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June 8, 2015
When we talk about arthritis, usually we are talking about osteoarthritis. There are many types of arthritis, as most of us have heard of some of the other types: rheumatoid, septic, and post-traumatic just to name a few. However, to the non-medical individual, arthritis in the standard literature refers to osteoarthritis. This is the type of arthritis we all get as we age and our joints get stiffer and lose flexibility.
As we enter middle age, changes in our joints occur that usually we have no control. The cartilage, which covers the ends of our bones and act as the shock absorbers to the joints, begin to break down and in extreme cases disappear. Although the symptoms usually do not appear until the later part of our life, we know now that changes occur in the joints at the microscopic level as early as our second decade of life. Sad times ahead, it seems for most of us!
Ask any person in their 60s or 70s how their joints feel compared to how they felt 30 years ago. Usually the complaints of morning stiffness, aching, and soreness in the weightbearing joints are the norm. Several factors contribute to making this disease worse. We know that being overweight taxes the weightbearing joints, smoking and poor exercise habits are not good ideas, and a family genetic predisposition can be a contributing factor.
Excess weight on our bodies literally wears the cartilage out to raw bone in the hips and knees. It takes years for this to happen, and once the pain becomes so severe an individual cannot exercise to try and lose the weight. It creates a cycle with no win possible. Some individuals are just born with great genes, as their cartilage does not break down as fast as others. We see elderly people who exercise regularly, and despite X-rays that demonstrate advanced arthritis, they seem to have less pain and function quite well. Aqua therapy and stationary bicycles are excellent options for individuals with arthritis of the knees and hips. Non-weightbearing type movements that promote flexibility and lubrication of the joint can offer remarkable results.
It is very frustrating, as this is a progressive disease, and can be crippling. Each time we take a step, the pressures placed across our hips and knees are about three times our actual weight. This causes repetitive stresses to the cartilage layers covering the bones, and any excess stresses can cause the cartilage to thin and simply wear out. At this point, research is leading to the idea that the solution is at the biochemical level: the cartilage type, location, and ability to be influenced by certain chemical signals in the body may be the key to solving this puzzle.
We have several options to treat arthritis, but to date none cure. We have available to us over-the-counter drugs, glucosamine/chondroiton sulfate, prescription anti-inflammatory medicines, and a myriad of holistic type remedies. Surgical options, which range from arthroscopic outpatient procedures to wash out debris and smooth out the worn rough spots to complete joint replacement are available. Indications for these procedures vary, and many people have extremely successful outcomes. Exercises like low-impact aerobics, walking, and the above-mentioned aqua therapy are great ways to make arthritic joints feel better. Some people swear by massage therapy and acupuncture.
Despite the range of options available, we do not have an answer to the dilemma of why and how our cartilage wears out as we get older. The day of when we can simply take a pill to replenish our diseased cartilage is likely to be decades away. Until then, we must concentrate on the prevention of the disease and slow the progression. We recommend activities that keep you moving to lubricate and keep the joints flexible. Keep your weight down. I recommend to my patients that they should stay within 10 lbs. of their high school graduation weight. This will keep the undue stresses off the joints, and preserve the cartilage. Maintain a strong healthy diet: avoid fatty fried foods, do not snack, avoid or quit smoking, and drink alcohol sensibly.
The day will come when science will unlock the key to this crippling disease. Until then, we must do all we can to prevent and delay its'progression, so that each of us can enjoy productive active lifestyle for years to come. We cannot avoid it, but we can prepare for it.