Osteoarthritis

Osteoarthritis is one of over 100 forms of arthritis. Growing up, I always assumed that arthritis was an inevitable part of getting old. It seemed like every elderly person I knew was always complaining about their “rheumatism” or their ‘’trick knee” that acted up when it rained. Now that I am getting older, I too have some aches and pains attributed to arthritis. But one thing I’ve learned is that disabling arthritis pain is not the fate of everyone over 50, as I once thought. Perhaps we can learn a thing or two about osteoarthritis and see what can be done to manage it better if we get it.

What is Osteoarthritis?

Osteoarthritis (OA) is also known as degenerative joint disease (DJD) or osteoarthrosis. It is a progressive joint disorder caused by deterioration of the cartilage, resulting in inflammation and pain. The cartilage is a tissue that acts as a “shock absorber” on the ends of joints. When it is destroyed, painful bony spurs and cysts form between the joints. The most commonly affected joints are the weight-bearing ones such as the knees, hips, spine, feet, and hands. The origin of the word “osteoarthritis” comes from three Greek words meaning “bone,” “joint,” and “inflammation.”

OA is the most common form of arthritis, and a leading cause of disability in people over the age of 50. It is rare in folks under 45, but is found to some degree in 30% of Americans over 45, and about 80% of those over 65.

OA typically starts out slowly and develops gradually over a period of years. As the cartilage begins to wear down, the bones begin to literally rub together on each other causing inflammation and pain. This results in bone spurs and fluid-filled pockets in the marrow of the bones called subchondral cysts. As OA progresses, pain is also caused by accumulation of fluid in the joints and the bones themselves can become deformed. There is minimal pain at the beginning of the illness. Some folks experience pain in only one joint at first, or only on one side of the body. Often the first symptom many patients notice is stiffness in the joints after getting out of bed in the morning. Gradually, other common symptoms develop, such as:

• Painful joint or joints while in use, after use, or after a period of resting it.
• Noticeable increase in pain and soreness after a change in the weather. Many people seem to be particularly susceptible to changes in humidity.
• Diminished range of motion in affected joints.
• Swelling and stiffness in a joint after use.
• Joints in the fingers and thumbs often become enlarged and bony knobs called nodes can form, giving the fingers a gnarly appearance. These nodes are sometimes called “Heberden’s and Bouchard’s nodes,” and they tend to run in families. These are most commonly found in the early stages of OA, and are less pronounced later on.
• Tenderness and swelling in the soft tissues around the joints.
• Joint crepitus, which is a cracking sound when the joint is moved.

What Causes Osteoarthritis?

Osteoarthritis is broken down into two main forms: primary and secondary. Primary OA is a response to the wear and tear upon joints after years of repeated use.  It usually rears its head in people over 40. The weight bearing joints seem to take the brunt of abuse. It is a function of age, but with a little preventative living, you can avoid many of the negative influences of osteoarthritis.

Wear and tear is the mechanism that brings on the OA, but researchers are starting to see that there is more to it. The cartilage is actually a gel-like substance composed of a mixture of compounds called a collagen matrix. The cartilage normally goes through a process of breaking down old cartilage and replacing it with new. This is accomplished by a number of enzymes that work together. Researchers believe that as people age and the joints get more wear and tear, somehow the mix of enzymes is thrown out of balance, and the cartilage begins to be destroyed. Over time, the cartilage progressively loses its ability to repair itself. In addition, one of the body’s responses is to attempt to replace the lost cartilage. Unfortunately, this often mistakenly results in the growth of new bone along side of the existing bone. This is the source of painful bone spurs, and can eventually lead to bone deformities.

Secondary OA is the result of trauma or injury to a joint, and can occur anywhere in the body. It is much less common than primary OA. This type of OA is often caused by:

• Sports injuries
• Automobile or other traumatic accidents
• Repeated attacks of other types of arthritis such as gout or septic (bacterial or infectious) arthritis
• Repetitive stress injuries, often associated with occupational factors such as assembly line work, computer keyboarding, or construction
• Developmental abnormalities that result in poor bone alignment or posture.

