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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Monday, April 23, 2012

“J” is for Joints

By Laura Corio, MD

Arthritis

Osteoarthritis(OA) is a degenerative joint disease that affects many adults. It is a frequent cause of joint pain and disability in the aging, commonly presents in patients over 40, and is multifactorial. Its causes are many, including aging, gender, genetics, occupation, previous injuries, muscle weakness, obesity, sports activities, and lack of osteoporosis. Common joints involved are knees, hands, hips, spine, feet and shoulders. Pain and stiffness are common complaints.

One of the strongest risk factors is aging, with 97% of patients over the age of 65 affected. Women seem to be more at risk for OA than men. Obesity seems to affect the knees and the hands, but less on the hips. Lack of muscle strength, a previous injury, and physical activities related to sports or occupation increase the risk for OA. Genetics definitely are involved, especially in hands and knees. There has been some (conflicting) evidence of a relationship between osteoarthritis and hormone replacement therapy, but if you are on HRT and doing well, there is no reason to stop it based on the development of osteoarthritis.

X-rays and MRI imaging will help diagnose what is happening in the joints. If a diagnosis is made, a Rheumatologist may be the physician you need to see.

The thought process when it comes to OA is to control pain and swelling of the joints, improve the quality of a patient’s life, educate the patient about how to minimize the disability, and prevent the disease from worsening. Resting the affected joint to reduce pain may be good but only for a short period of time, since the muscles around the joint can weaken. If a patient is overweight, losing some pounds will help lower extremity joint mobility and pain. Physical therapy, exercise, and isometric strengthening and even water aerobics can all make a huge improvement in the arthritic joints. Heat and cold  can both raise the threshold for pain. If the patient is really having a difficult timing coping and depression is part of the picture, psychosocial intervention can also make a huge difference in how a patient deals with their disability.

The goal with managing patients with osteoarthritis is to help control the pain and improve the patient’s quality of life. Analgesics such as Tylenol are tried first. If there is little improvement, non-steroidal medications such as Advil are attempted. Sometimes, injecting steroids into the joint can be satisfactory. Persistent symptoms may need to be treated with colchicine, a medication used for gout that is also helpful for other joint pain. If all medications have been tired without relief, it may be time for surgical intervention.

My last word about osteoarthritis is about vitamins. It has been shown that vitamin C in a dosage of 200 mg daily can reduce the risk of progression of OA by three-fold in patients with OA. Beta-carotene, another antioxidant, also helps reduce the risk as well. 9000IU daily is what the experts recommend. Vitamin D in a dosage of 1000 IU of D3 will also reduce the risk for the progression of OA. Lastly, three grams of omega 3 fatty acids daily is the recommended  dosage according to osteoarthritis experts. Limit omega 6 fatty acids because they will make your joints worse.

Clearly this a disease that can affect all adults. Keep moving, stay active, exercise, and do not let this get the better part of you. There are treatments available both alternative and conventional and educating oneself about all that is available is essential for coping with osteoarthritis. I hope I have given you some solid information about OA.

Stay tuned for “K” is for “Kidneys and Bladder”

Photo: Creatas

Posted by: Laura Corio, MD at 12:15 pm

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