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 7 million doctor visits per year and is 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 not 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 arthritis sufferers are hospitalized each year for serious stomach trouble caused by NSAIDs, and about 16,500 die.

In April 2005, the U.S. Food and Drug Administration issued a health advisory for both prescription and over-the-counter (OTC) NSAIDs, asking manufacturers to beef up warning labels. The FDA requested that warning labels for prescription NSAIDs advise patients about the potential for serious cardiovascular problems and potentially life-threatening gastrointestinal bleeding that is associated with this class of drugs. The agency also recommended that NSAIDs not be prescribed for anyone who has recently undergone coronary artery bypass surgery. The FDA says that available evidence doesn’t indicate an increased risk for cardiovascular problems with short-term use of OTC NSAIDs. However, in April 2009, the FDA issued a new rule requiring all manufacturers of over-the-counter acetaminophen and NSAIDS to revise product labels by April 2010 to ensure 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 called COX-2 inhibitors offered relief for arthritis sufferers until questions about their safety arose. In April 2005, the FDA asked the manufacturer of one COX-2 inhibitor, Bextra (valdecoxib), to withdraw the drug from the market. After reviewing available data, the agency concluded that the risk of taking the drug outweighed its benefits. In June 2005, the FDA asked the manufacturers of all COX-2 inhibitors to add a boxed warning label advising users of an increased risk of cardiovascular problems and gastrointestinal bleeding associated with the drugs. One COX-2 inhibitor, Vioxx (rofecoxib), was voluntarily removed from the market in September 2004 after reports that it caused increased risk of stroke and heart attack in some people.

In 2007, the American Heart Association recommended that doctors change their approach to prescribing pain relievers to patients at risk of heart disease. The AHA recommended that COX-2 inhibitors be used as the last line of treatment in patients with heart disease or at risk of heart disease, after trying physical therapy, exercise, weight loss, heat or cold therapy, aspirin, acetaminophen and less-selective NSAIDS.

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.

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