Osteoarthritis

Severe osteoarthritis of the hands

One of my patients came to see me today with severe right knee pain.  This is not a new problem, and in fact, we have been dealing with flare ups of  her osteoarthritis for years.  It mainly affects her knees and hands and today her right knee was swollen and felt like the "bone was rubbing together" with each step. She could hardly walk because of the pain.

Osteoarthritis is also known as degenerative arthritis and it is one of the most common maladies of aging joints, affecting millions of people.  The cartilage in joints wears down and inflammation causes the bones to build up spurs and small micro tears.  It affects women more than men and  the cause is unknown.  There are likely genetic factors as it tends to run in families.  Arthritis can occur in any joint but the most common are the fingers, wrists, hips, neck and spine and knees.  Stiffness (especially in the morning) and pain are the main symptoms that limit mobility.

You can see the bony changes that have occurred over time in my patient's hands. (click on the photo for a better view)  Note the swelling at the wrists and the way the thumbs angle inward.  She cannot stretch those thumbs out and there is wasting of the intrinsic muscles in her hands.  Surprisingly, she was not experiencing any pain in her hands or wrists today, although in the past it has been a problem.  Today it was the knee.

Because arthritis is chronic and affects millions of people, there are many purported "cures" and treatments.  Many of them are a big waste of money.  Here is what has worked for many patients:

• Stay active and keep weight down.  Work on flexibility and range of motion.  For severe arthritis pain, aquatic exercise helps without causing more pain.
• Yoga
• Heat on the painful area alternating with ice as anti-inflammatory.
• There is no proof for the "anti-inflammatory" diet, but eliminating sugar, glycemic white flour and processed foods increases energy levels and helps with weight control.  If you aren't exercising you probably need very few calories and they should be mainly fruits, vegies, grains and protein.
• Trial of gluten free diet
• Pain relievers like Nsaids, tylenol and aspirin can help
• The evidence is still not clear for glucosamine or other supplements.
• Cortisone injections
• Hot tubs/hot baths
• Joint replacement

A cortisone shot will hopefully help this patient and quite down the flare up in the knee.  Osteoarthritis is truly a pain and it requires a lot of attention.