This Issue

Exercise key
to slowing common painful condition

With more options today, surgery not the only recourse

Best remedy for osteoarthritis? Get up and go

Q & A

A closer look

Signs and Symptoms

• Pain during or after joint movement

• Limited range of motion or flexibility

• Cracking noise during joint movement

• Stiffness, especially after long periods of inactivity
• Swelling or tenderness in afflicted joints

• Bone spurs — extra pieces of bone that form around affected joint

• Muscle weakness

• Joint deformity

Signs and Symptoms

Risk Factors

A lifeline

The umbilical cord is the baby’s lifeline, but once clamped and cut after the baby is born, it can be the lifeline for someone else. Cord blood — once considered medical waste — is rich in stem cells, which can be used in transplants. But time is limited. You have to complete enrollment to donate cord blood by the end of the 32nd or 34th week of pregnancy depending on the blood bank used.

• Call the Be The Match Registry at 800-507-5427 to find out which hospitals in your state participate.

In Massachusetts, Brigham and Women’s Hospital and University of Massachusetts Memorial Medical Center take part.

• If your hospital is not listed you can still donate. Contact the Carolinas Cord Blood Bank at 919-668-2071 or Lifeforce Cryobanks at 800-869-8608

There is no cost to you and no harm to you or the baby.
If you don’t donate, the blood is thrown away.
A closer look

KNEES are commonly afflicted by osteoarthritis causing pain, stiffness and difficulty in walking and performing normal day-to-day activities. The cartilage, a smooth tissue covering the surface of joints, begins to wear away, which can lead to bone rubbing against bone, muscle weakness and malalignment of the knee.

Copyright 2011 American College of Rheumatology

THE HAND is another common site of osteoarthritis. Bony prominences called Heberden’s nodes may develop near the joint closest to the nail, while Bouchard’s nodes are bony enlargements of the middle joints. Heberden’s nodes are more common in women and may have a genetic link.

A weighty situation

Relief from pain

Initiative to Eliminate Cancer Disparities
2011 National Minority Cancer Awareness

April 17 - April 23

Boston Public Library Cancer
Awareness Display

• Codman Square Branch Library
690 Washington Street

• Mattapan Branch Library
1350 Blue Hill Avenue

• Brighton Branch Library
40 Academy Hill Road

April 28: 12 - 1 p.m.

Secondhand Smoke Exposure
Harvard Street Neighborhood
Health Center
632 Blue Hill Avenue

May 16: 11 a.m. - 1 p.m.
Skin Cancer Prevention
Roxbury YMCA
285 Martin Luther King Boulevard

April 21:
9 a.m. – 4 p.m.

Reducing Cancer Disparities & Promoting Health Equity Among Socioeconomically Disadvantaged Populations
Beth Israel Deaconess Medical Center
Riesman Lecture Hall, 330 Brookline Avenue

Registration is required:

All events are open to the public
For any additional information contact
Athene Wilson Glover at 617-632-4860

Another good reason to visit the dentist

“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance

The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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Risk Factors

• Age — the incidence increases with age

• Gender — women are afflicted more than men after age 45

• Continued overuse of or trauma to joints

• Overweight and obesity

• Fractures and other joint injuries or infections

• Congenital defect or weakness in a joint

• Occupations that include tasks that place repetitive stress on a particular joint

• Other types of arthritis, such as gout and rheumatoid arthritis

• A genetic defect in joint cartilage

Exercise key to slowing common painful condition

Valerie Bertrand knows that exercise is the best remedy for osteoarthritis that afflicts both knees. Here she walks along a trail in Franklin Park. (Ernesto Arroyo photo)
Say this about Valerie Bertrand — she is determined to get in shape and lose weight. She can be found five days a week working out at Body By Brandy Fitness Studio.

Her goals are clear and her reasons are even clearer. If she doesn’t, she knows the pain in her knees will only get worse. And that is something she is trying to prevent.

Seven years ago, Bertrand, now 54, was diagnosed with osteoarthritis (OA), one of the leading causes of disability in America. Afflicting an estimated 27 million in the United States alone, OA is the most common form of more than 100 different types of arthritis. Others include gout, lupus, fibromyalgia and rheumatoid arthritis.

OA is often called degenerative arthritis because the joint literally deteriorates. Cartilage — a hard but slippery tissue that covers the ends of bones — begins to wear away and eventually bone rubs against bone causing not only a grating sound but pain, swelling and loss of motion of the joint.

About 25 percent of people with knee OA have pain when walking and are limited in normal activities of daily living, such as climbing stairs or kneeling and stooping. Many can walk only with the assistance of a crutch or cane.

Dr. Elinor A. Mody, director of the Women’s Orthopedic and Joint Disease Program at Brigham and Women’s Hospital, is a rheumatologist, a doctor that specializes in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. She readily admits that though the cause of OA remains a mystery, one thing is clear — OA is extremely prevalent. “I could take X-rays of most people over the age of 40 and find some level of osteoarthritis of the spine,” said Mody.