Basically, the risk factors for developing either type of OA can be summed up as follows:

• Age:  If you are over 45, your risk is increased.
• Gender:   The incidence of OA is slightly higher in females than in males.
• Obesity:  Carrying around excessive extra pounds is one of the biggest aggravating factors for OA. Obesity can cause a person to develop OA, and it can also make existing conditions much worse. It accelerates the wear and tear on the joints and enables OA to progress much faster.
• Weak Quadriceps:  If your thigh muscles are weak or underdeveloped, it makes your chances of getting OA in the knees much greater. This is often a problem for obese people.
• Surgery:  If you have had surgery on a joint, such as the knee, you have a greater chance of developing OA in that joint.

How Can Osteoarthritis be Treated?

The main consideration in treating OA is pain management. Pain is the biggest complication associated with OA. There are many options when it comes to dealing with pain. One issue I would like to address first off is the use of “nonsteroidal anti-inflammatory drugs” or NSAID’s. These are one of most commonly suggested drugs to control the pain of OA. They include aspirin, ibuprofen, and naproxen sodium First of all, they can have serious side effects, especially after long-term use. Some of these include cardiovascular problems, liver and kidney damage, and gastrointestinal bleeding. The side effects alone are enough reason not to use these medications. However, there is more. The way these drugs work is to inhibit enzymes that contribute to inflammation. The problem is, when they block those enzymes, they also block useful enzymes that help produce healthy cartilage, and the joints deteriorate further. So the short-term result is less pain, but behind the scenes these drugs are enabling the OA to get worse over time. The risks are just too great, and I do not recommend the use of these medications.

What is the best way to manage pain for sufferers of osteoarthritis?  There are more natural methods that are safer and more effective:

• Glucosamine Sulfate is a marvelous natural substance that has worked wonders for folks with OA. Glucosamine is a molecule that is manufactured by the body. In joints, its main purpose is to stimulate the synthesis of a certain compound found in cartilage. As we age, the body often loses its ability to produce ample glucosamine, and this contributes to the debilitating effects of OA. When glucosamine supplementation is used, the body is naturally encouraged to build healthy cartilage again, and this helps to lessen the painful symptoms of OA. This is the ultimate in treatment. Not only does it help the pain, but it also helps the body to repair itself and get to the root of the problem.
• Chondroitin Sulfate is another supplement partially composed of glucosamine that has proven effective, but it is not nearly as helpful as glucosamine. However, very impressive results have been obtained in studies done using glucosamine and chondroitin together. I would suggest using a supplement that is composed of both of these.
• MSM (methyl-sulfonyl-methane) is another natural substance that has helped many folks with OA. MSM is the major form of sulfur found in the body. Sulfur is critical in the healthy functioning of joints, tendons, ligaments, and cartilage. Supplementation with sulfur has been recognized since the 1930’s to be of benefit to arthritis sufferers. MSM is in an especially effective form that gets very good results with many patients.

The proper diet is a great tool for managing OA, both to lessen existing symptoms, and to prevent the onset of OA. Here are some suggestions:

• Perhaps the most important thing that can be said regarding diet is that if you are overweight, control the amount you eat, exercise, and make every effort to stabilize your weight. Being overweight is the biggest factor that impacts folks with OA. If you could only do one thing to deal with your OA, I would definitely choose losing weight.
• Focus on including a lot of fruits and vegetables in your diet. Some are particularly helpful with OA. Flavonoid-rich fruits such as strawberries, blackberries, blueberries, and cherries are wonderful. Also, as we mentioned above, sulfur is great for OA. Foods that are high in sulfur include Brussels sprouts, cabbage, garlic, and onions.
• Ginger is an excellent inflammation fighter, and many people have seen significant improvement in both pain and mobility in their joints from using ginger. Fresh ginger is the best, and you can add it to many dishes to spice up the flavor as well. It also can be brewed as a tea.
• There are certain foods that you will want to avoid. Vegetables of the “nightshade” or “solanaceae” family seem to stimulate inflammation. These include potatoes, eggplant, tomatoes, and peppers.

Exercise is very helpful for OA sufferers, but many tend to shy away from it because it seems to worsen their pain and inflammation. One form of activity that is low impact and a favorite of a lot of arthritis patients is swimming. Instead of aggravating the joints, it seems to relieve pain as it builds strength. Another form of hydrotherapy that is also popular is a good old-fashioned warm bath. Don’t need any special equipment for that. Just head to the bathtub and relax.