May is National Arthritis Awareness Month and osteoarthritis is the most prevalent of all forms. Dr. Raj Sinha discusses causes, treatments and options for patients living with osteoarthritis.
About 50 million Americans are afflicted with osteoarthritis at any given time, but the condition gets short shrift when being considered among today's "sexy" diseases. As an orthopaedic surgeon specializing in hip and replacement, I frequently hear the comment "My doctor told me it's just arthritis." Just arthritis? I wouldn't say that about a disease process that ravages some body parts so badly that we have to replace them with metal and plastic in nearly a million people a year in this country.
We generally think of arthritis as something that afflicts the elderly, but in fact, most people begin to see wear and tear of their joints in early adulthood. Although there are over 100 forms of arthritis, including some that affect children, the most common form is osteoarthritis (OA). It affects women 2 to 1. There is a genetic component, though poorly understood, as well as environmental and injury factors, that leads to the erosion and breakdown of the cartilage in our joints. It manifests initially as stiffness, and then progresses from there to pain, loss of flexibility, deformity and decreasing ability to remain active.
Although there is no cure, there are many things we can do to slow the progression. First, get off the couch! Obesity has been linked to OA through mechanical factors, i.e. too much force on the joint. However, recent research suggests that obese patients secrete a hormone that accelerates the breakdown of cartilage. Every 10 pounds lost translates into up to 70 pounds less force on the hips and knees -- that's per joint and per step.
A second treatment option is to maintain strength and flexibility. The stronger our muscles are, the less pressure on the cartilage. The more flexible our joints are, the better the cartilage nutrition. Activities like yoga and pilates encourage flexibility, and in turn strength through increasing the length of the muscles (weight lifting builds strength by increasing the bulk of the muscles). There is truth to the phrase lean and mean.
Thirdly, since pain is a significant part of the disease, we frequently need something for pain control. Medications such as Tylenol, nonsteroidal anti-inflammatories (NSAIDS, e.g. naproxen, ibuprofen, aspirin, and many others, both over-the counter and by prescription) play an important role in allowing you to be active. Injections of cortisone of lubricants (e.g. hyaluronic acid) are also helpful when pain medications are insufficient. Nutraceutical medications such as glucosamine and chondroitin may have a role in pain relief. However, no peer-reviewed scientific study has demonstrated that they rebuild cartilage. Similarly, stem cell injections and prolotherapy (injections of sugar and vitamins) have not been proven to be any more beneficial than cortisone injections, according to my colleagues, though they can cost tens of thousand of dollars.
Lastly, at the end stage, when the pain is severe and intolerable, and all of the above treatments have failed, joint replacement may be needed. We have been performing joint replacements since the mid 1960s and our understanding and technology have greatly improved. Every knee is distinct in both its size and shape, but traditionally implants were not designed to match individual anatomy; there were only standard sizes. Now, just as there are drugs that are genetics-specific, we have knee implant options that are designed and made to match each patient individually. From a biomechanical standpoint, such customization promises to normalize the feel of the knee, decrease the stiffness, increase patient satisfaction, and allow increased activity levels. In my opinion, this has been the single most significant advance in knee replacement technology in the last three decades. Today's joint replacement patients are encouraged to remain active and play sports. In my community, there is a "Bionic" softball team and a "Bionic" golf tournament, in which all of the participants have had at least one joint replaced. There has even been one foursome with 16 replaced joints between them!"
As surgeons, we understand that nobody wants surgery. That's why weight loss and exercise are critical to slow disease progression. However, it's reassuring to know that patients can lead an active and pain free life with modern joint replacements.