FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

EXERCISE, MEDICATION KEYS TO LIVING WITH OSTEOARTHRITIS

Question: I have suffered with arthritis since I was in my late 20s. My doctor gives me medication that helps keep the pain under control, but I'm concerned that I may become crippled by it. Does osteoarthritis always become crippling?

Answer: Arthritis is defined as inflammation of a joint. Osteoarthritis just one of many types of arthritis is characterized by roughened and misshapen joint surfaces and involves one or more areas such the fingers, knees, hips, feet, or spine. Even though the joints are distorted and painful, their range of motion is usually still fairly good. And despite the requirement for inflammation in the definition of arthritis, the amount of inflammation in osteoarthritis is usually small.

Osteoarthritis is by far the most common type of arthritis. It is estimated that there are 60 million Americans who suffer with this condition. One third of adults age 25 to 75 have X-ray findings of osteoarthritis of the hands, feet, knees or hips, even though 40 percent of them have no other symptoms of the disease. Osteoarthritis can be mild and almost unnoticed or it can be severe and crippling. It is the illness responsible for 5 percent of disability retirements. Arthritis is second only to heart disease in this regard. So, your concern about becoming crippled is justified.

Question: Should I be doing anything besides taking my medication to prevent my arthritis from becoming crippling?

Answer: No one has discovered a cure for osteoarthritis, at least not yet. The best treatment for the condition requires establishing the proper balance between exercise to maintain muscle strength and joint mobility, rest to reduce the stress on the arthritic joint or joints and medication to reduce the pain and inflammation.

Physical therapy is an important part of arthritis treatment. Specific exercises are prescribed to strengthen muscles without putting excessive stress on the arthritic joints. Heat, braces and other physical modalities are also often beneficial. The purpose of physical therapy is to maintain the ability to do one's necessary activities in a normal or near normal fashion. There is usually a reduction in discomfort, too. However, that benefit should be considered a bonus. It's not the primary reason for sticking to a physical therapy program.

Medication can help control the pain and minimize the inflammation of osteoarthritis, but it can't slow its progression. The drugs most commonly used are in a "family" of non-steroidal, anti-inflammatory medicines. Aspirin is the oldest member of this family, but there are quite a number of close and distant relatives. These anti-inflammatory medications are sufficiently different that your doctor may ask you to try several before you find one that gives you good relief of pain and stiffness.

The pain of arthritis can also be helped with medications other than anti-inflammatory drugs. Acetaminophen, commonly sold under the brand name Tylenol, is an affordable and safe medication for arthritic pain. It can even be taken along with an anti-inflammatory medication. Another medication, Zostrix, is applied like a liniment and gives satisfactory relief of pain to some people. There are even electrical devices called Transcutaneous Electrical Nerve Stimulation (or more simply, TENS) units that block the signals along pain nerves and give good relief to some who suffer from arthritic pain.

Unfortunately, none of these measures alone or all of them in combination can guarantee that your arthritis will not progress to the point of producing a crippling disability. Follow your doctor's advice. Use all the modalities that he or she recommends to maintain your comfort and your ability to perform the tasks you must do. Even if, and I stress the "if," your arthritis progresses to a crippling stage, there are many joint replacement surgeries than can help restore your mobility and reduce your discomfort.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.