By Kara Thom
After reading a list of risk factors for osteoarthritis (OA), the noninflammatory form of arthritis that results from wear and tear, I began to wonder what my future held. The risk factors included:
Getting older. Check.
Being female. Check.
Joint injury or overuse. Check.
Was I supposed to just wait for the diagnosis?
The answer from rheumatologist Elaine Husni, MD, MPh, from the Orthopedic and Rheumatologic Institute of the Cleveland Clinic, was a resounding no. But for all of us active and getting-older females who like to play hard, that no is qualified. “If you have modifiable risk factors, decrease them,” says Dr. Husni.
I can’t change being female or stop myself from getting older, and I don’t have any other risk factors for OA (see sidebar). That leaves me with joint injury and overuse. Now I was ready for the doctor to tell me I was doomed.
Osteoarthritis Risk Factors
AGE: With each passing year, your cartilage – the rubbery substance that lubricates the ends of bones – starts wearing down, and the body’s repair process can’t keep up with the deterioration.
FEMALE: It’s an issue of alignment; the female pelvis is usually wider, so the line from hips to knees is at an angle, putting more pressure on those joints. Researchers are also looking into whether menopause has an impact on OA.
WEIGHT: More weight puts more stress on joints. The knees are particularly susceptible.
PREVIOUS INJURY: Once a joint has been injured, its integrity is compromised and it becomes more susceptible to OA.
MISALIGNED JOINTS: Having joints that don’t quite match up like the puzzle pieces they should be – say, from dislocation or double-jointedness – can cause them to rub the wrong way and contribute to OA.
HEREDITY: Certain gene defects affect collagen and the speed of deterioration.
DISEASE: A few rare metabolic diseases are associated with OA.
But crossing the overuse line for any particular person is impossible to determine, Dr. Husni says. “In general, physicians do not have a cutoff in terms of number of days per week or number of hours per day that will put you at higher risk. Some OA studies demonstrate that those who train competitively for most of their lives (i.e., Olympic-level or lifetime marathoners) are at a higher risk of OA as opposed to those who exercise for fitness or pleasure.” She cautions, however, that these studies are small and limited to certain sports, which make it impossible to generalize for all people.
Dr. Husni encourages those of you who do train at a high intensity to take measures to prevent injuries, which can compromise surrounding joints by damaging the soft tissue that acts as shock absorbers, putting you at risk for OA no matter how much you train. Also, make strength training a priority in your fitness routine. “Weak muscles allow joints to move more than they should and accelerates the wear-and-tear process,” she says.
When Squeaky Joints Start to Scream
Osteoarthritis has many calling cards, most notably joint pain. Another common symptom is something called gelling – when you experience short-term stiffness in a joint after periods of immobility. And that crunching sound you hear in your knee, shoulder, or elbow? That’s a symptom called crepitus that occurs when cartilage wears away and the joints rub against each other.
If you feel you have these symptoms on most days during a month (especially if you are, ahem, in middle age), it’s time to see your physician. The only way to tell if osteoarthritis has invaded your joints is through an X-ray. A look at your bones can pinpoint cartilage loss (which can lead to the bones of the joint rubbing against each other) and detect any bony overgrowth, called osteocytes, which can also irritate the surrounding bones.
“If you’re worried about pain and it’s chronic, it’s important to get diagnosed,” says Dr. Husni, especially if it’s keeping you from daily activities. “The condition is progressive and can get worse without treatment.”
Juicing Your Joints
There isn’t a cure for OA, nor is there a way to reverse the progression. But you can slow it down with a continuum of treatment options.
Early-stage treatment usually starts with nonsteroidal anti-inflammatory medications, such as aspirin, ibuprofen, or naproxen (all available over the counter). If these aren’t well tolerated or the pain is too severe, the next course of action is a corticosteroid injection directly into the joint. Physical therapy enters the picture to help patients beef up opposing muscles surrounding a joint. If osteoarthritis is advanced and pain is debilitating, the last resort is surgery, either arthroscopic or joint replacement.
A small 1999 study published in the Annals of Internal Medicine showed that 63 percent of people who visited a rheumatologist for osteoarthritis, rheumatoid arthritis, or fibromyalgia also used some form of complementary medicine.
Chiropractic was among the most sought-after form of complementary treatment. Seventy-three percent of patients in the study who tried chiropractic care found it to be helpful. Another popular treatment was acupuncture, which is available to patients as an adjunctive therapy at the Cleveland Clinic’s Orthopedic and Rheumatologic Institute. Scientific studies suggest that acupuncture is effective for pain relief, although how it works remains a mystery. Still, Dr. Husni sees acupuncture making a difference in her practice. “Patients tend to take less medications, and it’s very low risk.”
Supplementation is another option. Perhaps the best-known supplement for joint health is glucosamine. Osteoarthritis patient Mimi Englander, 47, from Littleton, Massachusetts, started taking glucosamine two years ago because, she says, it seemed to work for her dog. “Since going on the glucosamine, I have only a vague recollection of how the pain in my knee used to be a factor in getting out of bed every day.”
Dr. Husni cautions that it may not work that well for everyone. In fact, a National Institutes of Health study found little benefit with glucosamine compared with a placebo, but the anecdotal evidence is strong. Dr. Husni recommends that patients try it for three months; if they feel a benefit, it’s worth the money.
Another supplement she encourages patients to try is fish oil, especially if they have difficulty tolerating nonsteroidal anti-inflammatory drugs. “It has anti- inflammatory properties, and there’s no harm in a three-month trial.”
For those just feeling the crepitus creeping up, new treatments are being studied, among them cartilage regeneration and cartilage grafts. “There aren’t a lot of OA therapies this minute, but a lot of funding is going into osteoarthritis and it’s an exciting time,” says Dr. Husni.
Rheumatoid Arthritis
Arthritis isn’t one disease but an umbrella term for many. The most common types are osteoarthritis, which is a degenerative disease caused by too much stress on the joints, and rheumatoid arthritis (RA), an autoimmune disease. RA affects the lining of the joints, or synovium, and because it’s a systemic disease, sometimes other areas of the body too, such as the tear glands, salivary glands, heart, and lungs. RA is considered an inflammatory form of arthritis and has a symmetrical distribution, meaning joints on both sides of the body are affected. OA can strike a joint on just one side and is considered noninflammatory. Like OA, RA is also more common in women, but it typically strikes earlier, when a woman is between 20 and 50 years old. Juvenile arthritis conditions affect approximately 1 in 250 U.S. children under 18.
