Time and trauma can both take a toll on joints, resulting in damaged cartilage and osteoarthritis. The painful, sometimes disabling condition impacts an estimated 16 million Americans.
Treatment options range from nonprescription medicines to exercise, injections, arthroscopic cleansing of the joint space, physical therapy and in some cases total joint replacement, according to Dr. Scott Johnson, who specializes in physical medicine and rehabilitation for The Orthopedic Specialty Hospital (TOSH).
Johnson and Roger Petersen, director of physical therapy at TOSH, will be featured during Saturday's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, the duo will take phoned-in questions about osteoarthritis.
Osteoarthritis is diagnosed with a thorough physical examination and imaging studies. X-rays, bone scans, CT scans and magnetic resonance imaging are all options that aid diagnosis, Johnson said. They can show bone spurs, worn-down cartilage and loss of bone space.
The degeneration can attack any joint, but is commonly found in fingers, the spine and weight-bearing joints like the hips and knees, he said. Some people develop it in the shoulder. Any joint can be affected.
While it's primarily a result of aging, cartilage deterioration can also follow injuries, sometimes many years down the road. Some families have a genetic tendency to the condition, which can also be caused by defective cartilage, malalignment, excess weight and underlying diseases. And other conditions like rheumatoid arthritis, gout and pseudo gout may change the normal structure and foundation of cartilage to cause osteoarthritis. Whatever the cause, loss of the cartilage cushion between the bones may lead to painful bone-on-bone grinding that's "miserable," Johnson said.
One of the first suggestions a doctor might make is weight loss, if the patient is heavy. Losing unneeded pounds reduces the stress on joints. Regular exercise and a healthy diet are crucial, as well.
The condition is more apt to plague people who are 45 or older and women are more often affected than men.
Most experts recommend a conservative treatment approach before they consider surgery, starting with teaching self-care.
"We try to encourage moderate exercise, aquatic exercise, physical therapy," said Johnson. "There's no perfect diet, but eating healthy and keeping a positive attitude is important." Johnson also recommends the right footwear — a soft, cushioned shoe. Heat and cold can help. So can relaxation techniques and medication to control pain, including topical pain relievers like sports cream or capsaicin, Tylenol and on to more serious pain relievers including prescription-strength anti-inflammatories and in the most severe cases, opioids. The aggressiveness of the treatment increases as pain in the joint increases. Some doctors also recommend injections of corticosteroids, but limit the number to three or four a year. If the relief doesn't last, it's not a good idea to keep injecting the medication, he said.
"Joint replacement is kind of the last step," said Johnson. But they are frequently done and can help significantly, although he noted it's "never as good as the original joint."
The research on limiting the progression of osteoarthritis is relatively new, he said, but there are some new treatments "on the horizon" including grafts of collagen cells or tissue-cultured cells.
Right now, the focus is on "coping skills," including exercise. It's important to maintain flexibility and strength, to know your limits and not become too fatigued or over-exerted. Assistive devices like canes and walkers can also provide some relief.
E-mail: lois@desnews.com