures that show promise.
Any final comments or suggestions?
Dr. Wei: Lose weight, stretch, and exercise. These are the most important factors in managing osteoarthritis.