Expert Advice on Osteoarthritis Relief Patience White, M.D., Explains Causes and Help for Joint Pain

Could you be at risk for osteoarthritis, the most common type of arthritis? To find out, you’ll want to check your parents’ medical histories and consider your weight. Patience White, M.D., explains the latest symptoms and treatments, including alternative therapies, for this chronic condition... You don’t have to be old to be affected by osteoarthritis symptoms. The disease can show up even in your early 20s. So how can you stay active and pain-free? Is there new osteoarthritis treatment on the horizon? In an edited conversation with Patience White, M.D., vice president of public health for the Arthritis Foundation and a rheumatologist at the George Washington University School of Medicine, in Washington, D.C., we get answers to these and other questions. What is osteoarthritis — and how is it different from rheumatoid arthritis? Osteoarthritis is the most common type of arthritis, affecting approximately 27 million Americans. It occurs when joint cartilage loses its elasticity and breaks down, causing the connecting bones to rub against each other. The joints most affected include the hips, knees, hands, lower back and neck. The number of diagnosed cases of osteoarthritis is estimated to reach 67 million by 2030. Statistics show that about half of all adults develop knee osteoarthritis at some point in their lives. The condition is common because the joint carries our weight, is put under stress as it moves with every step and is prone to injury in sports and other activities. Rheumatoid arthritis, in contrast, is an autoimmune disease in which a person’s immune system attacks the body’s own tissues. This causes fluid build-up, inflammation and pain in the joints. It’s a systemic disease, meaning the pain can occur anywhere. What causes osteoarthritis? There are many risk factors for osteoarthritis, but genetics may play the largest role. Inherited knee and hip osteoarthritis can originate from either side of your family, but osteoarthritis of the hand generally comes from the mother’s side. Since many people with osteoarthritis are undiagnosed, you may need to delve into your parents’ history. Knee or hip problems could mean knee or hip osteoarthritis. Does Mom have knobby fingers? It’s probably due to osteoarthritis of the hands. What are the other major risk factors? Injuries also cause osteoarthritis, especially if they are severe enough to require surgery. The next most common risk factor is weight. About 66% of adults diagnosed with arthritis are obese, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. Is there anything you can do to reduce the risk of osteoarthritis? Absolutely. Most important: lose weight. More than 65% of people in the U.S. are overweight, according to the CDC, and at great risk for knee osteoarthritis. Every pound you gain puts four pounds more pressure across your knees. Losing 10 pounds takes 40 pounds of pressure off your knees. There is evidence that obese people have greater levels of inflammatory hormones, which can irritate joints and make them more vulnerable to injury. Stay active. It improves the strength and balance of the muscles and ligaments that help the knee work. Moderate activity three times a week can reduce the risk of disability from knee osteoarthritis by 47%, according to the CDC. Can medications control osteoarthritic pain? Yes, but none will work as well as losing weight. In 2004, researchers at Johns Hopkins Medical Institutions in Baltimore found that a 15-pound weight loss reduced osteoarthritis pain by 40%, improved function by 50% and reduced stiffness by 50%. In contrast, medication caused only a 28% improvement in these factors. Taking any pain medication over time leads to a [higher] risk of side effects. Long-time use of non-steroidal anti-inflammatory drugs (NSAIDs) can cause bleeding in the stomach, and acetaminophen can cause liver damage. Anti-inflammatory creams and lotions can be effective, but even these can be absorbed through the skin and cause side effects or interact with other medications. Taking medication initially will reduce pain levels so you can be more active. More physical activity and weight loss will decrease pain and require less medication. That will slow the progression of the disease and prevent you from becoming disabled. What’s the best way to lose weight? Can a certain diet or foods reduce your osteoarthritis symptoms? There’s no evidence that a specific diet can affect osteoarthritis. But it is critical to keep your bones strong — and that means getting enough calcium and vitamin D. For adults, the current recommended daily allowance (RDA) for calcium is 1,000 milligrams (mg) daily; for vitamin D, 600 IU daily. It’s also important to lose weight in a lasting way. Avoid crash diets and make a commitment to change what you eat. Try to eat less meat and more fruits and vegetables. Fill two-thirds of your plate with fruits and vegetables. What’s the best way to start an exercise program? First, stick to low-impact activities, like walking and bicycling. These won’t pound on those lower-extremity joints. If you need help starting a new activity, check with the Arthritis Foundation, which offers exercise programs through state health departments and local YMCAs. The foundation’s website also has information about stretching, walking and various exercises. Why does tai chi help in the treatment of osteoarthritis? Several studies show that tai chi, a traditional Eastern series of slow, controlled movements, can improve strength, flexibility and balance, including one 2009 study at Tufts Medical Center of 40 adults with knee osteoarthritis. One group attended a tai chi class; the other group did stretching exercises. Following a 12-week program, participants were instructed to continue at home. The tai chi group reported greater improvement in pain, physical function and quality of life and less depression than the stretchers. Can mechanical devices — orthotics, braces and canes — help reduce the pain of osteoarthritis? With knee osteoarthritis, supportive, flexible footwear is critical. Orthotics may help by providing arch support. This will keep your legs more stable as you walk, reducing strain on the knee. Braces can help stabilize a joint after an injury, but reliance on them should be limited. You lose strength and range of motion when you don’t use the knee for long periods. Do alternative treatments, such as massage, meditation and acupuncture, help? There’s evidence that acupuncture can help knee and hip osteoarthritis. A 2006 German study followed 3,633 patients with knee and hip osteoarthritis. One group received 15 sessions of acupuncture and regular medical treatment; the control group only received medical treatment. In three months, the acupuncture group showed “marked clinical improvement” compared with the control group. Licensed acupuncture practitioners are listed at the American Academy of Medical Acupuncture, or the National Certification Commission for Acupuncture and Oriental Medicine. Meditation and guided imagery techniques can also help you cope with pain, while massage may relax your muscles. You can find more information about managing your osteoarthritis symptoms through meditation here. Do supplements, such as glucosamine and chondroitin, help prevent osteoarthritis pain? Research shows they don’t prevent joint degeneration. A recent study indicated that patients with moderate to severe knee osteoarthritis had similar results whether they took these two supplements, the NSAID celecoxib or a placebo for pain. Glucosamine and chondroitin may be helpful for moderately severe pain, but they are expensive, and their benefit is still unclear. What other issues can affect people with osteoarthritis? They’re at risk for obesity-related conditions, including diabetes and heart disease. Half of all people with diabetes also have osteoarthritis. This is why it’s especially important for people with osteoarthritis to eat a balanced diet, stay active and lose weight: It helps lessen pain and reduces the risk of developing one of these conditions. Are there new developments in surgical treatments for osteoarthritis? Joint replacement is one option for severe, long-term osteoarthritis. Knee and hip joints are commonly replaced with metal or plastic parts, most of which last about 20 years. In 2003, the last year for which figures are available, there were approximately 418,000 total knee replacements and more than 220,000 hip replacements in the U.S., according to the American College of Rheumatology. There are efforts to develop artificial cartilage that would replace diseased tissue, the fundamental defect that leads to osteoarthritis. Check out The New Knee Replacement for more information. Learn more about this condition in our Osteoarthritis Health Center. What's Your Inflammation IQ? Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life.