Sunday, July 22 2018 9:55

Avoiding and Treating Arthritis

Written by Dr. Eric Levicoff, Rothman Institute

Since women are more often affected by arthritis than men, it pays to be informed.

Arthritis is an extremely common health problem, annually affecting more than 23% of the population over 18 and over 50% of those older than 65. Studies show that women are more commonly affected than men, with 26% of all women over 18 reporting doctor-diagnosed arthritis, compared with 19% of men.

While we’re not quite sure why women are more affected by arthritis than men, some clinicians point to hormones and genetics. Female joints tend to be more elastic than male joints, and that elasticity can allow more movement within the joint leading to higher rates of cartilage wear. Also, there’s an increased incidence of arthritis in women after menopause, leading some to consider hormonal differences as a contributor to increased incidence in females. While women report more cases of most types of arthritis than men, the difference is most pronounced for osteoarthritis of the knees. Rheumatoid arthritis is less common than osteoarthritis, but even that affects women twice as frequently as men.

So, women need to be aware of ways to avoid and treat arthritis.


What is Arthritis?

Basically, arthritis is a deterioration of articular cartilage, or loss of the padding that covers bones in your joints, such as knees and hips. This cartilage padding provides a cushion that protects your bones and joints during daily activities.

And while knees and hips are the most commonly affected joints, arthritis can involve any joint—ankles, shoulders, hands, wrists and feet. When the padding wears down, your bones endure higher degrees of stress—causing inflammation, swelling and pain.

The two main types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis, the more common type, usually affects large joints (hips and knees) more than smaller joints, and typically results from wear and tear.

Rheumatoid arthritis, on the other hand, is an autoimmune disorder in which the immune system mistakenly thinks tissues of the joints are foreign to the body and attacks them, resulting in erosion of the cartilage even without wear and tear. Rheumatoid arthritis can affect people of any age (even children) and usually affects smaller joints (hands and wrists) as well as larger joints.


Can I Avoid Arthritis?

While arthritis is very common, there are measures you can take to help prevent or slow the progression of cartilage loss. An ounce of prevention applies here.

Perhaps most important is remaining active. While that may initially seem counterintuitive, getting regular exercise helps strengthen bones and keep muscles strong. The muscles surrounding your joints can help absorb a lot of impact, protecting those joints from harm.

Both weight-bearing activities (walking and jogging) and non-weight-bearing activities (swimming and cycling) can help keep muscles in shape. Core strengthening programs (yoga and pilates) are also important in maintaining your overall fitness, balance and flexibility.

Maintaining an exercise program is also critical to maintaining a healthy weight, thus reducing the amount of stress on joints. Due to the way we’re built and the way we walk as humans, losing 10 pounds can result in a net decrease of 50 to 70 pounds of force that our hips and knees endure with every step!


Do I Have Arthritis?

The most common symptom of arthritis is joint pain, which is commonly accompanied by swelling. Sometimes there’s a feeling of locking, catching or even instability or weakness in the joints.

When symptoms become bad enough to limit your activities, it’s a good idea to see a physician. Primary care doctors, orthopedists, rheumatologists and sports medicine specialists, among others, can evaluate, diagnose and treat many forms of arthritis. In addition to listening to symptoms and performing a physical exam, your doctor may order tests such as x-rays, MRIs or bloodwork to help determine if you have arthritis.


How Is Arthritis Treated?

The challenge in treating arthritis is that cartilage is a very fickle substance. Unlike skin and many other organs in the body, cartilage lacks the blood flow critical for healing. So when cartilage erodes, it doesn’t grow back.

In addition, while doctors and researchers are working hard for solutions, the ability to replace cartilage is limited. Consequently, the main treatment of arthritic joint pain is to relieve symptoms.

Much of the pain and swelling caused by arthritis comes from inflammation in the joints, and so many treatments focus on eliminating inflammation. Things such as ice, anti-inflammatory medications (Ibuprofen and Naproxen) and brief periods of rest are all effective ways to calm down inflammation and reduce pain.

In some cases, braces and physical therapy can help decrease stress and strain on joints, reduce pain and increase flexibility.

For rheumatoid arthritis, new medicines can very effectively limit the immune system’s attack on the joints and significantly reduce or, in some cases, eliminate the progression of cartilage loss.

For some, symptoms evolve to the point that more aggressive measure must be considered. Painful inflamed joints often respond well to localized injections of corticosteroid or hyaluronic acid.

Corticosteroid, or cortisone, is a powerful anti-inflammatory that can be delivered directly into a painful joint to reduce swelling, inflammation and pain. Placing the medicine directly into the joint with a needle can help maximize the strength of the treatment and limit side effects sometimes seen with oral medications.

Similarly, painful joints can be injected with hyaluronic acid, a molecule found naturally in and around cartilage cells and the joint fluid that typically lubricates the joint. These injections can reduce pain by reducing inflammation and increasing the viscosity of the joint fluid, easing symptoms.


What Are Other Options?

Current studies involve two other types of injections called platelet rich plasma (PRP) and stem cell treatments. These types of injections use your body’s own healing potential to improve joint function, reduce pain and potentially regenerate cartilage. Because these injections are not yet approved by the FDA for treating arthritis, they are considered experimental. While there’s hope these types of “biological” treatments will help fight arthritis, data on effectiveness and overall safety is limited.

Finally, if severe symptoms persist and substantially limit your activity and quality of life, surgery can replace arthritic joints. Joint replacement surgery is an effective, definitive treatment for end-stage arthritis, but should be considered only after all other appropriate nonsurgical treatments have failed or are deemed inappropriate.

Surgery is an elective procedure, merely another option for those who can’t get relief from other measures. Before choosing joint replacement surgery, you must receive a full and comprehensive examination by an orthopedic specialist as well as the appropriate medical doctors to determine whether surgery is appropriate. Risks and benefits of the surgery, recovery time and later rehabilitation and expectations should be completely understood to ensure the best possible outcome.


Eric Levicoff, M.D., is board certified in Orthopaedic Surgery and an Assistant Professor at Jefferson Medical College. He received his medical degree from Jefferson Medical College, completed his residency at the University of Pittsburgh Medical Center, and was a fellow at the renowned Scripps Clinic in San Diego. Dr. Levicoff is an expert in hip and knee reconstructive surgery, and has a strong background in managing acute and chronic orthopaedic injuries.

Tagged under: Arthritis, Women's Health