Arthritic aches and pains don’t have to be the hallmarks of aging. A more comfortable life is within reach.
By Alyson Black
A Common Complaint
Osteoarthritis, the most common form of arthritis, affects more than 27 million Americans. If you’re one of them,you already know the signs: pain, stiffness, a loss of flexibility. Most of this is caused by everyday wear and tear over time. “Think of baseball players,” says rheumatologist David A. Worth, MD. “They traumatize their joints from an overuse of their shoulder, their wrist. Those injuries contribute to osteoarthritis and wear and tear. Non-athletes can experience the same thing, most often in the hands, hips, and knees. As we get older, we ache a little in the morning. But once people are up and moving about, they’re often much more comfortable.”
Living With RA
Unlike osteoarthritis, which develops in response to wear and tear, rheumatoid arthritis (RA) is actually an autoimmune disease that causes severe inflammation, resulting in the destruction of joints. RA can strike at any age and often affects younger people, though Nucatola explains that common peaks are seen early in life and then again later in life, typically between 50 and 70 years of age. Medications can shorten the duration of the disease, but it’s a group of researchers in the U.K. who may really hold the key to unlocking the cage of RA. Scientists at Britain’s Newcastle University have begun the first phase of clinical testing on a new RA vaccine, which is purported to work by altering a patient’s white blood cells to turn down an overactive immune system.
The Truth About Gout
Gout, a severely painful form of arthritis characterized by sudden onset, redness, and swelling, is seen frequently in aging populations. It occurs as a result of high levels of uric acid, usually owing to diet, kidney disease, or genetics. Your body produces uric acid when it breaks down purines, substances that are found naturally in your body and in certain foods, including organ meats, anchovies, asparagus, and mushrooms. Normally, uric acid dissolves in the blood and passes through your kidneys into your urine. But if your body manufactures too much uric acid or your kidneys excrete too little, the acid can build up, forming sharp, needle-like urate crystals in or around a joint. It’s these crystals that cause sufferers so much pain.Though gout is more common in men than in women, women become increasingly susceptible after menopause. And both genders should be excited to learn about febuxostat (Uloric), the first new gout medication to receive FDA approval in 40 years.
What You Can Do
The best defense against osteoarthritis is a combination of diet and exercise. Eating a proper diet will help you maintain a healthy weight and avoid obesity, which makes people especially prone to the disease; exercise is useful for maintaining muscle tone, which helps to support the joints themselves. “People have to understand the impact their lifestyle has on their joints, particularly weight-bearing joints,” says Nucatola. “The choices you make early in life do catch up with you later. There is a lot to be said for diet and exercise.”If prevention is no longer an option, pain management is key. For most people, a combination of rest, ice, heat, and over-the-counter pain relievers offers enough help in dealing with symptoms. But if those don’t do the trick, a primary care physician will likely refer you to a rheumatologist. Explains Worth: “We treat with stronger medications that other doctors may not want to use. Our goal is to make people functional—to make them comfortable at work and at home. Some things work out, some things don’t. We work with the patient. They have to be comfortable enough to call at the first sign of a side effect. A lot of these drugs require constant monitoring. We fine-tune each plan to the individual, and go by specifics rather than generalizations.”
Alternative Therapies
Pills and injections aren’t necessarily the only remedies, and they don’t work for everyone. “There are physiological changes that happen in the human body that we just can’t change,” says Nucatola. “You can’t do things at 50 that you could do at 25, and you shouldn’t try. We grow up with the idea that we can do anything, but it’s not realistic. Things do change. There are modifications to be made that a pill can’t address.”Nucatola explains that simple changes can go a long way: “I frequently recommend physical therapy and occupational therapy to help patients learn how to use their joints properly. Physical therapy can take stress off joints. And through occupational therapy, a lot of people are surprised to discover that changing the size of the barrel of their pen or learning how to move a pot on the stove can make a difference.”
Other options include paraffin-wax treatments to soothe hand joints, acupuncture, water therapy, and stretches. Changing home and work environments can help, too. “There may be ergonomically unsatisfactory conditions that are affecting you,” says Worth. “Your chair may be throwing off your posture, or maybe you’re not sitting properly at your computer.
“The nice thing about rheumatology these days is that we have so many treatment options that we didn’t have before,” he says. “It’s really miraculous what’s happened in medicine in the past five years. But we try the simple things first—things that are easier, cheaper, and have fewer side effects.”
For a referral to a rheumatologist, call (866) 819-1939.
Bare Bones
In caring for painful and inflamed joints, rheumatologists regularly come across bones in need of help, too. Osteoporosis, a potentially dangerous demineralization of bone that leads to significantly increased risk for fractures, is of particular concern with post-menopausal women. “Bones are constantly in a state of flux,” says Jodi Sebastian, MD, of Atlantic Rheumatology & Osteoporosis Associates. “We reach peak bone density in early adulthood; after that, it’s a matter of retaining as much density as possible.” To test for osteoporosis or its precursor, osteopenia, doctors rely on DEXA scans, X-rays that measure bone density against the standard of a healthy young woman. “The idea is that if you catch someone who has osteopenia, you can decrease their chance for progression to osteoporosis,” says Sebastian. “Similarly, if a patient’s scan reveals the presence of osteoporosis, we can intervene so that she doesn’t lose even more bone density.” Prescription drug therapies like Fosamax and Actonel can help stop the progression of osteoporosis, but to decrease your risk for developing it in the first place, Sebastian offers these suggestions:
Exercise. Sure it’s a great way to build muscle and endurance, but exercise also helps to build and maintain bone density.
Don’t smoke. Smoking has a significant effect on accelerating bone loss.
Consume proper amounts of calcium and vitamin D. Depending on your age, this may range from 1,200 to 1,500 mg of calcium, plus 400 to 800 IU of vitamin D. Check with your doctor to determine your individual requirement.
April 2009
