Menstuff® has compiled the following information on Arthritis. Get answers to your basic questions at the Arthritis Center and the Rheumatoid Arthritis Center.
How is arthritis treated?
Treatment begins after diagnosis by a physician who may prescribe medication to reduce inflammation, pain, swelling and loss of motion. As part of a comprehensive plan for arthritis treatment, your doctor also may prescribe occupational and physical therapy, which can provide additional help in your recovery.
How can occupational therapists help?
Occupational therapists can teach you how to reduce strain on your joints during daily activities. They can show you how to modify your home and workplace environments to reduce motions that may aggravate arthritis. Occupational therapists may provide splints for your hands or wrists, and recommend assistive devices to aid in tasks such as driving, bathing, dressing, housekeeping and certain work activities.
How can physical therapists help?
Physical therapists provide exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another. They also can teach you how to use walking aids such as crutches, a walker or a cane if necessary.
What are the goals of treatment?
These important members of your health-care team will work closely with your doctor to tailor a program to your specific needs, whether your arthritis is widespread or confined to one joint or body area.
The goals of treatment are to accomplish the following:
Therapy should be started early in order to reduce painful symptoms of inflammation, prevent deformity and permanent joint stiffness, and to maintain strength in the surrounding muscles.
When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and improve muscle strength and endurance.
What are some benefits of occupational and physical therapy programs?
Education about your kind of arthritis, so that you can be a well-informed member of your health-care team.
A dietary plan if you are overweight, to reduce the stress of excess weight on supporting joints of the back, legs and feet. (As yet, no specific diet -- other than a diet designed for weight loss -- has proved helpful for arthritis.)
Foot-care advice, including choice of well-fitting shoes with shock-absorbing outer soles, and sculptured (orthotic) insoles molded exactly to the contour of each foot.
Therapeutic methods to relieve discomfort and improve performance through various physical techniques and activity modifications.
What are some therapeutic methods?
Rest: Bedrest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem.
Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints, and a soft collar can support the neck while you are sitting or standing.
Thermal modalities: Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, help relieve local pain. Heat also relaxes muscle spasm around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising may help you exercise more easily.
Exercise: An important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that may vary as your needs change.
Range of motion exercise -- Gentle movement of each joint through its normal range of motion will help relieve stiffness, improve and maintain joint movement, and increase flexibility.
Strengthening exercise -- These exercises help preserve or increase muscle strength. Isometric exercises tighten and strengthen the muscle without moving the joint, and are most useful when joints are tender. Isotonic exercises strengthen the muscle by using it to move a weight.
Water exercise -- Warm water helps relieve pain and relax muscles. Swimming is not necessary, as water exercises may be done while sitting in a shallow pool or standing in shoulder-high water. Support by the water decreases body weight applied to the joints of the spine, legs and feet. Water support of the arms and legs also helps you move your joints through range of motion exercises more easily.
Recreational exercise -- This does not replace your therapeutic exercise program, but may enhance it with a variety of enjoyable activities. Some examples are games, sports, exercise classes, running and swimming, all of which can benefit muscle strength and joint range of motion. Running and swimming are excellent aerobic activities and will help improve your endurance and lessen fatigue. Any exercise needs to be tailored to the patient's disease and limitations.
Therapy for joint surgery patients:
Preoperative programs of education and exercise, started before surgery, are continued at home. They may be changed in the hospital after surgery to fit new needs in the rehabilitation period. These exercises may be added to your usual exercise regimen and you may find your ability to exercise has improved after surgery.
Joint protection techniques:
There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these include:
Control your weight to avoid putting extra stress on weight-bearing joints such as the back, hips, knees and feet.
Be aware of body position, using good posture to protect your back and the joints of your legs and feet. When possible, sit down to do a job instead of standing. Change position often since staying in one position for a long time tends to increase stiffness and pain.
Conserve energy by allowing for rest periods, both during the workday and during an activity.
Respect pain. It is your body's way of telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.
