March 2008

What is arthritis and what causes it?

Arthritis is commonly just thought of as joint pain, but arthritis is not just one condition with one cause and a standard set of symptoms. Arthritis is actually a complex disorder, with many variations of type, many different causes and widely varying symptoms. Treatments vary widely from exercise alone, to occasional mild, over the counter medicines, to daily strong prescription medication. The most common type of arthritis is called osteoarthritis, the focus of this column. It affects more than 21 million Americans, including many seniors.

This condition results from degeneration of the joint cartilage. In most people, cartilage breakdown is due to both mechanical ("wear and tear") effects and biochemical effects.
Heredity can be a trigger, like the common form that causes enlargement of the knuckles and hands. Current research focuses on genetic abnormalities and the chemistry and function of cartilage and is rapidly advancing our understanding of osteoarthritis.

Is joint pain a sign that I’m developing arthritis? What are the other symptoms?

Not every ache or pain in our joints is due to arthritis. Strains and sprains commonly cause temporary joint discomfort. Infections can also cause joint pains. Osteoarthritis, on the other hand, is a permanent disorder.

Our joints are composed of bones and the soft cartilage. Osteoarthritis is a gradual degradation of both types of tissue. The spectrum of symptoms include stiffness, aching sensations or outright pain, swelling, crackling sounds with movement, and eventually a limitation of range of movement of the joint. It may involve one joint or many, and may or may not be accompanied by inflammation, noted as heat and redness. Onset of symptoms is usually mild and occasional, and may progress to severe and constant.

If it doesn’t run in my family, am I not at risk?

Heredity is only one of the many risk factors for development of osteoarthritis. Age is the strongest risk factor, and women are more likely than men to develop it. Being overweight is a strong risk factor, as is frequent, repetitive injury to a joint, either through occupation or sports.

How is osteoarthritis treated?

Treatment varies according to the type and severity of the condition. The physician’s goal is always to relieve pain, reduce swelling, maintain joint function and improve quality of life.

The two most important treatments are exercise and medications, both of which should be discussed with your physician.

Exercise

Maintaining good general health and controlling your weight is very important. Keeping your joints mobile, through mild, low- to no-impact exercise is always a good idea. Proper exercise will not "wear out" a damaged joint. Joints and muscles need to be exercised to prevent stiffness and weakness. Plus, exercise will make you feel better and help you maintain a healthy weight. Excess body weight places extra force and pressure on arthritic joints and causes osteoarthritis to progress more rapidly. Stretching exercises will help prevent the stiffness associated with osteoarthritis and help prevent injury. Strengthening exercises will help fortify the muscles and ligaments surrounding a joint, which in turn will protect and reduce stress on the joint. For example, stronger thigh muscles take some of the stress off of weight-bearing joints, like knees and hips.

Medication

Medication is also part of the treatment tool kit and should be discussed with your doctor. Plain or long-acting acetaminophen, on a regular or daily basis, is helpful for mild symptoms. Over the counter anti-inflammation drugs, such as Ibuprofen, Naproxen and aspirin are useful for more severe symptoms or when swelling is present. More severe and chronic symptoms may be treated with joint injections of steroids or lubricating medications, such as hyaluronans, with which your doctor is familiar. Many over-the-counter herbal and other anti-arthritis preparations have been touted as effective treatment however, to date, no studies have consistently shown these to have any proven value.

Any medication, whether over-the-counter or prescription, has potential side effects and may not be appropriate for everyone and should always be discussed with your physician.

Barry Hansen, M.D., is a family medicine physician at the Sunnyvale Center of the Palo Alto Medical Foundation, formerly known as Camino Medical Group.