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Top Ten Things to do for Arthritis

The treatment options covered in this article relate to osteoarthritis, although many of them may be helpful for patients with rheumatoid arthritis. Please ask your physician before starting any treatment.

Get a Correct Diagnosis

First, See A Physician

A correct diagnosis is essential before starting treatment. Many patients with bone and joint pain assume they have arthritis. There are numerous causes of joint pain that are not related to arthritis. Your physician will use your history, examination, x-rays and possibly your blood work to determine if you have arthritis and, if so, what type of arthritis you have. It is only after this that a treatment plan will be recommended. Always consult with a physician to obtain a correct diagnosis.
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Start an Exercise Program

Moderate exercise is an integral part of treating arthritis. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.

Aquatic Therapy
Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water's buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening. Hydrostatic pressure can also assist with reducing the swelling in joints and edema in the legs.

Walking
Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.

Biking
Either regular biking or stationary biking is an excellent endurance exercise. However, patients with kneecap problems may aggravate their condition with biking. Be careful not to increase the resistance or ride up and down hills too quickly. As with any endurance exercise, you should be able to carry on a conversation while you are engaged in the activity.

How much exercise it too much?
If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.

For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.

How do I stay consistent with exercise?

  • Seek help from a health care professional to assist you in setting up an individualized program.
  • Make a plan! Write it down! Set goals!
  • Exercise at the same time each day so it becomes part of your routine.
  • Find an exercise buddy.
  • Look for an appropriate exercise class.
  • Stay in the habit of doing some exercise each day.
  • Stay in the habit of doing some exercise each day.
  • Vary your exercise routine and rotate your exercises.
  • Evaluate your progress and enjoy your success.
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Modify Your Activities

  • Modify Your Activities and Use Self-Help/Assistive Devices
  • Proper body mechanics can lead to less strain on your joints. The following        activity  modification guidelines may be helpful:
  • Practice good posture by standing up straight.
  • Avoid stooping while standing.
  • Avoid sitting in low chairs to reduce stress on your knees when sitting and standing.
  • Avoid impact-loading activities (e.g., running, jumping, etc.).
  • Reduce climbing activities (e.g., stairs, hills, etc.).
  • Avoid any activity that causes prolonged discomfort.

Weight Control

Being overweight puts weight-bearing joints under extra pressure and stress. Because the joints are eccentric (not in the centerline of your body), the force across the joint is three times greater than a person's body weight when that person balances on one leg. For example, a 150-pound person places up to 450 pounds of pressure on the joint. The good news is for every single pound lost, subtract three pounds of force off the hip or knee. The bad news is for every one pound gained, add three pounds of force to the hip or knee. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.

A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. If you have been diagnosed with gouty arthritis, some dietary restrictions are indicated. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to advise you on a weight-loss program to fit your needs.

Simple everyday tasks may be hard to accomplish with arthritis. The following self-help/assistive devices may help minimize pain, discomfort and stress, and assist you in accomplishing tasks. Ask your physician or physical therapist about the following self-help devices.

Support

If you are walking with a limp, consider an assistive device such as a cane, a crutch or a walker. Ask your physician or occupational therapist (OT) about different types of assistive devices and which type is best for you.

Canes

It is important to use canes properly since you can actually stress other joints with an abnormal gait (walking) pattern. Canes should be used in the opposite hand of the affected joint; for example, hold a cane in your right hand if your problem is with your left leg.

Walkers or Crutches

If you are unsteady with a cane or cannot grip it well, you may be able to use either one or two crutches or a walker. This will provide support and balance.
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Use Heat and Cold Treatments

Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.

Heat /Cold

  •   Use prior to activity
  •    Increases blood flow
  •    Improves motion
  •    Decreases joint ache
  •    Helps relax muscles
  •    Use after exercise
  •    Decreases blood flow
  •    Decreases swelling
  •    Better for pain
  •    Reduces inflammation

You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.
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Use Nutritional Supplements

Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.

Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.

Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.

Vitamins C and D. Some studies have indicated that patients low in Vitamins C and D may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.

Calcium. Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. Calcium may accumulate in bone spurs around arthritic joints in response to increased pressure on the joint. However, too much calcium is not the cause of arthritis.

