At some point, nearly everyone suffers from arthritis–whether it’s  a little stiffness that makes it awkward to get up from the couch or extreme pain when moving a skillet on the stove.

While arthritis can occur at any age, the incidence of osteoarthritis, the most common kind, increases dramatically with age, affecting about 90 percent of persons age 80 and over.

There are many reasons for joint and muscle stiffness, of course, but even when it’s a sign of early arthritis there’s no reason to panic. One study of 63 patients diagnosed with mild to moderate osteoarthritis of the hands or knees in the late 1970s found very little progression of the disease over an 11-year period.

Whatever the cause of stiffness or pain around the joints, it’s important not to use it as an excuse to curl up on the couch, which will quickly lead to weight gain, weakening of muscles and further deterioration of cartilage and soft tissue.

Osteoarthritis is known as “wear and tear” arthritis, but it’s also more prevalent among persons who are sedentary and overweight. There’s no evidence that normal–or even high–levels of exercise pose a danger to healthy joints.

Persons who have suffered traumatic injury to a joint–such as a ligament tear in the knee–may develop arthritis earlier and with greater severity. And some athletes may have an increased risk because of repetitive motions or  high-impact activities. Even so, studies have shown that the right kind of exercise–carried out to minimize repetition and impact–can actually ease pain in arthritis patients and slow progression of the disease.

An important component of exercise for persons with arthritis is strength training. With stronger muscles to absorb the shock, normal activities and aerobic exercises such as walking can be carried out with less pain and discomfort.

A Tufts study, published in the Journal of Rheumatology, found that subjects performing simple strength training exercises reached a level of daily functioning they hadn’t experienced in years. The exercises included leg lifts with ankle weights and modified squats (repeatedly bending into a chair from a standing position and then back up).

Range of motion, or stretching, exercises can also be helpful in maintaining joint and muscle flexibility. For an arthritis patient, of course, all exercise activities should be discussed with the medical team and, in some cases,  monitored.

In the early stages, mild or occasional joint pain can be managed with over-the-counter medications. Aspirin, ibuprofen and other nonsteroidal antiinflammatory drugs (NSAIDs) are ideal for reducing inflammation as well as pain. When taken in large quantities over a period of time, however, they can lead to unwanted gastrointestinal bleeding as well as the risk of kidney problems. Acetaminophen (Tylenol) has traditionally been preferred, even though it has no antiinflammatory action, because it doesn’t carry as much risk of unwanted bleeding.

With early detection and diagnosis, doctors can prescribe newer arthritis medications which may be more effective in relieving symptoms with fewer side effects.       Although there’s no cure for arthritis, the pain and stiffness can be managed. In addition to medication, treatment may include:

·        Weight control. In one study, overweight women who lost an average of 11 pounds, cut by half the progress of their arthritis symptoms.

·        Joint protection through the use of splints, braces or taping.

·        Relaxation training. Constant pain can lead to feelings of stress, frustration, helplessness and exhaustion. Relief can come from progressive muscle relaxation, meditation, biofeedback, visualization, deep breathing or hypnosis. Massage can also relax muscles, improve circulation and improve a patient’s sense of well being.

·        Ice and heat therapy.

·        Assistive devices such as padded grips, extended handles and pickup devices.

·        A positive attitude. Studies have shown that individuals who take an active part in their treatment and maintain a positive attitude actually experience less pain and disability.

There’s no reason to let arthritis put your life in limbo. With knowledge about the disease and a positive attitude, symptoms can be successfully managed.

REFERENCES:

“Arthritis: New Treatments and Daily Decisions Are Keys to an Active Lifestyle,” Mayo Clinic Health Letter, Medical Essay, February, 1999.

“Arthritis 101: The Class That Relieves Pain,” Johns Hopkins Medical Letter, February, 1999.

“CDC: One in Three Adults Has Arthritis,” Medical Letter on the CDC & FDA, December 8, 2003.

G.C. Davis, M.L. Hiemenz and T.L. White, “Barriers To Managing Chronic Pain of Older Adults with Arthritis,” Orthopaedic Nursing, March-April, 2003.

“Exercise for Arthritis, Yes, But Which Kind?” Tufts University Health & Nutrition Letter, August, 2003.

“A Guide To Managing Rheumatoid Arthritis,” The Journal of Musculoskeletal Medicine, June, 2003.

“Guidelines Provide Recommendations for Managing Arthritis Pain,” Geriatrics, June, 2002.

“New Clinical Guideline for Managing Arthritis Pain: First Evidence-Based, Multidisciplinary Approach,” the Journal of Musculoskeletal Medicine, September, 2002.

