Managing Symptoms of Osteoarthritis

Osteoarthritis occurs when cartilage around joints becomes damaged through wear and tear, genetic predisposition or obesity. Although painful, it doesn’t mean you have to give up your favorite activities. Find out which lifestyle changes and medications can help, whether you’re newly diagnosed, in treatment or wondering if you’ll need a caregiver…

If you’ve noticed it’s harder to spring out of bed in the morning, you’re one of millions. Aches, pains and joint stiffness are all symptoms of osteoarthritis, and everybody eventually experiences them, says Stephen Paget, M.D., physician-in-chief emeritus, Division of Rheumatology at the Hospital for Special Surgery in New York City.

Welcome to getting older.

“The traumas of walking around accumulate,” Paget explains.

Not surprisingly, nearly everyone has some symptoms of osteoarthritis by age 70, and most women over 55 have them. About 27 million Americans have the condition, making it the most common form of arthritis, according to the Arthritis Foundation.

If you’re having pain, your doctor may first take X-rays to establish a diagnosis, says Harry Fischer, M.D., chief of the Division of Rheumatology at Beth Israel Medical Center in New York City.

X-rays are a logical place to start, but they don’t always match what you may be feeling. Only a third of people whose X-rays show osteoarthritis, or cartilage erosion, experience symptoms, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

“You can have late-stage knee osteoarthritis and be perfectly functional,” says Nathan Wei, M.D., director of the Arthritis Treatment Center in Frederick, Md.

While the cause of this condition is unknown and there’s no cure, you can manage symptoms of osteoarthritis in many ways.

“People with mild osteoarthritis can [carry on] with regular exercise, weight control and occasional anti-inflammatory medications,” Wei says. “Some people can get by on just acetaminophen,” which relieves only pain, not deterioration.

Stretching daily and staggering days of aerobic exercise and strength training helps by giving muscles time to repair, Wei says.

Losing weight will lessen pain and prevent osteoarthritis from progressing quickly, Fischer adds. Start by eating more fruits, veggies, whole grains and lean meat, such as poultry or fish. Cut high-fat sugary processed foods altogether.

Keep track of what you eat. Participants who kept daily food and exercise records lost twice as much weight as those who didn’t, according to a 2008 study of 1,685 overweight or obese people at the Center for Health Research in Portland, Ore.

Treatments for Osteoarthritis
Osteoarthritis progresses differently in each person, and discomfort varies widely, based on diet, exercise, genetics and weight, Fischer says.

So you may need to try different remedies to find what works best for you.

The most common medications for osteoarthritis treatment are available over the counter, such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory medications (NSAIDs) which include ibuprofen (Advil) and naproxen (Aleve). These are also available as prescription topical medications.

Topical medications “are safer than oral versions for symptoms of osteoarthritis,” Fischer says. That’s because the medications act on pain locally, not systemically throughout your whole body.

Systemic OTC and prescription anti-inflammatory medications can increase the risk of ulcers, gastrointestinal bleeding, liver damage, heart attacks and stroke.

That’s why most physicians recommend taking oral anti-inflammatory medications for only one to two weeks and under a doctor’s supervision.

For pain, Paget advises that women take no more than 2,000-3,000 mg of acetaminophen each day or a low dose of 200 mg of NSAIDs 3-4 times a day. For inflammation, he recommends taking 600 mg-800 mg of ibuprofen 3-4 times a day.

If your osteoarthritis treatment includes NSAIDs, check your liver and kidney functions with your doctor every few months, says Fischer. NSAIDs can weaken them.

Your doctor may also suggest mobility aids, including a cane or braces, to relieve symptoms of osteoarthritis, such as joint pressure. Even wearing more comfortable, cushioned shoes can protect joints and help manage hip and knee osteoarthritis, says Fischer.

Exercise – guided by a physical therapist – may be more important than medication for osteoarthritis treatment. A therapist will give you at-home exercises designed to strengthen back and abdominal muscles, which in turn support the spine, says Paget.

“Exercise is important for strengthening muscles that protect the joints and for encouraging endorphin production to make you feel better with less pain,” Wei says.

Low-impact aerobic exercise, such as swimming, walking and stretching, also improve range of motion. Look into gentle yoga as well.

If NSAIDs, exercise and diet aren’t controlling pain, your doctor may offer other osteoarthritis treatment options, such as a steroid injection into the joint several times a year to decrease inflammation. They also might recommend a series of three to five weekly injections of hyaluronic acid.

“This replenishes fluid in the joint and provides weeks to months of relief,” Fischer says.

If you’re leery of steroids, natural treatments for symptoms of osteoarthritis are also available. They include acupuncture or massage therapy, Fischer says.

Arthritis sufferers who received 24 acupuncture treatments over 26 weeks had a 40% decrease in pain and a 40% improvement in function, according to a 2004 study of 570 patients with knee osteoarthritis by the National Center for Complementary and Alternative Medicine.

If pain interferes with everyday activities, such as climbing stairs or getting in and out of chairs, your doctor may recommend joint replacement, particularly for hip or knee osteoarthritis.

Sound drastic? It has worked for many. Ninety to 95% of hip replacements were successful 10 years after surgery, and 80%-85% were still good 20 years after surgery, according to the Hospital for Special Surgery in New York City, a leading orthopedic institution.

Considering a Caregiver?
It’s unlikely your osteoarthritis will require a caregiver. But, if painful joints make moving difficult and joint replacement isn’t an option, “you may need someone to help you walk and get up and down,” Fischer says.

The caregiver’s primary task is to be aware of changes in the patient’s condition.

“If someone develops an acute pain, joint swelling or a sudden change in pain, contact the doctor,” he advises.

Caregiving usually falls to a family member, most often a spouse, says Wei.

That can be physically and emotionally stressful. A patient may start to rely on her caretaker, relinquishing daily functions she can still do, which may further erode her health.

“It’s important to let the patient do what she can,” Wei says.

Both of you need to be aware of caregiver burnout.

“The caretaker needs to stay healthy and be effective,” Wei says. “If they can’t do it any longer, the patient may need an assisted living arrangement, and there’s no shame in that.”

“Don’t be a martyr – get help,” Wei advises.

For more on the condition, visit our new Osteoarthritis Health Center.

For more information, visit our Arthritis Health Center .

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