As it is now, the economic impact of OA is staggering. The disease results in 662,000 hospitalizations, 11 million doctor visits and 632,000 total joint replacements each year. It costs the U.S. economy nearly $128 billion per year in medical care and indirect expenses, including lost wages and productivity.

The disease is on the rise — largely in part to increased longevity, the surge in baby boomers and ever burgeoning waistlines. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, a component of the National Institutes of Health, estimates that the prevalence of OA will increase to an estimated 67 million people by 2030.

Contrary to a widely held myth, OA is not necessarily a disease of the elderly. Actually, its incidence rises sharply around the age of 45, according to the Centers for Disease Control and Prevention (CDC), and largely affects the working population. It begins even earlier in people who have sustained a joint injury or were born with a congenital abnormality of the joint. A teen who injures his knee playing football in high school could suffer from OA before the age of 30.

For Bertrand, the worst times of day are mornings. “I feel like a baby taking its first steps,” she said. “Both knees ache.” It takes about 15 minutes for her to limber up and walk normally. The pain is not all surprising: OA runs in her family. “My mother and sister have had surgery on both knees,” she said.

Like countless others, Bertrand ignored the aches and pains in her knees for years. Eventually, she sought care from a specialist. He referred her to a surgeon who explained that “her knees were not good, but they weren’t crying for help,” she recalled.

The exact cause of OA is not known, but likely culprits are age, obesity, joint damage, inactivity and genetics. The Arthritis Foundation (AF) states that obesity alone increases the chance of developing OA by two thirds in a person’s lifetime. What is troubling, according to Mody, is that childhood obesity has been found to have a lasting effect and can result more commonly in OA of the hip in adulthood. Females are impacted more than men, and are more afflicted in the knees and ankles.

It is hard to predict the path of the disease. Its onset is gradual. Typically, the joints affected are the weight bearing joints — hips, knees and lower back — but the neck and hands are targets as well. Knobby protuberances on the sides of the joint closest to the nail — called Heberden’s nodes — are signs of OA in the hand.

But unlike rheumatoid arthritis, OA follows no set pattern. It can damage one hip and leave the other intact. Symptoms can be so mild that people are unaware of its existence, or severe enough to prevent normal activities.

In addition, the magnitude of pain does not always correlate to X-ray images. A severely deteriorated joint may be pain free, while another that shows little damage can result in pain and decreased function and stability.

OA is not reversible. Once joint damage occurs there is no turning back and there is no cure. But it may be possible to prevent or delay its incidence and reduce its impact once established. For instance, experts have found that for every one pound of weight loss, there is a four-pound reduction in the load exerted on each knee.

That’s the theme behind the action plan called a National Public Health Agenda for Osteoarthritis, a collaboration between the CDC and the AF. The overall goal is to prevent osteoarthritis and “dispel the myth that osteoarthritis is an inevitable part of aging.” The blueprint includes education, physical activity, injury prevention and weight control.

Elinor A. Mody, M.D.
Director, Women’s Orthopedic and
Joint Disease Program
Brigham and Women’s Hospital
The key is exercise. “Exercise and muscle strengthening take force off the joints,” Mody said. “Work on the core (trunk), quadriceps (muscles of the knee) and balance. This is particularly helpful for women.”

For the most part OA can be handled without surgery. Often the first line of attack is over-the-counter drugs, such as acetaminophen and NSAIDS, or non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen. More severe pain may require narcotics or injections of steroids into the joints.

Topical analgesic creams are helpful to some, while heat or cold can relieve others’ pain. A study conducted by the National Institutes of Health determined that the supplement glucosamine chondroitin sulfate did not improve joint structure or significantly reduce the pain of OA of the knees. The authors, however, were quick to point out that if patients report benefit, there is no reason to suggest they should be taken off of their supplements.

Another alternative form of medicine has shown measurable improvements in knee function and pain relief. A 2005 study published in the Annals of Internal Medicine was able to demonstrate that acupuncture — in conjunction with other therapies — was successful in improving knee function and relieving pain in people with OA of the knee.

Bertrand admits that her OA has made some activities harder to do. “I can’t drive for more than an hour,” she said. “My knees stiffen up and get painful.” Her car poses another problem. It takes her a while to get out. “You should see me,” she laughed. “Seventy-year-old people are passing me. I look elderly.”

She laments that she cannot clean her house as well as she used do. The bending and squatting are too hard on her knees. She says she can’t dance like she used to. “I like dancing, but I can’t do my James Brown moves anymore.”

In the interim, she uses acetaminophen and NSAIDS to ease the pain. She rarely requires cortisone injections. She is not sure if glucosamine is effective, but she takes it anyway. “Maybe it would be worse if I didn’t take it,” she reasons.

She sleeps with a heating pad. And she makes sure she takes a bath instead of showers at least three times a week. Not only does the warm water help, but she wants to maintain the ability to climb in and out of the tub.

In spite of everything she keeps moving. “I don’t want to be dependent on anyone,” she said.