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May 5, 2011 – Vol. 5 • No. 7

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Arthritis:
Exercise key to slowing common painful condition

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.

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.

Comments on Be Healthy? Contact Karen Miller at kmiller@bannerpub.com