Alice Park, “What You Can Do: You Don’t Have To Suffer. There Are Many Ways To Find Relief,” Time, December 9, 2002.

“Trained GPs Can Spot Signs of Early Arthritis,” GP, June 23, 2003.

Nancy Walsh, “Lower Arthritis Risk with Higher Fruit, Vegetable, and Vitamin C Intake: first Prospective Study,” Family Practice News, May 15, 2003.

Two Major Types

Under the category arthritis, there are more than 100 joint and soft tissue disorders. The two most common types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, which accounts for roughly half of all arthritis cases, usually begins after age 40 and becomes increasingly prevalent with advancing age. Often known as “wear and tear” arthritis, osteoarthritis involves the wearing away or deterioration of cartilage, the tough, slippery material that caps bones and keeps them from rubbing against each other in joints. Although it can occur, many years later, as a result of a traumatic injury to a joint, it is most common among persons who are sedentary and overweight. Scientists believe it can be attributed primarily to an imbalance of enzymes that allows cartilage to break down faster than it is replaced.

Rheumatoid arthritis, which affects about two percent of American adults, typically occurs between ages 20 and 40 and tends to affect women more than men. It is an autoimmune disorder in which the immune system mistakenly attacks the synovial membrane that protects and lubricates joints, causing them to become inflamed, swollen and painful. Eventually, the inflammation can cause extensive damage or destroy the joint. Unlike osteoarthritis, rheumatoid arthritis typically affects corresponding joints on both sides of the body. The most common sites are the wrists, knuckles and small joints of the feet.

[SOURCE: “Arthritis: New Treatments and Daily Decisions Are Keys to an Active Lifestyle,” Mayo Clinic Health Letter Medical Essay, February, 1999; The Johns Hopkins White Papers, Arthritis]

New Doubts for Old Drug

For pain relief, osteoarthritis patients have traditionally been advised to choose acetaminophen (Tylenol) over aspirin or nonsteroidal antiinflammatory drugs (NSAIDS). Although it lacks the antiinflammatory action of NSAIDs, acetaminophen is considered equally effective for relief of symptoms and less likely than NSAIDs to cause unwanted gastrointestinal bleeding.

Recent studies call into question both assumptions. A study published in Archives of Internal Medicine found that acetaminophen was no more effective than placebo and less effective than the NSAID diclofenac (Cataflam, Voltaren) in relieving knee pain and stiffness. Other studies have found that at doses of 2,000 milligrams or more a day, acetaminophen can also pose a risk of gastrointestinal problems.

[SOURCE: “Knee Arthritis: Flawed Therapies,” The Johns Hopkins Medical Letter, August, 2003]

Pumping away Pain

A Tufts University study of 24 osteoarthritis patients found that subjects doing strength training exercises had a 43 percent reduction of pain and a 44 percent improvement in 17 physical aspects of daily life–from shopping to putting on socks and shoes. The exercises included leg lifts with light weights and modified squats (getting in and out of a chair).

[SOURCE: “Exercise for Arthritis, Yes, But Which Kind?” Tufts University Health & Nutrition Letter, August, 2003]

Fruit Fends Off Arthritis

An ongoing population based study in Europe (the EPIC study) revealed that persons with the highest consumption of fruits and vegetables had a reduced risk of developing arthritis. Fruit consumption was associated with a 1.5 times reduction of risk, greater than that for vegetables. The strongest protective effect was seen with foods high in vitamin C.

[SOURCE: Nancy Walsh, “Lower Arthritis Risk with Higher Fruit, Vegetable, and Vitamin C Intake: First Prospective Study,” Family Practice news, May 15, 2003]

Keep Joints Moving

Once considered off limits for persons with arthritis, exercise is now known to be one of the most effective arthritis treatments as well as a way of preventing or delaying the onset of severe joint symptoms. The American College of Rheumatology recommends at least 30 minutes a day of moderate aerobic activities such as walking or swimming. Surveys indicate that only about 30 percent of patients get this level of physical activity, however.

[SOURCE: “Twenty Exercises for Arthritis Management Launched National To Get Americans with Arthritis Moving to Help Manage Arthritis Pain,” PR Newswire, January 16, 2003]

Guidelines for Exercise

·        Talk with your doctor or other health care professional about any exercise program you start.

·        Don’t forget to warm up, cool down and stretch before and after a workout.

·        Start at a moderate to light level and work up gradually–especially if you’ve previously been sedentary.

·        Choose activities that are low in impact and without repetitive movements, quick starts and stops and changes of direction that might stress joints. Avoid jerking or bouncing movements.

·        Stop if you feel any new joint pain.

·        If you have swelling or pain after exercise, you may be doing too much.