Aching joints need care

When we sit, stand or kneel, our bodies move without a great deal of thought.  For people with osteoarthritis, movement becomes a problem.

According to UMC physician Dr Stephen Neely, Senior Orthopaedic Surgeon, “Osteoarthritis, the most common form of arthritis, attacks the cartilage, which is a specialised rubbery tissue that covers the end of the bones between your weight-bearing joints.  It provides a smooth surface so that joints move easily and almost in a friction-free environment.  As osteoarthritis progresses, cartilage wears and the underlying bone becomes compressed and irregular.  Instead of moving smoothly together, friction increases and the joint surfaces begin to rub against each other causing pain.”          

Aching pain and stiffness may be the earliest symptoms of osteoarthritis.  Dr Neely states, “Your range of motion in the affected joint may be limited.  Inflammation, although not common, can occur after excessive use of the affected joint.   Osteoarthritis normally occurs in all the joints of our body.  Your feet, knees, and hips are most susceptible because they are our weight bearing joints.”  

To diagnose osteoarthritis, your doctor will do a thorough history and physical exam, x-rays in a weight bearing mode to help show damage to the joint.  Blood tests and other laboratory tests may help rule out other types of arthritis such as the gout and rheumatoid disease.  Your doctor may prescribe a treatment plan to provide pain relief, increase motion and improve your strength.  Some treatment options in the algorithm for the care of the arthritic joint include:            

Medications:

Your doctor may prescribe medications to reduce pain and inflammation.  The anti-inflammatory medications and the strength depend on your specific diagnosis, disease severity, and your general physical health.  Conditions such as ulcer, asthma, kidney, and liver disease play an important role in modulating what dose of the medication is appropriate for you.  New medications are introduced regularly so it is important that you work closely with your doctor to find out what works best for you.  Sometimes, cortisone injected directly into the joint may help relieve pain and swelling for a time.  However, frequent injections into the same joint can cause further damage and have undesirable side effects.  The lubricant class of medications, commonly known as joint jelly, provides good relief in the clinical picture of moderate disease.  

Diet and exercise:

Eat a well-balanced diet that is low in fat and high in fibre.  Losing excess weight can reduce the stress on your joints and make a considerable difference in how they are able to repair themselves.  A sensible exercise plan can reduce the pain and prevent ongoing disability.  Ask your doctor for exercises to decrease stiffness and increase muscle strength.  Swimming or pool aerobics is great for patients with arthritis.  

Surgery:

If other treatments fail, your physician/surgeon may recommend total joint replacement surgery to replace the damaged and worn joint and cartilage with prosthesis.  The replacement is a highly efficient design that includes high strength metal pieces that fit closely to a matching sturdy polyethylene component.  These materials will enable your joint to move more normally.  In general, these replacement joints last for 10–20 years.  Dr Neely has personally seen a number of arthroplasties where the index procedure has lasted over 23 years.  Joint replacement surgery is successful in greater than 98 per cent of the cases in the relief of pain and increasing mobility.  

So, how do you know what treatment is best for you?  Talk with your doctor about a treatment plan that is best for you.  As your treatment progresses, your doctor may adjust your medication, diet or exercise program.  Keep your doctor closely informed about your symptoms, your general health, and any problems you may have with the medications prescribed. 

(Source: University Medical Centre: February 2009)