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When Joints Are Rubbed the Wrong Way The occasional twinge in your knees or hips is normal, but if you’ve got swelling and stiffness and your joints ache most days you could be one of the 27 million adults in the U.S. who have osteoarthritis (OA). Whether it’s from injury or general wear and tear, OA means the cartilage that covers and cushions the ends of bones in the joint breaks down and the bones start to rub together.
Symptoms. It’s a good bet you have OA, if you experience steady or intermittent pain in the affected joint, stiffness (especially after excessive activity, sitting or lying down for long periods), swelling or tenderness and a crunching sensation or the sound of bone rubbing against bone. The disease occurs most commonly in the weight-bearing joints of the hips, knees and lower back, but it can also affect the neck, fingers and the big toe. “The disease starts 10 to 20 years before you get symptoms -- and it takes 10 years for X-rays to show signs of osteoarthritis because you don’t see cartilage on X-rays,” explains Jason Theodosakis, M.D., M.S., M.P.H., an associate professor of family and community medicine at the University of Arizona College of Medicine in Tucson and author of The Arthritis Cure.
Risks. Osteoarthritis is not inevitable but certain factors like injuries, genetics, inactivity, being overweight and simply getting older can increase your risk. Most people develop the disease after age 45. Men under age 55 are more likely to have OA than women under age 55, but the pattern reverses after age 55, according to the Arthritis Foundation. While there’s no cure for the condition, new and improved treatments are available to help heal the hurt.
Easing the Pain. Acetaminophen can be used for mild pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen, naproxen, ketoprofen and Mobic -- can help relieve the pain, inflammation and discomfort of osteoarthritis. Unfortunately, they can also cause gastrointestinal (GI) bleeding and increase your risk of cardiovascular problems. Same with Celebrex, though this can be easier on the GI tract for some people.
Other pain relievers. Applying heat, ice or capsaicin cream (a topical analgesic) to the affected joint or acupuncture also can quell OA pain temporarily. In addition, corticosteroid injections can temporarily relieve pain and swelling but these should only be used rarely, Dr. Theodosakis says. Injections of hyaluronic acid, a component of joint fluid, can decrease pain for longer periods (up to six months) but we don’t yet know if they slow or stop progression of the disease. There’s increasing evidence for new, oral forms of hyaluronic acid as well. These may obviate the need for injections.
Supplements. While the evidence is mixed, two dietary supplements glucosamine (1,500 – 3,000 mg/day and chondroitin (800 – 1,200 mg/day) may decrease pain and slow progression of the disease, especially in the knees. Since they can’t hurt and might help, they may be worth trying but the relief of symptoms may not kick in for four to six months, Dr. Theodosakis says. Supplements of avocado soybean unsaponifiable (ASU, for short), a natural vegetable extract, can also help reduce pain and inflammation and possibly slow the progression of joint damage. The prestigious Cochrane Review named ASU as the herbal product with the most evidence for relieving osteoarthritis pain, based on the totality of the research over the past 20 years.
Mind-body. You can soothe achy joints and improve mobility with mind-body techniques such as progressive muscle relaxation, yoga, meditation, tai chi and guided imagery. A recent study from Korea found that tai chi is significantly beneficial for controlling pain and improving physical function in people who have osteoarthritis in the knee. For details about various options, consult the Arthritis Foundation’s guide to alternative and natural therapies.
Next steps. For most people, the best treatment is a combination of exercise, weight control, injury prevention, joint protection and drugs. Your doctor may recommend that you change or modify activities to avoid provoking or worsening the pain. You might, for example, switch from high-impact activities like running or jumping to low- or no-impact activities like swimming, cycling or using the elliptical machine at the gym, says J. Martin Leland, M.D., an orthopedic sports surgeon at the University of Chicago Medical Center.
Physical therapy. If the disease makes it hard to perform everyday tasks, your doctor may prescribe physical therapy to strengthen your muscles and improve flexibility and joint mobility or occupational therapy to teach you how to manage daily activities and tasks without putting undue stress on your joints. Surgery. Most people with osteoarthritis won’t need surgery but you may have to consider it if you have severe joint damage, extreme pain or limited mobility.