Friday, August 01, 2008


Painful arthritis can be managed

I was in India a few ago to see my parents. My dad has been complaining of knee pain for years. I decided to review the various options he has for his knee pain, which was caused by the most common form of arthritis – osteoarthritis.

So what is Osteoarthritis (OA)?

It is the most common joint disorder affecting middle-age and older people. Nearly 27million people in America are affected by this condition that can become progressively worse.

It starts with damage to the cartilage – the cushion pads that are in between the bone and this then causes changes in the structures around the joint. These can be a result of injury or in some cases overuse. Some patients have fluid accumulation, bone overgrowth and weakness in the muscles and tendons around the joint.

Most common areas are the weight-bearing joints – knees, hips and spine. Symptoms start as early as the 40’s with just some mild pain in the joint, which progresses slowly through the years. In the area of weight-bearing joints, it can result in difficulty walking and even standing.

When the spine is involved, this results in stiffness and pain and in some cases, significant disability because of chronic pain.

OA can also affect fingers and joints with previous injuries. Patients who have arthritis in the hands usually have a family history.

Because of injuries from extreme sports, we are now seeing arthritis in other joints that we classically did not see before because of injuries.

How is it diagnosed?

Physical examination is very helpful with joint crepitus (creeking), some joint deformity, and fluid on the joint. X-rays and MRIs are commonly used to document OA, and MRIs are also used for evaluating cartilage injuries.

Treatment options include:

1. Physical measures: guided exercises, support devices and thermal therapy are an integral part of managing OA. Acupuncture and chiropractic therapy have a role in treating certain patients.

2. Drug therapy: Topical agents and oral agents are available, as well as inflammatory and pain medications. Anti-inflammatory medications help with the swelling and in some patients we use pain medications.

3. Injections: Options include cortisone injections and hyaluronic acid agents.

4. Surgery: Arthroscopy and/or joint replacement are considered for patients with seriously damaged joints or patients with intractable pain.

5. Supplements: Many nutritional supplements have been used for treatment of OA, but most lack good research data to support their effectiveness and safety.

Your primary care physician, rheumatologist and orthopedic surgeon can help you with decisions regarding the plan of care for this very common pain condition. There is currently no medication that can reverse the process, but with the right treatment plan your quality of life can be improved.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physicia. E-mail Varma and all of the Healthy Living columnists at healthyliving.

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