Talk to your physician before taking any medications.
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Control Pain with Over-The-Counter Medications

Simple everyday tasks may be hard to accomplish when your joints hurt. The self-help devices listed below will help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

  • Orthotics to improve foot alignment
  • Braces for knee support
  • Wrist and Hand Splints for rest
  • Jar openers
  • Button threaders
  • Large grips for pencils, garden tools or other hand-held objects.
  • Abdominal supports to reduce stress on the back
  • Long-handled reachers or grabbers to help you pick things up without bending
  • Sock sliders to help you put on socks
  • Canes, Walkers or Crutches reduce stress across the joints


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Control Pain with Prescription Medications

Ask About Injections

Cortisone
Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active. Occasionally, a patient may experience a flare, which increases pain for a few days.

Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.

Always consult your physician before participating in any treatment option.

Hyaluronates
Hyaluronate injections have been approved for arthritis of the knee. They may help relieve osteoarthritis pain and restore joint function. Hyaluronate is a naturally occurring substance in joint fluid that provides lubrication and cushioning to the joint. As osteoarthritis continues to develop, the joint fluid becomes thinner, with less hyaluronate and thus loses its ability to properly lubricate and cushion the joint cartilage.

Several synthetic forms of hyaluronate have been developed to use in the knee joint. In order to be effective, anywhere from three to five injections must be given weekly. The effectiveness is usually not noted for at least a month. Patients do not need to significantly reduce activity following injection. Various studies have indicated maximum effectiveness at anywhere between 50-70%. Studies have shown that the more severe the arthritis, the less effective the injections. However, when effective, the relief may last for 6-12 months. Synthetic hyaluronate is made from rooster combs. Therefore, anyone who is allergic to feathers, chickens or egg products should not receive an injection.

Always consult your physician before participating in any treatment option.
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Bionicare

Bionicare is a new, non-invasive therapy (FDA approved) for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand. A wrap is placed on the affected site and attached to a small battery-powered transmitter for six to eight hours every day. The transmitter sends an electrical signal to the hyaline cartilage cells in your joint. This signal has been shown in animals to stimulate the cells to regenerate the cartilage and reduce the inflammatory enzymes that cause pain and stiffness in joints. Although cartilage growth has not yet been proven in humans, Bionicare has been shown to reduce pain and associated symptoms as well as produce overall improvement of the osteo-arthritic knee1 by physicians' global evaluation. A long-term study has shown that treatment with Bionicare can delay the need for total joint arthroplasty in a majority of patients treated for an average of one year.2

Bionicare is based on technology that has been well established over the past 30 years in stimulating bone cells to produce bone. There have been no adverse effects associated with Bionicare, except for a few patients who developed a rash from the gel.

Positive results probably require treatment for six months or more. Although it is possible to walk around wearing the wrap during the day, most patients apply the wrap at night.

Insurance payment for Bionicare depends on your insurance company, so a request will need to be submitted to the company if you want to be reimbursed. For self-pay patients, and for those who have insurance issues, the company offers a payment plan to help make the product affordable.

2 BioMechanics, April 2005; M. Mont, D. Hungerford, J. Caldwell et al.
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See an Orthopedic Surgeon

An orthopedic surgeon can provide you with all the options and expertise to decide whether surgery is right for you. While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, misalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient's post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

  • Knee Surgery Options
  • Hip Surgery Options
  • Shoulder Surgery Options
  • Ankle Surgery Options
  • Hands/Wrist/Elbow

Closing
We know that arthritis can sometimes make life difficult. We hope this has helped you understand some of the basics of treatment so that you understand your doctor's recommendations. Millions of people suffer from arthritis, but there are numerous organizations committed to helping you live better with your condition. This information is not intended to replace the experience and counsel of your orthopedic surgeon. If you have any further questions, please speak with your orthopedic surgeon.



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Knee Surgery Options

Arthroscopy
Arthroscopy is not helpful if you are suffering from severe arthritis. However, in patients with minimal arthritis, the meniscus within the knee joint can become damaged. The damaged tissue can lead to swelling and pain. You may think you have arthritis when you actually have a meniscus tear. In some cases, your surgeon may recommend a procedure called arthroscopy. Arthroscopy uses tiny instruments inserted into the joint through incisions that are about 1/8 inch long. Using tiny instruments, damaged tissue can be repaired or removed. This may provide relief from both pain and swelling while possibly slowing the development of arthritis.

Total Knee Replacement (Resurfacing Damaged Cartilage)
Your orthopedic surgeon may recommend total joint replacement if you have significant arthritis, and when non-operative treatments do not adequately relieve pain and restore joint function. The term "replacement" implies that a surgeon removes the entire joint during surgery, when in fact, a surgeon actually resurfaces the damaged cartilage found at the ends of the bones in your joint. Think of it as cartilage resurfacing surgery.

