Osteoarthritis (OA), also known as degenerative joint disease, is the most common form of arthritisthe medical term for a wide variety of disorders that involve inflammation of a joint.
OA results from the gradual destruction of cartilage, the smooth lining of a joint that reduces friction and absorbs shock. As the disease progresses gradually over the years, the cartilage cracks and flakes off, leading to subsequent pain and sometimes deformity whenever the underlying and now exposed bones rub together. All joints may be affected, but it is most common in the fingers, ankles and feet, knees, hips, neck and the spine.
About 90 percent of people over the age of 40 show x-ray evidence of OAtypically a gradual loss of the soft, smooth cartilage at joint surfaces and frequently compensatory overgrowths of bone at the joints, called spurs. These spurs may grind against each other as the joint moves. But most people do not experience symptoms until later in life. About 27 million Americans have symptoms of the disorder.
There are two types of OA. Primary osteoarthritis, resulting from normal wear and tear, most commonly affects thumb joints and the end joints of other fingers, as well as the hips, knees, neck, and lower spine. Secondary osteoarthritis can occur after injury to a joint; from disease; or as a result of chronic trauma (due to obesity, posture problems, or occupational overuse).
In some people symptoms of OA remain mild or even fade away. In others, symptoms grow progressively worse until they are disabling. Because the joints become stiff and painful, a person’s natural tendency is to minimize movement. Unfortunately, this can simply lead to a wasting of the muscles and to stiffer jointsand consequently more painsince inactivity weakens the muscles that stabilize joints.
Symptoms of Osteoarthritis
For some people, symptoms remain mild or nonexistent, while for others, symptoms worsen to the point of becoming disabling.
- Stiffness in the morning or after exercising
- Joint stiffness and pain that is aggravated by movement, relieved by rest
- Limited movement and loss of flexibility in the joints
- Audible crackling noises when an affected joint moves
- Redness, warmth, or swelling of a joint (rare)
What Causes Osteoarthritis?
The exact cause of osteoarthritis is still unknown, but it appears to be a combination of several factors, most notably a breakdown of the cartilage, the cushioning material of the joints. Time and use may wear it away, but OA is known to be not simply wear and tear but a disease that prevents the cartilage from repairing and renewing itself normally. Genetic factors are also probably involvedOA appears to run in families.
Obesity seems to increase the risk of developing arthritis in the back, hips, and knees. Poor posture and being sedentary may also promote OA. Also, a broken bone or overuse of a jointcommon among athletesmay speed up the development of osteoarthritis.
What If You Do Nothing?
For occasional mild joint pain and stiffness, there is no cause for concern since the symptoms typically clear in a matter of days. This is especially so if arthritis occurs in the fingers. However, if symptoms become more severe, especially if they affect your weight-bearing joints and therefore your daily activities, you may need to seek professional help.
Home Remedies for Osteoarthritis
First, see a doctor to make sure your problem really is osteoarthritis. There is no cure at present that can stop or reverse OA. You can, though, help slow the disease’s progress, decrease joint pain, and improve function with the following measures.
- Heat and cold can bring relief. Cold packs, warm compresses, heat lamps, and warm baths or showers may bring periods of relief from the throbbing pain or stiffness associated with arthritis. Experiment with both cold and heat to see what works best. Apply the heat or cold to the painful joint for 20 minutes three times a day.
- Support the joint. A splint, brace, neck collar, crutches, or a cane may provide the support you need, eliminating or reducing stress on a painful affected joint.
- Exercise. A regular exercise program designed by your physician or a physical therapist is one of the few effective therapies recommended to slow down the development and progression of arthritis. The program should be aimed at restoring, maintaining, and increasing flexibility, muscle strength, and overall fitness. Excellent activities include swimming, water aerobics, walking, and bicycling as well as strengthening and stretching exercises.
- Lose weight. Increasing evidence indicates that extra weight damages the weight-bearing joints and speeds up the course of arthritis. Reducing your weight to acceptable levels may help stop or reverse the process.
