In last week’s blog post we used a car tire analogy to help explain arthritis. This post focuses on the basics of diagnosis and treatment alternatives available for people who suffer from the pain, stiffness and loss of function that goes along with arthritis.
Diagnosis: Do I have it?
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 is usually 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”. 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 end stage 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 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: What do I do about it?
Experts in arthritis concede that although there is no known cure for arthritis, we can help manage the symptoms. The treatment of arthritis begins with exercise to keep the joint moving and to maintain the strength of the muscles around the joints. Experts in arthritis recommend continuous motion exercise beginning 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. Anti-inflammatory medicines such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) help many patients with arthritis.
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 called “chicken shots” because hyaluronic acid is a protein found both in rooster combs and in normal joints.
Finally, if x-rays show end stage arthritis and other treatments fail to control symptoms, surgery for arthritis may be necessary. The most common surgery for arthritis is joint replacement (total joint arthroplasty). The procedure involves cutting out the destroyed cartilage and bone then replacing it with metal and plastic parts. Hips and knees are some of the most commonly replaced joints 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 symptoms and your willingness to accept the risks of the treatment. When picking a course of travel on new highways, having a good map helps guide your path. The best resources are your family doctor, rheumatologist or orthopedic surgeon. Schedule a visit so they can help get you back on the road!