Don’t let joint pain wear you down


Here are some strategies and treatments for dealing with the most common form of arthritis
BY PRIYA CHOKSHI, MD

Osteoarthritis — chances are either you have it or you know someone who does. It is the most common form of arthritis, affecting 30 million Americans. We are more likely to get diagnosed with it as we get older, especially after age 40. In fact, about 1 in 2 people will develop osteoarthritis of the knee and 1 in 4 people will develop osteoarthritis of the hip. As May is Arthritis Awareness Month and the weather is getting better, it’s a great time to be discussing treatment options so you can get going and keep moving! After all, that’s what New Yorkers do!

What is osteoarthritis?

Joints in our body have a special cushioning for support called cartilage. Cartilage is a gel-like tissue that sits between the bones in our joints and allows for smooth movement and protection of the joint. When this cartilage breaks down, it can lead to damage of the joint and surrounding tendons, ligaments, muscles, and tissues — this is called osteoarthritis. Osteoarthritis is sometimes referred to as the “wear and tear” of joints.

What are the symptoms of osteoarthritis?

Symptoms can include joint pain, usually worse after movement or with touch, stiffness or locking, swelling, cracking/grinding noises with joint movement, and changes in the shape or structure of the joint over time. This can lead to decreased function and inflammation. Any joint in the body can be involved, including the hands, knees, hips, and spine. One or more joints can be involved at one time.

Am I at risk for getting Osteoarthritis?

As we get older, all parts of our body experience the wear and tear of age, use and overuse. The same goes for our joints and the risk of osteoarthritis increases for everyone with age. Some people have a genetic risk or underlying health condition, such as diabetes, that puts them at increased risk. Some people who are born with a deformed joint, such as bowleg or knocked knees, are more prone to getting arthritis in the affected joint. Another risk factor is being overweight. The extra weight can add stress on the joints. Excess fat tissue can cause inflammation in the body.

Lastly, previous injury or repetitive stress on the same joint, such as with work tasks, sports activities, or accidents can also put added stress on a joint over time and lead to osteoarthritis.

When should I see a doctor, and which specialists should I see?

If the joint pain or stiffness is persistent or affecting your ability to complete daily routines, you should discuss it with your doctor. They may refer you to a rheumatologist — a doctor who can diagnose and treat arthritis of different kinds and can tell if your pain is from osteoarthritis or some other cause, such as gout, rheumatoid arthritis, psoriatic arthritis, Lupus, or from an underlying musculoskeletal injury.

An orthopedics referral would be helpful if there is severe bone damage requiring surgery or joint replacement. Physical and occupational therapists can help create a dedicated therapy plan for patients to continue following on a regular basis. Pain management specialists may offer additional treatment options when pain is debilitating. Often, these specialists work together to care for someone with arthritis.

What tests can be done to diagnose Osteoarthritis?

A doctor usually makes a diagnosis based on a combination of methods, including medical history, physical examination, blood tests and imaging studies. Laboratory tests can be done for inflammation and to look for other causes of arthritis. If you have swelling in the joint, your doctor may also perform an arthrocentesis to drain the fluid and send it to the lab for analysis to check for infection or inflammation. Imaging studies such as x-rays, cat scans, or magnetic resonance imaging (MRI) scans can check for the location and extent of damage as well.

What is the treatment for Osteoarthritis?

Unfortunately, once the joint damage from osteoarthritis occurs, it cannot be reversed. However, the symptoms can be managed and progression of the arthritis can be delayed with appropriate care. Your doctors may suggest multiple approaches to managing your joint pain – including lifestyle changes, medications, injections, therapy, or surgery. The goal of treatment is to reduce pain and improve function.

What lifestyle changes can I make?

Weight loss and exercise are important parts of the treatment plan for osteoarthritis. Excess weight puts stress on the joints, such as the knees and back, which are not designed to carry the extra load. For every 10 pounds of weight lost over 10 years, the risk of developing knee osteoarthritis decreases by up to 50 percent.

Eating a healthy diet low in fat and sufficient in Vitamin D and calcium can help you maintain an adequate weight and prevent co-morbidities that predispose to bone disease.

Exercise — specifically low impact activities such as walking, swimming and biking — helps to strengthen the muscles surrounding the joint, and keep the joint from stiffening and becoming dysfunctional over time.

“But I can’t even bend my knee, how am I supposed to exercise?” patients sometimes ask. Physical therapists can be helpful in designing a treatment plan for osteoarthritis that is right for you.

There are also many other forms of therapy aside from exercise. These include stretching, yoga, acupuncture, massage, heat/ice application, electrical stimulation, or even relaxation and stress management techniques to reduce muscle tension and pain. It may help to try more than one approach to maximize the benefits.

Occupational therapists may also provide devices to help you maximize function and perform routine activities. Examples include supportive braces or orthotics, shower chairs, canes, or even special utensils for eating.

You can also make changes with how you bend, lift and carry objects. Consider using ergonomic devices at work or around the house so you can continue performing your daily activities in the best way possible.

Which medications can I use?

There are many different medications that can help with the pain of osteoarthritis. The two most common types of medications include: acetaminophen (i.e. Tylenol) and non-steroidal anti-inflammatory drugs (i.e. ibuprofen, Motrin, Advil, Aleve, etc.). Many of these are available over the counter, and your doctor may prescribe stronger formulations. It is important to take these as per prescription instructions as they may have side effects. Your doctor may also recommend other types of pain control medications such as duloxetine, gabapentin or muscle relaxers if they feel your pain may be related to other underlying conditions related to the osteoarthritis.

Topical treatments such as capsaicin, nsaid gels, and lidocaine patches may provide localized relief.

If the pain is severe, your doctor may recommend a procedure such as a corticosteroid injection or lubrication injection of hyaluronic acid directly into the joint. These injections may provide pain relief and help with the swelling and mobility. You can discuss with your doctor which approaches to osteoarthritis management are right for you.

What if I’ve tried everything but still have significant pain?

If the joint pain is severe and there is significant damage or you cannot function, you may need a joint surgery or replacement. An orthopedic surgeon will decide if surgery is right for you based on your history and imaging studies.

Are there any other non-medical or new treatment modalities in the pipeline?

Many patients use remedies that do not have enough scientific evidence to be recommended or prescribed by the doctor but still seem to provide relief for them. These can range from taking omega-3 fatty acid “fish oil” supplements to turmeric pills to mud baths to CBD oil to platelet rich plasma treatment. The patient has to understand the risks and benefits of trying these options. Scientists are also currently doing research to look for new treatments that may prevent or cure osteoarthritis in the future.

Osteoarthritis is a very common and painful disease with the potential to cause severe disability. However, you can take an active role in preventing and managing the symptoms and health care professionals can provide guidance, support and treatment options. Research shows that people with osteoarthritis who take part in their own care report less pain, make fewer doctor visits and enjoy a better quality of life. And a happy, healthy and active life is the ultimate goal!

Priya Chokshi, MD is an assistant professor of medicine (Rheumatology) at Mount Sinai St. Luke’s and Mount Sinai West