- Eat healthy foods. Eat more fish and moderate amounts of lean meat. Use healthier dietary oils for cooking too, such as cold pressed olive oil, nut oil, borage oil and flax oil because they could help reduce inflammation.
- Check for food allergies. Among other symptoms, they may trigger osteoarthritis pain.
- Stop smoking and drinking alcohol because it can interfere with the healing process.
- Capsaicin can help. Capsaicin creams can be beneficial for arthritis pain. Capsaicin, the substance that makes hot chili peppers hot, is an ingredient in some nonprescription salves and lotions. Capsaicin acts partly as a counterirritant and partly as a suppressant of pain impulses. Capsaicin creates a little diversionary pain that masks the real one, but it also blocks substance P, which is present in aching joints as part of the body’s pain-and-inflammation chemistry. You may need to use the cream three or four times daily, and you may not notice any improvement until you’ve applied the cream for a week or more.
- Medications may be most effective. A number of drugs, including over-the-counter pain relievers, can ease arthritis pain. You may need to experiment to find the most effective drug and dosage. Any of these drugs can cause problems such as gastrointestinal bleeding, however, so if you are taking any painkiller on a long-term basis, you need a physician’s advice and supervision.
"Miracle Cures": Be Skeptical
Two nutritional supplements—glucosamine and chondroitin sulfate—are promoted as nothing less than "miracle cures" for arthritis. Both substances, produced naturally in the body, reputedly not only relieve pain, but can even, in some cases, bring about a complete reversal of the disease.
For most people, there is probably no harm in trying the supplements for possible pain reduction—and one promising controlled study showed that glucoasamine can also help slow deterioration of cartilage as well as relieve pain in some cases. But no studies have shown these supplements are effective at reversing arthritis, and little research has been done regarding their long-term safety.
Glucosamine can have adverse effects on blood sugar levels and so might pose risks for people with diabetes. In the United States the supplements are also unregulated, so that you can’t be sure of what you are getting or how much to take.
MSM and SAM-e are two other supplements that are supposed to help alleviate arthritis pain. There is no scientific evidence to support the use of MSM, though there is some preliminary research showing that SAM-e may provide relief.
If you decide to try a supplement—or any other unproven arthritis treatment—always talk it over with your doctor, to be sure you’re not doing anything that can harm you.
Arthritis and Exercise
If you have OA, it need not limit your mobility—at least not if you exercise and keep moving. But many of the 40 million Americans who suffer from OA don’t exercise because of pain and stiffness in their joints. Thus, the muscles grow weaker and the joints become more painful.
Many people with osteoarthritis can maintain flexibility, and even restore it to some degree, through a well-designed exercise program that is implemented gradually and followed regularly. Specialists have devised scores of exercises to stretch muscles or strengthen important joints. Exercise may cause you some pain at first, but the discomfort should diminish.
The exercises illustrated here are a way to begin, and fall into two categories.
Range-of-motion exercises relieve stiffness, restore flexibility, and help with joint movement. If you haven’t yet lost your full range of motion, an exercise like the shoulder stretch can help prevent such loss as well as help minimize joint stiffness. Tai chi, the gentlest form of martial arts training, offers an excellent range-of-motion exercise.
Strengthening exercises are particularly important because weak muscles add to joint problems. Many studies have found that strength training can relieve knee pain, improve strength, and boost physical functioning. With isometric exercise, you contract the muscle without moving the joint. Isotonic exercises, using bands, weights, or machines, require you to move the joints and can result in greater strength gains. Water workouts, free weights, or weight machines can be useful.
Aerobic exercise is also beneficial. Continuous movement for 10 minutes or longer, such as walking, swimming, and cycling (at low pedal resistance, over level surfaces at first) can definitely reduce pain and improve physical functioning. Rowing, water walking, aqua aerobics, and ballroom or other low-impact dancing are also excellent choices.
Generally, it’s wise to avoid high-impact activities like tennis, aerobic dance, or running, which can overload sore joints.
