Something More: Osteoarthritis

Most of us know better than to drain the oil from our car and let the motor run. The heat from the friction would soon cause it to seize, destroying it in minutes.

Osteoarthritis, the most common form of arthritis, is another example of what happens when protection against friction is removed. It occurs when the cartilage, the smooth tissue covering the ends of bones where they meet at our joints, breaks down and wears away. The bones rub together, causing pain, swelling, and stiffness. Bone spurs develop, permanently changing the joint’s shape.

The result, as the approximately 27 million Americans who are afflicted with osteoarthritis know too well, is painful and even crippling.

Osteoarthritis is incurable, and no cure is expected in the foreseeable future. Still, advances in medical technology and research have made inroads both in treatment and prevention.

While osteoarthritis is simply wear and tear on joints, genetics and lifestyle are factors in predicting who may experience osteoarthritis. Trauma to joints from sports and occupations can break down cartilage.

An Ounce of Prevention

People who want to minimize or delay onset of osteoarthritis can take steps, advises Edward P. Petrow, Jr., DO, a physician with the Tucson Orthopaedic Institute.

“The most important thing you can do is lead an active lifestyle,” he says. “The saying that a rolling stone gathers no moss applies to our bodies. We peak around age 25 and are in a state of decline from then on. The only thing that seems to slow that down is diet and exercise.”

The onset of osteoarthritis doesn’t mean activity should end, he notes, but it might require switching gears. Giving up exercise can make it worse.

“People with arthritis sometimes have to change gears,” Petrow says. “They may switch from running to cycling or swimming.”

Runners may feel they are losing exercise benefits, for example, if they switch to walking, but walking burns the same amount of calories per mile covered as running. It takes longer to cover the distance, but walking also can be more enjoyable.

It’s important to choose an alternative you enjoy, he adds.

“I ask people, ‘What do you love to do?'” he says. “If you love to run and I tell you to swim and you hate to swim you’re not going to do it. Find an activity that you can modify to fit your lifestyle.

“I think Tai Chi is fantastic,” Petrow continues. “I encourage our patients to practice it, more for balance and proprioception. Balance is like muscle: you can train and improve it.

Better balance and muscle tone help prevent falls, and can decrease pressure on joints.

“Every little bit helps,” he says, but people should not expect total relief.

“Muscles are shock absorbers and exercise can help,” he says, “but when you have bone on bone, it doesn’t matter how much muscle tone you have.”

As with most medical conditions, a healthy diet is important in minimizing damage to joint, and that’s a lot less complicated than some people may realize. Expensive supplements, for example, are likely to be a waste of money.

“A lot of the information about supplements is voodoo,” Petrow says. “Keeping a healthy body weight will by far help your joints more. Every extra pound of body weight exerts three to four pounds of force on you knee joints, every step, every day.

“Calories are just a number, and you need to look at how to deduce them,” he adds. “It’s simple math.”

Fad diets and supplements come and go, he notes, and some might do actual harm.

“Study results are published in a vacuum, and often the media grabs one tidbit and it becomes the new in thing to do,” he says, adding that mainstream media can play a role in popularizing unproven diets and supplements.

Not Your Grandmother’s Joint Replacement

People contemplating joint replacement may be reluctant to consider it because of past experiences by friends and relatives. They may want to take another look; a lot has changed, even in the past 10 years.

“The marriage of techniques and technology has helped orthopedics deliver a better lifestyle,” says Petrow.

People who were advised to delay replacement because the joints wear out now can expect them to last 20-25 years. And the surgery techniques have improved significantly. The practice of “banking blood ahead of time for transfusions during surgery is no longer needed, for example, and the hospital stay has decreased from three weeks to a few days. 

“We are delivering joints through smaller incisions, which are less invasive,” Petrow said. “When you combine that with improved technology we’re entering a golden age of what we are able to do.”

“The nuts and bolts are the same,” he continues. “We have better instrumentation to make more accurate incisions, and we’ve improved our techniques.”

Surgeons now do hip replacement through the front, which reduces the amount of muscle to cut, making recovery faster.

Technology and improved methods help, but Petrow says the skill and experience of the surgeon remain the most critical considerations for people seeking joint replacement.

Drug Therapies: Relief, but at a Cost

Medication can relieve the pain, but Petrow urges caution in using drugs to treat arthritis.

“I remember a pharmacology professor telling us that all medicines are poison, and we should try to avoid taking poisons,” he says. “Nutritional therapies like glucosamine and injectibles will not bring back what’s gone; they just treat the symptoms, and they come with a price.”

Sometimes the price can be higher than people realize.

“Celebrex was a popular arthritis prescription drug, then we learned about heart disease and stroke issues,” Petrow says, adding that with medications, “less is better, so use them only when you need to.”

At some point, Petrow says, science will allow doctors to harvest cartilage out of a joint, grow it in a laboratory and transplant it to a patient, but as of now such procedures are just a dream.

“Growing and transplanting cartilage is the Holy Grail in orthopedics right now,” he says. But it’s a long way off.”

Osteoarthritis is incurable, but incurable does not mean hopeless. People with osteoarthritis have a variety of treatment options, and going over them with a physician could minimize the impact on their enjoyment of life.

“If you have pain in your joint that limits your lifestyle, you should talk to someone about it,” Petrow advises. “People may think they are too old or too young to undergo treatment for arthritis, but you’re never too old or too young to enjoy your life, and you only get one.

Don’t assume that what was true for a friend or relative 10 or 20 years ago applies today.

“A lot of misconceptions have lingered from the earlier days of orthopedic surgery,” he says. “Motion is life. If you can’t enjoy your life, sit down and talk to someone about it – no matter what your age is.”

Written by Mark Flint

As published in Tucson Osteopathic Medical Foundation publication, “Something More for You, the Osteopathic Patient”, Vol. 14, Issue 1, 2012