Americans are wearing out their joints. Knee replacement
is now among the most common major surgeries, up 162 percent in the last
two decades, according to an analysis of Medicare data published in
September 2012 in the Journal of the American Medical Association. The
increase is partly due to the population growth of aging baby boomers.
It also reflects rising rates of obesity and the fact that a more active
group of people is unwilling to live with the pain and disability of osteoarthritis. Surgery to replace joints is a good option if your condition has become
disabling and new tools make it easier. But
it's possible to delay or prevent the need for surgery, even if you
already have symptoms. Following is a roundup of evidence-based approaches that can help
protect your joints and minimize the painful symptoms of arthritis.
Achieve a healthy weight
Achieve a healthy weight
"Obesity is one of the most important modifiable factors
contributing to the need for joint replacements," says Joseph D.
Zuckerman, M.D., chairman of the department of orthopaedic surgery at
the NYU Langone Medical Center in New York City. Being overweight
increases the stress on your joints and might even hasten the breakdown
of cartilage. Obesity can also have systemic effects that are not well
understood. Research suggests that it even increases the risk of
developing arthritis in joints that don’t bear weight, such as those in
the hand. Excess weight makes it more likely that mild osteoarthritis will
eventually become severe. For example, among people ages 60 to 64 with
early osteoarthritis, 63 percent of those who are obese will develop
debilitating disease within 10 years, compared with 37 percent of those
who aren’t obese, according to estimates based on the 2008 U.S. Census
and other government data. Fortunately, even modest weight loss—as little as 5 percent of your body
weight—has been shown to reduce the risk of arthritis later. Research
suggests that losing weight reduces pain in people who already have the
disease.
Stay active
Stay active
Because osteoarthritis can arise from the overuse of
joints or from sports injuries, some people who have the condition worry
that exercise will make it worse. In fact, the opposite may be true.
Limited evidence suggests that routine physical activity is linked to
healthier cartilage in the knees, according to a 2011 review of 28
studies. "Even if you already have evidence of arthritis, regular
moderate activity is important to alleviate symptoms and slow the
progression of the disease," says Lynn Millar, Ph.D., P.T., a professor
of physical therapy at Winston-Salem State University in North
Carolina. People have a higher likelihood of ending up disabled from
arthritis if they're sedentary. Along with regular aerobic exercise, aim for two to three sessions a
week of strengthening activities using weights, resistance bands, or
your body weight (such as push-ups and squats). The exercises are
important to build the muscles that support the knees and other joints.
And incorporate stretching or other flexibility training into your daily
activities. Take breaks while working at your desk to extend your legs,
stretch your hands, and roll your shoulders.
Treat injuries promptly
Left untreated, injuries such as a small tear in the knee
cartilage or a shoulder tendon can set in motion a wear-and-tear
process that leads to joint deterioration. See a doctor for any injury
that causes severe pain or swelling, or minor pain that doesn’t resolve
after a week or so. Perhaps more important, take steps to minimize the risk of injury in the
first place. Choose the proper equipment for your activity. For
example, don't wear running shoes, which are designed to keep your
weight from shifting sideways, to play tennis. Strive for a balance in
your choice of activities and in how often you do them; it’s better to
do shorter sessions throughout the week than try to catch up with a
marathon session on the weekend. And listen to your body. "No pain, no
gain does not apply to arthritis patients," says Zuckerman.
Consider nondrug steps
Consider nondrug steps
Finding effective ways to alleviate pain, swelling, and
stiffness is critical to staying active. Many people find that one or
more of these nondrug measures can reduce the need for pain medication:
~ Acupuncture.
~ Heat and cold. Moist heating pads, a warm, damp towel, or a warm bath or shower can help relax and soothe stiff joints. Ice packs can help with acute pain and swelling.
~ Massage.
~ Mechanical aids such as a cane, crutch, or walker can take a load off painful hips and knees. Over-the-counter knee braces that slip on or fasten with Velcro may also decrease symptoms, and they're often a better option than custom leg braces, which can be bulky and expensive, Zuckerman says.
Simplify drug treatment
~ Acupuncture.
~ Heat and cold. Moist heating pads, a warm, damp towel, or a warm bath or shower can help relax and soothe stiff joints. Ice packs can help with acute pain and swelling.
~ Massage.
~ Mechanical aids such as a cane, crutch, or walker can take a load off painful hips and knees. Over-the-counter knee braces that slip on or fasten with Velcro may also decrease symptoms, and they're often a better option than custom leg braces, which can be bulky and expensive, Zuckerman says.
Simplify drug treatment
Newer, heavily advertised name-brand drugs such as duloxetine (Cymbalta)—which
is usually used to treat depression, but is also approved for treating
chronic musculoskeletal osteoarthritis pain—often doesn't work any better than
basic pain relievers, as well, they cost more and can carry a greater risk
of side effects. Zuckerman advises patients to instead start with a
tried-and-true pain reliever, such as over-the-counter acetaminophen (Tylenol
and generic). It's inexpensive and generally considered safe as long as
you don't exceed the maximum dosage of 3,000 milligrams a day. For
inflammation, try an over-the-counter nonsteroidal anti-inflammatory
drug (NSAID), such as ibuprofen (Advil and generic) or naproxen (Aleve and generic). You can also talk with your doctor about topical versions of the NSAID. Prescription gel can be particularly effective for pain in smaller
joints, such as ankles, elbows, fingers, and toes. And you'll avoid the
risks associated with prescription oral pain drugs. Finally, shots of anti-inflammatory steroids are an effective short-term
remedy for moderate to severe pain and swelling in the knees and hips,
especially during flare-ups. But you shouldn't get more than three or
four shots a year, since more frequent injections might cause further
joint damage.
Use supplements wisely
Use supplements wisely
Despite mixed evidence and a lack of support from major
health groups about the role of the supplements glucosamine and
chondroitin in treating osteoarthritis, some people think they help.
It's reasonable to try them if you want, Zuckerman says, but if you
don't experience relief within three months there's no point in
continuing to take them. Don’t use these supplements if you take the
blood thinner warfarin (Coumadin and generic) because they may intensify the effect of the drug. To avoid potential interactions, keep your doctor and pharmacist
up-to-date on any supplements as well as over-the-counter medication you
use. And keep in mind that supplements and other "natural" remedies can
still cause drug-like side effects. In a recent study of 877 people who
had suffered liver damage after taking drugs or supplements,
researchers concluded that four cases were "highly likely" or "possibly"
due to flavocoxid (Limbrel), a prescription plant derivative
marketed as a "medical food" for managing osteoarthritis. Our
consultants advise against using it.
Skip unproven treatments
Skip unproven treatments
In particular, the most recent data suggest that injections of hyaluronic acid (Synvisc)
directly into a joint, known as viscosupplementation, isn't worth the
risk. In a review of 89 clinical trials involving over 12,000 patients,
published in August 2012, the authors concluded that
viscosupplementation did little or nothing overall to relieve pain or
increase function in people with knee osteoarthritis. But it did
significantly increase the risk of serious side effects.
~ Consumer Reports
~ Consumer Reports