Before You Start
Exercises must be individualized, depending on the joints involved and the degree of pain. Your doctor or physical therapist will help you develop an exercise program that focuses on your most painful joints and takes into consideration your overall level of fitness. Whatever exercises you do, there are some general rules.
Start gradually and never overdo it. Follow the instructions of your doctor or physical therapist. There will probably be some pain or discomfort, but stop a particular exercise if there’s unusual or severe pain. Cut back if necessary, but don’t stop exercising entirely.
Always warm up first. After walking in place for a few minutes, do some gentle stretches. Gently massaging stiff joints may help, as may heat (a warm bath or shower, or an infrared lamp). Wear a sweat suit, or leg or arm warmers.
Vary your exercises, so that you work different muscle groups. Don’t rely on one long, strenuous (and painful) session a week. Begin with as few as three repetitions of an exercise. Over the course of several weeks try to work up to 10 repetitions, or as many repetitions as your doctor recommends.
Gentle exercise should be a daily routine. And it’s a long-term project—you shouldn’t stop for more than a few days.
Note: Remember, unless you know you are healthy and have only mild osteoarthritis, talk to your doctor before attempting any of these exercises.
Shoulder stretch. Reach one palm over shoulder and place back of other hand on lower back. Slide hands toward each other, trying to touch fingertips (many people can’t reach that far). Alternate arms.
Leg strengthener. Stand in front of chair. Slowly bend at hips and knees as if to sit down, but don’t go all the way down to the seat. Lower your hips as far as you can without sitting. Keep your upper body upright. Then slowly straighten up.
Arm curl. Hold one end of an elastic band in fist, palm up, the other end securely under arch of foot. Start with arm extended downward (but elbow not locked). Slowly curl forearm toward shoulder, keeping elbow close to side. Then lower slowly; repeat. Switch arms.
Osteoarthritis can’t be prevented, but you may be able to slow the progress of the disease by following the self-care measures outlined above. Losing weight (if you are overweight), gradually starting an exercise program, and avoiding any repetitive activities that can cause wear and tear on joints are the most helpful measures.
Beyond Home Remedies: When To Call Your Doctor
If joint pain or stiffness begin to interfere with daily activities, call your physician.
What Your Doctor Will Do
Your doctor will take a history and perform a thorough exam of your joints to determine the presence and extent of arthritis. X-rays may be taken and, in rare cases, fluid may be drawn from an affected joint through a needle for analysis in a laboratory.
If you need pain relievers on a daily basis, you and your doctor should discuss the risks and benefits of different medications. The first line of treatment is usually acetaminophen (such as Tylenol and generics), which does not cause stomach upset or bleeding, but can affect liver and kidney function over the long term. Nonsteroidal anti-inflammatory drugs (NSAIDs)—aspirin, ibuprofen (such as Advil and Motrin), or naproxen (Aleve)—are the next option if acetaminophen doesn’t work or stops working. Because NSAIDs can cause gastrointestinal bleeding and/or ulcers when used over the long term, you should take them under medical supervision. Be sure to consult your doctor about using these drugs if you have high blood pressure or diabetes mellitus, since they may cause problems with your kidneys.
As an alternative, your doctor may suggest that you try one of the new prescription NSAIDs known as COX-2 inhibitors. They are designed to have the pain-relieving effect of NSAIDs with a lower risk of gastrointestinal bleeding. These heavily-promoted drugs are expensive, and are so new that the long-term effects are not completely known. Other medications are also available that your doctor can prescribe to reduce NSAID-related stomach problems. But if you have arthritis and are doing well on nonprescription pain relievers, there is probably no need to switch.
Stronger or more specialized medications can be prescribed for severe flare-ups of arthritis pain if more conventional pain relievers aren’t effective. When joint pain and stiffness become severely debilitating, there is a range of surgical procedures that can make arthritis more tolerable. Each has its own benefits and limitations, and you should always be sure that the surgery is your best option. But fortunately, most people who have osteoarthritis will never need to have surgery.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media