Osteoarthritis

What is osteoarthritis?

Osteoarthritis, by far the most common form of arthritis among older people, is a condition brought on partly by aging and long-term wear-and-tear in the joints. After years of use, the cartilage that cushions the joints can break down until bone rubs against bone. Spurs often grow on the sides of the affected bones, which only adds to the pain.

Osteoarthritis is rarely crippling, but it can have a major impact on a person's life. Many people miss work days or skip favorite activities when the pain flares up. The condition is responsible for more than 27.5 million outpatient doctor visits per year, according to data from the Arthritis Foundation. It is also the number one reason for joint-replacement surgery.

For most people, it takes several decades to wear down enough cartilage to cause osteoarthritis. However, younger people can develop it as well - often as the result of an injury or joint malformation. Before age 45, osteoarthritis is more common in men, but after age 45 it is more common in women. Once women reach menopause, they are much more likely than men in the same age range to develop arthritis pain. Overweight people and those with a family history of arthritis are also especially vulnerable to the condition.

Osteoarthritis is a permanent condition that causes pain, but it generally responds well to medication, exercise, or both.

What are the symptoms of osteoarthritis?

The most obvious symptom of osteoarthritis is joint pain during or after use of the joint. In severe cases, the joints still ache while at rest or during the night. The joint may become swollen and stiff, limiting range of motion. Osteoarthritis most commonly affects finger joints, especially among women. The next most frequent sites of pain are the knee and hip. Less frequently, people can develop osteoarthritis in the shoulder, elbow, wrist, or back.

The condition doesn't always produce perceptible symptoms. In fact, many people with osteoarthritis of the fingers don't even know they have the condition, even when x-rays clearly show deteriorating cartilage in their joints. Osteoarthritis in the knees and hips, however, usually causes significant pain.

Women with osteoarthritis of the hands often develop bony lumps called Heberden's nodes at the last joints of their fingers. The lumps, seen less commonly in men, may be painful at first but are mainly just a cosmetic problem once the discomfort abates.

How is osteoarthritis treated?

When arthritis pain first strikes, the over-the-counter painkiller acetaminophen (the ingredient in Tylenol and similar generic products) is your best choice for relief. But be careful -- although it's perfectly safe for the average person at recommended doses, acetaminophen can cause liver damage at high doses. It's important never to take more than 4 grams -- or 4,000 milligrams -- of acetaminophen a day; and no more than 3,000 milligrams per day if you take it for prolonged periods (more than a couple of weeks). Because many products such as cold medicines include acetaminophen in their ingredients, it's not always easy to tell how much you're getting. In fact, more than 56,000 people accidentally overdose on acetaminophen on each year and wind up in the emergency room.

If you have underlying liver disease, check with your doctor to see what a safe dose for you would be or rely on another painkiller. You should avoid acetaminophen if you routinely have three or more alcoholic drinks a day, though one drink a day is thought to be safe.

Acetaminophen will probably do the job for a while, but many people with osteoarthritis eventually need stronger relief. In the past, that often meant switching to large doses of aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), effective but potentially dangerous remedies. (Again, avoid alcohol while you're taking these painkillers.)

NSAIDs can definitely ease the pain of osteoarthritis, but they also greatly increase the risks of bleeding ulcers, especially in people over 60. Over 100,000 people are hospitalized each year for serious stomach trouble caused by NSAIDs, and about 16,500 die.

The Food and Drug Administration requires that the active ingredients of these drugs are prominently displayed on the drug labels and that the labels warn of the risks of stomach bleeding for NSAIDs and severe liver damage for acetaminophen.

Powerful drugs such as Celebrex and other COX-2 inhibitors offered relief for arthritis sufferers until questions about their heart safety arose; Celebrex is now the only COX-2 inhibitor on the market. A 10-year study of more than 24,000 people with arthritis, published in the New England Journal of Medicine in 2016, found that Celebrex was no more dangerous for the patients than the ibuprofen and naproxen. In addition, it seemed to cause fewer kidney problems.

Arthritis doctors hailed the study, with some saying they would now favor Celebrex over other NSAIDS. However, the AHA recommends that Celebrex not be used in arthritis patients with heart disease, at least until doctors have prescribed other medications as well as exercise and weight loss.

What else can I do to relieve arthritis pain?

Whatever medication you take, it should be only one part of your fight against arthritis. Here are some other things you can do to relieve the pain and improve your mobility.

Exercise. Your joints may ache, but they aren't calling out for rest. A combination of moderate stretching, weight lifting, and aerobic exercises such as swimming and cycling can give you strength, flexibility, and some relief from pain. Your doctor can help you find an exercise program that gives you maximum benefits with little discomfort. There are even special stretching exercises for the fingers.

Maintain a healthy weight. If you're overweight, shedding a few pounds can help take strain off your joints and reduce pain.

Watch your posture. Good posture can help ease and prevent osteoarthritis pain in your back, hips, and knees.

Adapt your environment to your condition. If you have arthritis in your fingers, for instance, you may need shoes that fasten with Velcro instead of laces.

Find a support group. Sharing your experiences with others can be deeply rewarding. Support groups are also an excellent place to learn practical tips for coping with arthritis.

Further Resources

The Arthritis Foundation http://www.arthritis.org
Provides information on many forms of arthritis and helps patients find a support group.
800-283-7800

The Arthritis Helpbook (Perseus, 1995)
A book by Kate Lorig, RN, PhD, and James Fries, MD, it is full of tips for managing arthritis and fibromyalgia.

References

>Marcus, M. Celebrex arthritis drug safety study surprises heart experts. CBS News, November 13, 2016

Arthritis. Johns Hopkins White Paper.

FDA. FDA requires additional labeling for over-the-counter pain relievers and fever reducers to help consumers use products safely.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on Health: Osteoarthritis. http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm

Office of Dietary Supplements. Dietary Supplement Fact Sheet: Vitamin D. http://ods.od.nih.gov/factsheets/vitamind.asp

American Heart Association. AHA statement recommends doctors change approach to prescribing pain relievers for patients with or at risk for heart disease.

American Liver Foundation. The American Liver Foundation Issues Warning on Dangers of Excess Acetaminophen.

FDA. FDA Proposes Labeling Changes to Over-the-Counter Pain Relievers. http://www.fda.gov/bbs/topics/NEWS/2006/NEW01533.html

Lee, WM. Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology 40(1). http://www.liverfoundation.org/about/news/33/

Nonprescription Drugs Advisory Committee, FDA. http://www.fda.gov/ohrms/dockets/ac/02/questions/3882Q1_Discussion%20Points%20Final.htm

Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis and Rheumatism. 1998;41:1343-1355.

Felson DT. Nonmedical therapies for osteoarthritis. Bulletin of Rheumatic Diseases. 1998;47:5-7.

Hochberg MC, et al. guidelines for the medical management of osteoarthritis, part II. Osteoarthritis of the knee. Arthritis and Rheumatism. 1995;38:1541-1546.

FDA Public Health Advisory. FDA Announces Important Changes and Additional Warnings for COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). http://www.fda.gov/cder/drug/advisory/COX2.htm.

National Osteoporosis Foundation. NOF's Five Steps to Bone Health and Osteoporosis Prevention. http://www.nof.org/prevention/index.htm

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