The 100 types of arthritis affects an estimated 43 million Americans each year, most of whom suffer from three primary types, according to Dr. Michael Darnell, D.O. with Payson Regional Bone and Joint. Those three types are osteoarthritis, rheumatoid arthritis and gout.
“Arthritis is the most common cause of disability in the U.S. —one in six are affected,” Darnell said.
Darnell spoke about arthritis to a packed house at the May 14 Lunch & Learn program at the Payson Regional Medical Center’s Senior Circle.
In addition to discussing arthritis, he covered joint anatomy and treatment options.
Each joint has ligaments connecting bone to bone; tendons connecting muscles to bone; and cartilage, which lubricates and cushions for movement.
Arthritis attacks the cartilage — a white, slippery tissue that is a quarter-inch thick and covers bone ends in every joint. Through wear and tear, overuse or injury, the cartilage degenerates, usually in the knees, hips, back and hands.
The destruction of cartilage generally begins in a small area, but eventually results in bone-on-bone contact. Its victims suffer from swollen, painful and stiff joints.
• Joint warm to the touch
• Joint swelling
• Joint pain and immobility
• Joint stiffness
• Decreased activity
• Impaired lifestyle
• Joint deformities
To have arthritis properly diagnosed, Darnell recommended seeing an orthopedic surgeon. The steps for diagnosis include providing a medical history with symptoms, health and activity level; an examination of the joint through range of motion tests and checking for joint-line tenderness and joint deformities; an X-ray.
Darnell said an X-ray shows very clearly where cartilage is reduced or missing in a joint. Healthy cartilage shows up as a dark space on an X-ray. Arthritis thins that dark space to a shadow of itself.
Exercise can make a big difference by nourishing cartilage, which keeps bones strong and joints limber. Exercise strengthens muscles and helps prolong the “life” of joints. The exercise he suggests: walking, swimming, biking, water aerobics and working with a physical therapist if needed to build stamina, steadiness and ability to exercise.
Other lifestyle changes can also help deal with arthritis. Modifications suggested include working on your posture; lifting correctly; resting properly; and weight control. Darnell said being overweight places extra stress on joints — we put three pounds of pressure on our joints with every single pound of body weight (a person weighing 150 pounds therefore can place up to 450 pounds of pressure on each joint). Extra weight accelerates the rate of cartilage destruction and makes it harder to exercise properly.
He recommends adding vitamins and minerals to the diet, since evidence links low intake of Vitamin C and D intake to an increase in arthritis.
“Too much calcium does not cause arthritis,” Darnell stressed, however, too little calcium can cause osteoporosis.
While Glucosamine and Chondroitin Sulfate, usually taken together, can help with arthritis, neither can rebuild cartilage, Darnell said.
When you have an arthritis flare up, try ice, heat and over-the-counter medications, he said.
Ice decreases local circulation and swelling; acts as a local anti-inflammatory; decreases pain; improves exercise tolerance.
Heat increases local circulation; promotes relaxation; helps muscles and joints stretch; and decreases joint and muscle aches.
OTC medications commonly used for arthritis are acetaminophen, aspirin, Naproxen and ibuprofen. The topical creams with capsaicin can also help block pain, but Darnell said check with your doctor before using.
Naproxen and ibuprofen are both nonsteroidal anti-inflammatory drugs (NSAIDs) and can reduce swelling, but can have stomach and blood side effects. So again, before using, ask your physician.
Another treatment for arthritis is cortisone, which provides pain relief, though it may be variable with each person and reduces swelling. However, using it long-term may injure cartilage, Darnell said.
Darnell said some patients use Hyaluronate, a naturally occurring substance in cartilage delivered through a series of injections. Darnell said it relieves pain, restores function, provides lubrication to cartilage and relief may last from six to 12 months. He also said it is not known to have any adverse interaction with other medications.
Somewhere between the old standbys and more complex treatments for arthritis, braces and self-help devices may help a victim of arthritis modify their lifestyle.
Self-help devices are such things as jar openers and button threaders for arthritic hands, large-grip pencils and pens, garden and kitchen tools, long-handled reachers, grabbers and sock sliders. Additionally orthotics can help with arthritic knees and hips.
The use of canes and walkers, as well as crutches is also helpful.
The final treatment option is surgery: arthroscopic and total joint replacement.
Arthroscopic surgery is a minimally invasive surgical procedure on a joint involving use of an arthroscope — an endoscope is inserted into the joint through a small incision. Arthroscopic procedures can evaluate or treat many orthopedic conditions including torn cartilage (known by doctors as “meniscus”), torn surface (articular) cartilage, ACL reconstruction, and trimming damaged cartilage. Unlike traditional surgery, the procedure doesn’t open up the joint. Knee arthroscopy involves two small incisions, one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery time and may increase the rate of success by minimizing trauma to the connective tissue. Professional athletes often rely on this procedure to speed healing time and scarring. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.
The procedure can work with almost any joint, but most often involves the knee, shoulder, elbow, wrist, ankle, foot and hip.
Total joint replacement involves more invasive surgery, removing the damaged areas of the bone, implanting the replacement parts and a longer recovery time.
Darnell insists his patients exercise before and after a replacement procedure.