Knee replacement implants, typically made from a metal alloy and polyethylene (plastic) are used to resurface the joint. Total knee replacement resurfaces the end of the femur (thighbone), the top of the tibia (shinbone) and sometimes the back of the patella (kneecap). The implants are designed to restore function and eliminate as much discomfort as possible while allowing the patient to return to a more active lifestyle. Newer, less invasive surgical procedures allow rehabilitation and walking to begin the day of or day after surgery. Knee replacement patients usually stay in the hospital for two to three days. Therapy that begins in the hospital will normally continue after discharge for at least two to six weeks.

Total knee joint replacement has been extremely successful in helping patients with arthritis return to their normal activities while also relieving their discomfort.

Unicompartmental Knee Replacement
The knee is composed of three separate compartments. The term "uni" means one. Osteoarthritis sometimes develops in only one compartment of the knee, while the other two compartments are undamaged. Patients who have osteoarthritis in only one compartment may be candidates for a unicompartmental knee replacement.

The advantage of a unicompartmental knee is that the resurfacing occurs only with the damaged portion of the knee, preserving the undamaged cartilage. With this procedure, you may have a smaller incision, a quicker recovery and less bone removal. Many patients are not good candidates for unicompartmental surgery. Your surgeon will determine if a unicompartmental knee replacement is appropriate for you.

Cartilage Saving Operations
There are some operations that are designed to save the cartilage. They are usually only successful when arthritis is localized to a small area and in younger patients.

Microfracture Arthroplasty
Using an arthroscope, small holes are drilled into the exposed bone in an attempt to encourage the cartilage to grow. This has met with some success when the area is not large. The cartilage that grows will not be as strong as the original cartilage. Six weeks of crutches with minimal weight on your leg may be required.

Cartilage Transplantation
Cartilage can be transplanted from your own cartilage or from a donor to an exposed area of bone. Prolonged non-weight bearing may be required while healing occurs. This procedure is reserved for younger patients with small defects and is not recommended for people with significant arthritis.

Growing Cartilage
Cartilage cells can be harvested during an arthroscopic procedure and then grown in a lab for later transplantation. These cells are then implanted. Prolonged non-weight bearing may be required while healing occurs. This procedure is reserved for younger patients with small defects and is not recommended for people with significant arthritis.

Osteotomy
A bowlegged or knock-kneed deformity can cause increased pressure on one side of the knee. Osteotomy is a technique that attempts to change the angle of the shinbone by either removing or adding a small wedge of bone. The procedure attempts to restore a more natural alignment to the leg, relieving pain and restoring function. It does require a long period of healing and may not effectively relieve all the discomfort. It is used primarily in young, active people who may not be ideal candidates for joint replacement surgery.



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Hip Surgery Options

Total Hip Replacement (Resurfacing Damaged Cartilage)

When non-operative treatment fails to control the discomfort and stiffness from arthritis of the hip, your surgeon may recommend total hip replacement. Hip replacement implants, typically made from a metal alloy and polyethylene (plastic) or from a metal-on-metal alloy, are used to resurface the joint. Total hip replacement surgery replaces the upper end of the femur (thighbone) and resurfaces the acetabulum (socket). The implants are designed to restore function and to eliminate as much discomfort as possible while allowing you to return to a more active lifestyle.

Newer, less invasive procedures have allowed rehabilitation and walking to begin the day of or day after surgery. Hip replacement patients normally stay in the hospital two to three days. Therapy that begins in the hospital will usually continue after discharge for approximately two to six weeks.

Total hip replacements have been extremely successful in helping patients with arthritis return to their normal activities and also relieve their discomfort.




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Shoulder Surgery Options

Pain and stiffness in the shoulder may necessitate a shoulder replacement. The ball end of the shoulder (humeral head) is replaced with a metal ball. The socket (glenoid) may or may not be resurfaced with polyethylene (plastic). Most shoulder replacement patients stay in the hospital for only one to two days. Therapy usually continues for three months or more after discharge.

Ankle Surgery Options

Arthritis of the ankle can be quite painful. Two options exist for the ankle. Fusion of the ankle is the most common form of treatment. Fusion makes the ankle stiff but is very effective in reducing pain. Total ankle replacement is another option. The joint surfaces are resurfaced with metal and plastic much like a total knee replacement.

Hands/Wrist/Elbow

These joints do not require you to bare weight on them therefore can often be treated without surgery. However, in some cases, either fusion of the affected joint or replacement can be performed.
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