Osteoarthritis

One of the most common questions that I get asked on a daily basis is “Doc, how can I have arthritis?? I am so young!”

I have been involved with competitive figure skating, dancing (ballet, tap, jazz) and in my last 20 years I have engaged in long distance running and playing tennis.  I have been conscious of  the effects of the chronic stress I have been placing on my joints  since childhood.  Am I going to develop arthritis?  The answer is..  I don’t know but I am at risk for sure.

There are so many types of arthritis but osteoarthritis  (OA) is the most common and progressive joint disease that usually affects middle age and elderly individuals.  In reality, it can affect people at any age.   It is commonly referred to as “wear and tear arthritis or degenerative arthritis”.  We hear so much information about heart disease and cancer, however, osteoarthritis is a leading cause of disability in the United States and can affect more than 30 million men and women.  OA is different from RA since rheumatoid arthritis is an autoimmune disorder caused by immune factors and chemicals resulting in joint and inflammation of many organs.

How does this type of arthritis happen?

The two bones that compose the joint structure is protected by a tough connective tissue calledcartilage that allows the bones to move smoothly against each other.  Over time and with age and repetitive motion, the cartilage can break down and become damaged. The bone surfaces of the joint can become rough and the surrounding tendons and ligaments around the joint can also deteriorate resulting in joint pain and irritation.  The synovium or joint lining can also become inflamed.

When the cartilage deteriorates completely, “bone on bone” interaction can occur because the cartilage can no longer be repaired.  This type of chronic arthritis can affect the hands, fingers, knees, hips, lumbar spine (low back)

Symptoms:

  • Joint pain
  • Joint stiffness (usually not lasting all day unlike RA and may happen after prolonged sitting/standing or waking up)
  • “Crackling/grinding noise”- called crepitus, “Locking”, “Popping”
  • Bony deformities on hands, knees or extra bone spurs that feel like hard “bumps and lumps”
  • Decreased flexibility
  • Swelling
  • Joint instability if severe especially in the knee
Mayo Clinic

WHO IS AT RISK?

  • Increase age
  • Obesity – I see this every day in my office especially in people with BMI >30). The increased body weight adds more mechanical stress tow eight bearing joints like the knees and hips. 
  • Repetitive stress- I’m a runner so I know that I am at risk!  Certain occupations can also place people at risk for OA
  • Genetics or family history
  • Trauma or prior injuries- Some people with prior cartilage and ligament injuries or prior fracture or surgery can develop OA.
  • Sex- Women are more at risk
  • Certain medical conditions like Diabetes, Chondrocalcinosis, Hemochromatosis(excess iron overload in the body) can increase risk
  • Existing joint deformities from birth/childhood or people with cartilage defects

EVALUATION PROCESS

A rheumatologist will obtain a complete history and conduct a thorough exam looking for deformities, bony enlargement of the joints, listening for crepitus and determine the amount of swelling, mobility and flexibility of the joint.

Often a radiograph (X-ray) will be ordered. There are specific findings on musculoskeletal imaging that can be seen with OA.  Ultrasound or MRI may also be done to evaluate for other problems in the tendons, soft tissues and ligaments.  Blood tests to rule out RA may also be done.  A joint fluid analysis can be conducted if swelling is present.  This analysis can also determine if gout or inflammatory arthritis exists.

WHAT DO I Tell my Patients?

  1. Stay active, Stay active, Stay active!  
    1. It is important to aim for at least 30 minutes of physical activity daily or every other day to help strengthen the muscles around the joints.
    2. Try swimming, yoga, or tai chi if you are worried that running or jogging may ultimately increase your risk.  This advice is tough for me. I have actually cut down my running to three times a week and took up strength training, cycling and yoga.
    3. Wear supportive shoes. Change your sneakers every few months and get help from a professional who specializes in shoes.
  2. Be conscious about achieving and maintaining the ideal body weight for you! 
    1. Talk to your physician about this number!!  Weight loss can help relieve the stress on the joint and therefore reduce pain
  3. Try physical therapy and increase stretching!
  4.  Rest your joints a few times during the week!
  5. Medications may be an option for some people
    1. Tylenol (Acetaminophen)
    2. Over the counter gels, creams, patches
    3. Nonsteroidal Anti- Inflammatory agents (naproxen, Ibuprofen)
      1. Please speak to your physician to see if this medication is appropriate for you especially if you have a history of high blood pressure, kidney and ulcer disease, bleeding problems
    4. Steroid and Hyaluronic acid injections (knee)
    5. Duloxetine (Cymbalta) has been approved by the FDA and used by some physicians for relief
    6. I’m not a fan of narcotics for chronic pain!!
  6. Assistive support devices (walker, cane, brace)
  7. Surgery for severe cases

WHAT ABOUT OTHER ALTERNATIVE TREATMENTS?

Living in NYC, I have so many patients who want to try other supplements or eat certain foods to help with degenerative arthritis.  Some of the supplements that have been successful for patients include glucosamine, fish oil, ginger, and eating a diet rich in omega – 3 fatty acids, vitamin C and D , beta- carotene which may have anti-inflammatory properties.  More studies need to be conducted to evaluate efficacy

Harvard Health

BOTTOM LINE:

There are some factors that we have no control over when it comes to osteoarthritis prevention like gender, genetics, cartilage defects, but we can ALL control our weight and maintain a healthy personalized body mass index to help reduce joint stress and hopefully progression of degenerative arthritis.  I know it can be a difficult challenge but it is necessary to avoid developing depression and sleep problems from chronic joint pain, joint deformity and disability.

MAINTAIN THAT WEIGHT TO MAINTAIN YOUR JOINT CARTILAGE!

References: Current Diagnosis and Treatment in Rheumatology
The American College of Rheumatology 

Disclaimer:  This blog contains my personal opinion based on personal and clinical experience, tips from trainers, health coaches and lastly research.  This blog does not endorse specific treatments, procedures, products.  You should always consult with a doctor, nutritionist, or other healthcare professional to discuss your own health and lifestyle goals and regimen based on your medical history.  Thank you for reading!