Arthritis is the wearing out of the surface on the end of the bones and affects both large joints (hips, knees and shoulders) and smaller joints in the hand, feet and spine. Arthritis can come from injury and aging as well as specific problems with the soft tissues around the joints. Other causes of arthritis are uncommon diseases like rheumatoid arthritis, psoriatic arthritis and lupus.
Diagnosis
Most patients suspect they have arthritis when their joints ache and are stiff in the morning. Frequently their stiffness improves with gentle motion but may come back after they sit still for some time ("gelling" phenomena). Pain often improves with light activity but ususally gets worse later in the day after harder activity, walking long distances or standing for a prolonged time. Over months or years the ability to bend or straighten the joint ("range of motion") may decrease. Joints may swell from fluid collecting in the joint or from the growth of bone spurs (osteophytes) as the cartilage wears away. Fingers and knees may become "knobby". Your doctor may want you to rate your pain on a scale of 1 - 10 and try to measure how much motion is left in the joint. The most important finding is a major decrease in the function of the joint.
A simple x-ray is the first diagnostic test to prove arthritis of most joints. X-rays can show the bone spurs and decreased space between the bones that can be found with severe endstage arthritis. Lab studies are rarely needed to diagnose the most common types of arthritis, but blood tests are helpful in diagnosing inflammatory arthritis such as rheumatoid arthritis, lupus or ankylosing spondylitis. A MRI (magnetic resonance imaging) study is the best diagnostic test for viewing the soft tissue of bones and joints. However, it is an expensive test that is useful only if x-rays don't make the diagnosis.
Treatment
Experts in arthritis concede that although there is no known cure for arthritis, we can help manage the symptoms. Many alternative medical treatments claim to "cure" arthritis. With the large population of people with arthritis to sell to, it is a good market for both ethical and unethical businesses. Drug companies have strict FDA regulations that require extensive testing for both safety and efficacy of new medicines.Unfortunately, FDA standards for vitamins, nutraceuticals and alternative supplements apply only after the product has reached the market. The rules say that supplements should be safe and does not require any proof of efficacy. Research on alternative prodeucts shows that there is a great variation in the amount of active substance in different brands of supplements and even different bottles of the same brand.This may be a good reason to avoid them.
The treatment of arthritis begins with exercise to keep the joint moving and to maintain the strength of the muscles around the joints. Gentle range of motion stretching exercises and low load, low impact resistance exercises provides pain relief in almost all studies. Exercise will increase endurance and strength, can increase function, may help with weight loss efforts and decrease the risks of fractures by stregthening bones and decreasing fall risks. Experts in arthritis recommend continuous motion exercise begininning with 15- 30 minutes each day. Fitness walking, low tension stationary biking, low angle treadmill walking and water aerobics are tolerated well by most patients.
Patients are often interested in medications to help manage the pain from arthritis.Acetaminophen (Tylenol) is a pain medicine that is a first choice drug for arthritis because it is available without a prescription and is safe when used at recommended doses. Overdosing can cause liver toxicity and failure. Anti-inflammatory medicines such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) are also available over the counter (OTC) without a prescription and help many patients with arthritis. Doctors can write prescriptions for higher doses of anti-infammatory drugs which are more effective but also carry higher risks of side affects. The most common side affects of these medicines include increases in blood pressure, stomach upset and ulcers, and kidney damage. Newer more expensive medicines (celecoxib "Celebrex") have been developed that may decrease the stomach side affect but still carry risks to kidneys and blood pressure.Oral narcotic medicines are used by some doctors for pain relief but they are associated with many side affects and can frequently cause problems with long term use.
Salves, creams and ligaments are sometimes used for arthritis symptoms. Mentholated rubs (Bengay, Icy Hot) are made from a cream of an aspirin-like drug and menthol.Capsaicin cream is made from the chemical used in pepper spray. Both help some patients with pain but may cause stinging or burning of the eyes or other sensitive areas. Prescription creams with anti-inflammatory drugs are becoming more popular but have most of the same side affects of the oral versions.
When exercise and the usual drugs don't adequately relieve pain, patients are often willing to try more invasive means to help. Cortisone injections have been used for over fifty years and can be a safe and effective way to temporarily reduce pain for most people. Newer injections made with hyaluronic acid are commonly used to decrease the inflammation and pain for knee joints. These shots are sometimes callled "chicken shots" because hyalurionic acid is a protein found both in rooster combs and in normal joints.
Finally, if x-rays show endstage arthritis and other treatments fail to control symptoms, surgery for arthritis may be necessary. A small percentage of patients do have complications from surgery including scarring, pain, bleeding, infection, stiffness and the usual risk of anesthesia. The most common surgery for arthritis is joint replacement (total joint arthroplasty). Orthopedic surgeons are specialists in the management of arthritis and have developed replacements of hips, knees, ankles, shoulders, elbows, wrists and fingers. The procedure involves cutting out the destroyed cartilage and bone, then replacing it with metal or plastic parts. Hips and knees are some the most commonly replaced joint and over 90% of the patients who get them get rid of 90% or more of their arthritis pain and are able to maintain their range of motion and function for 10 to 20 years or more.
Treatment for your arthritis depends on the cause of your arthritis, your age, the severity of your syptoms and your willingness to accept the risks of the treatment. Avoiding high demand activities, weight loss, gentle exercises, canes or walkers, pills, injections and various surgical procedures can all be effective treatments.
Arthritis Camp
This informative camp is held the first Thursday of every month from 5:00 p.m. – 7:00 p.m. at our Northwest Austin office. If you are scheduled for a hip or knee replacement or have arthritis and want to know more about your treatment options please come and join us for a FREE informative evening. Refreshments will be served! Please RSVP TODAY by calling (512) 439-1100 or emailing us.
Click on the links below to find out more about arthritis and treatment options.
Arthritis of the Foot and Ankle
Arthritis of the Hand
Arthritis of the Knee
Arthritis of the Shoulder
Arthritis of the Thumb
Arthritis of the Wrist
Inflammatory Arthritis of the Hip
Osteoarthritis
Osteoarthritis of the Elbow
Rheumatoid Arthritis of the Foot and Ankle
Glucosamine and Chondroitin Sulfate
Glucosamine and Chondroitin Sulfate Clinical Trials
Viscosupplementation Treatment for Arthritis
What are NSAIDS
Total Joint Replacement