A therapist can show you ways to do everyday tasks without worsening pain or causing joint damage. Some joint protection techniques include the following:
Use proper body mechanics for getting in and out of a car, chair or tub, as well as for lifting objects.
Use your strongest joints and muscles to reduce the stress on smaller joints. For example, carry a purse or briefcase with a shoulder strap rather than with your hand.
Distribute pressure to minimize stress on any one joint. Lift dishes with both palms rather than with your fingers, and carry heavy loads in your arms instead of with your hands.
If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.
Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist can suggest devices that will be helpful for tasks you may find difficult at home or at work.
A few examples of helpful devices include a bath stool in the shower or tub, grab bars around the toilet or tub, and long-handled shoehorns and sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices.
As the central member of your treatment team, you are the person responsible for following through with your therapy program. This includes taking medicines as prescribed, continuing at home with daily exercises and complying with other instructions from your therapist. You should discuss questions and problems, as they come up, with your doctor and your therapist, so that the program can be adjusted to best meet your needs.
A positive attitude, patience and persistence will help you get
the greatest benefit from your occupational and physical therapy
activities, which are so important in meeting the challenges of
Source: The Cleveland Clinic, 800.223.2273, x 43771, my.webmd.com/content/article/44/2945_607
Rheumatoid Arthritis Patients With HMO Coverage
May Not Have Access To New Medications
Care By A Rheumatologist Means Better
Treatment For Many Arthritis Sufferers
New Knees When Other Options Fail
First Step In Treating Arthritis -- Keep
What types of exercise are best for
people with arthritis?
Arthritis - Your Reward For Wear And Tear
Common Knee Surgery Doesn't Work
HHS Issues Report On Medical
Innovation And Seniors
Staph-Link Protein May Help Arthritis
Labeling Changes For Arthritis Drug
Arthritis Drug Can't Be Labeled As
Was Celebrex's Safety Overstated?
Treating Rheumatoid Arthritis at Home
Research Shows Promise For New Class Of
Report Links Vioxx To Meningitis
Arthritis Drug May Cause Liver Damage
Limited Mobility Bra
Geriatrics Society Guidelines Give Hints
To Older People On How To Live Without Pain
New Studies Add To Vioxx Debate
Rheumatoid Drug May Prolong Life
Widely Used Arthritis Pills May Be New
Treatment For Cancer
Supermarket Chain Pulls Oxycontin
Clinical Trial Protections Sought
Risks Of Arthritis Drugs Studied
Cartilage Attracts Immune Attack
Boomers Search For Relief From
New Weapons to Assault an Epidemic
Late last month, as he entered a medical office on the Upper East Side of Manhattan, Mr. Crawford moved in what must have seemed like slow motion to him. Decades of constant pounding had taken their toll on his left hip. Pain and weakness prevented him from walking more than three blocks at a time. "Basketball is a tough business, but you're not thinking about that at the time," Mr. Crawford said. His diagnosis: moderately severe osteoarthritis.
Mr. Crawford is not alone. About 21 million Americans are afflicted with osteoarthritis. (According to a federal study, the figure will soar to more than 30 million by 2020, as the baby boomers grow older.) Women stand a greater chance than men of developing the disease, especially women over 65. But some arthritis experts are noticing a change in their patients: more men developing severe cases, and earlier, in their 50's rather than in their 60's and 70's, which may be attributed to more participation in strenuous sports.
At the same time, however, a variety of promising treatments and technological advances, from new drugs to viscous injections to high- tech prostheses, are keeping pace with the epidemic, offering relief to those who suffer from the nation's leading cause of disability.
Lube Job for Joints
While osteoarthritis affects the entire joint be it knee, hip, wrist or fingers its primary target is cartilage, the tough, slippery coating at the ends of bones that lets them glide over each other when you bend your knees or throw a baseball. With osteoarthritis, the protective cartilage wears away (which is why it is sometimes referred to as "degenerative" arthritis). As the cushioning cartilage erodes, bone eventually rubs against bone, causing the pain and stiffness that Fred Crawford knows all too well.
