Managing Osteoarthritis Before It Manages You

Osteoarthritis, also called osteoarthroses or degenerative joint disease, is one of the most common types of arthritis affecting nearly 21 million Americans. Osteoarthritis is associated with progressive loss of cartilage, the material that provides cushion to the ends of bones. In addition, there are changes in the bone below the cartilage leading to bony overgrowth commonly known as spurs. While the cause of osteoarthritis is not yet known, a number of factors increase the risk of developing this condition, which can result from an inherited predisposition to osteoarthritis, combined with obesity, joint injury and aging.

Osteoarthritis typically affects joints such as knees, hips, lower back, neck and hands. Before age 50, the prevalence of osteoarthritis in most joints is higher in men than in women; however, after this age, more women are affected by osteoarthritis of the hands and knees.

The occurrence of the disease increases with age, rising two to ten fold in people ranging in age from 30 to 65. Symptoms of osteoarthritis include pain or stiffness of the joints after periods of inactivity or excessive use along with a “grating” or “catching” sensation occurring during joint movement. Osteoarthritis is responsible for a greater difficulty in walking and stair climbing than any other disease. Although osteoarthritis may have a genetic predisposition, several steps can be taken to prevent, delay or manage it.

Excessive body weight augments the load placed on joints, such as the knee, increasing joint stress and hastening the breakdown of cartilage. For example, a force of nearly three to six times one’s body weight is estimated to be exerted across the knee while walking. Therefore, a mere 10 pounds of additional body weight is essentially an extra load of 30 to 60 pounds on the knees.

Population-based studies have consistently shown a link between being overweight or obese and osteoarthritis of the knee. If obesity increases the development and progress of knee osteoarthritis, can weight loss reverse these effects? Felson et al in the Framingham study illustrated among women with a baseline body mass index (BMI) greater than or equal to 25, weight loss was associated with a significantly lower risk of knee osteoarthritis. In this study, losing as few as 11 pounds (approximately two BMI units) reduced the risk of developing osteoarthritis in the knee by over 50 percent. A number of other studies have indicated weight loss substantially reduces reports of pain and is associated with greater improvements in physical function. Moderate exercise keeps joints flexible and helps maintain or improve muscle strength. Multiple studies have shown there is little or no additional risk of osteoarthritis from regular, moderate running. Weakness of the quadriceps muscle (muscle in front of the thigh) is common in patients with osteoarthritis. Studies have shown even a relatively small increase in quadriceps strength (20 percent for men and 25 percent for women) can lead to a 20 to 30 percent decrease in risk of osteoarthritis.

Although osteoarthritis cannot be cured, a number of treatment options are available from over-thecounter and prescription medications to intra-articular injections. Initial use of acetaminophen or Tylenol (up to 4000 mg/d) is recommended in mild-to-moderate osteoarthritis. Another treatment option is the use of non-steroidal anti-inflammatory drugs (NSAIDS). These, however, may be associated with problems of the gastrointestinal (GI) tract, kidneys and cardiac system. Additionally, glucosamine and chondroitin sulfate are currently marketed as “nutritional supplements” and have been shown to have positive effects on osteoarthritis. Intra-articular injections of hyaluronic acid derivatives and corticosteroids have also been shown to relieve pain in patients with osteoarthritis who fail to respond to non-pharmacologic therapy or analgesic drugs. In the management of osteoarthritis, surgery such as joint replacement needs to be considered in patients who have not responded adequately to medical management. Osteoarthritis is a major public health issue; however, a combination of treatment approaches can be extremely effective. The risk of osteoarthritis can be significantly reduced by maintaining an ideal body mass index (BMI) between 18 and 25, a healthy lifestyle and a regular exercise program, including quadriceps strengthening. Furthermore, research is ongoing to detect “biomarkers” for the identification of osteoarthritis, and a number of newer pharmacologic treatment options are being investigated.

Daksha P. Mehta, M.D., is a board-certified rheumatologist who practices at the Center for Arthritis & Osteoporosis in Elizabethtown, KY. She specializes in rheumatologic conditions, including osteoarthritis, rheumatoid arthritis, osteoporosis, as well as immunologic diseases. Her office also conducts numerous clinical trials. Visit their website at www.arthritis123.com.