The 60-year-old Mr. Crawford had been scheduled for hip-replacement surgery in April. But he canceled after hearing about a less drastic but more controversial alternative known as visco-supplementation a lube job for arthritic joints.
In visco-supplementation, a clear, thick liquid is injected into the joint in three weekly injections costing about $1,000 for the series. (Some health insurance plans cover the cost.) The relatively painless injections are intended to provide temporary relief for arthritic pain and stiffness. The key ingredient is hyaluronic acid, a chemical found naturally in the fluid of the knee and other joints that aids in lubrication.
The Food and Drug Administration approved two visco-supplementation products, Synvisc and Hyalgan, in 1997 and a third, Supartz, earlier this year. They are currently approved for treating symptoms of osteoarthritis of the knee that have not responded to drugs or other treatments. (None has yet been approved for osteoarthritis of the hip, so Mr. Crawford's injections, using Synvisc, are an "off-label" but permissible treatment.)
Visco-supplementation has drawn attention, not all favorable, partly from how it has been promoted. Full- page ads in magazines and newspapers contend that Synvisc offers "drug-free relief for osteoarthritis knee pain," which is technically true, as the products are classified as medical devices rather than drugs. But experts are also split over visco- supplementation's effectiveness.
"I think it doesn't work, and there's actually pretty strong evidence from clinical trials that it doesn't work," said Dr. David Felson, the director of the Arthritis Center at the Boston University School of Medicine. He said that the three large-scale clinical trials of visco- supplementation for knee osteoarthritis "show no effect compared with placebo injections of saline."
But visco-supplementation has its proponents, too. One is Mr. Crawford's doctor, Vijay Vad, a rheumatologist at the Hospital for Special Surgery in New York. Dr. Vad has "visco-supplemented" nearly 600 knees and 70 hips the first 25 as part of a recently completed clinical trial. For best results, he emphasizes, "careful selection of patients is essential."
According to Dr. Vad, the prime candidates for visco-supplementation are men in their 40's or 50's with moderately severe osteoarthritis of the hip or knee who have failed to improve with oral medications, physical therapy or cortisone injections. Following the injections, Dr. Vad insists that patients engage in a rehabilitation program that includes exercise and aquatherapy.
Mr. Crawford, for one, is a believer. "I have less pain and have already noticed improvement in my range of motion," he reported shortly after the last of his three Synvisc injections. He said he was looking forward to playing doubles tennis and taking his bicycle out of storage. But as for basketball, "I'm going to leave that to Kobe and Shaq."
The Surgical Solution
Dr. Richard Laskin, an orthopedic surgeon and co-chief of the knee service at the Hospital for Special Surgery, recently reviewed his hospital's database for the last 20 years, tallying up the numbers of men who had been candidates for hip or knee replacement surgery and noting their ages. One finding stood out: between 1980 to 1990 and 1990 to 2000, male patients in their 50's had tripled.
"Why am I seeing so many more men in their 50's when I used to see them much later?" Dr. Raskin asked. "It's because when they were in their 20's, they skied or played rugby or soccer or whatever and damaged their knees tore their anterior cruciate ligament or their medial meniscus, for example, and more men tended to do that than women." (Ligaments are bands of tissue that help stabilize a joint by binding together the bones within it; meniscuses are pads of tissue that help to cushion the knee joint.)
Even without directly damaging cartilage, traumatic injury to a
joint greatly increases the risk of developing osteoarthritis years
later. Tearing a ligament or meniscus makes the joint unstable,
creating abnormal stresses on cartilage during movement. Athletes who
suffer a major injury to the knee or hip, for example, are up to
seven times more likely to develop osteoarthritis in that joint than
the average person. More www.nytimes.com/2001/06/24/health/24KATZ-MH.html
Arthritis Drug May Cause Liver Damage