Arthritis

An estimated 43 million Americans (one in every 7 persons) have some form of diagnosed arthritis or other rheumatic condition and it is expected to rise to 60 million during the next 20 years. Arthritis affects people of all ages, although it is more prevalent among older adults and women. The disease causes pain, stiffness, and tenderness around the joints and typically affects the hands, feet, knees and hips. It can range from mild to severe. While arthritis rarely kills, it is a chronic disease that causes significant disability and reduces quality of life.

There are more than 100 types of arthritis but the most common forms among older adults are osteoarthritis and rheumatoid arthritis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has developed a fact sheet on Arthritis and Rheumatic Disease which answers some of the basic questions you may have about arthritis and rheumatic diseases.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis and affects nearly 33 million Americans. It is a chronic degenerative joint disease in which there is a progressive deterioration of the cartilage covering the ends of bones in the joint. As bone rubs against bone it causes joint pain and swelling,

OA is no longer considered a normal aspect of aging as it once was. There are significant differences between the normal aging joint and osteoarthritic joints. The amount of pain and disability that OA can cause ranges from mild to severe. It is the most common cause of activity limitations in people age 75 and older. Joint impairment occurs most often in the spine (92%), hands (58%), feet (55%), knees (35%) and hips (20%). Fortunately, early diagnosis and treatment can prevent much unnecessary disability and effective self-management can reduce the impact of this disease.

OA can cause considerable pain and disability. It is the most common cause of activity limitations in people age 75 and older. Joint impairment occurs most often in the spine (92%), hands (58%), feet (55%), knees (35%) and hips (20%). About 60 million Americans (7 percent) have osteoarthritis; by age 65 about 50% of older adults have symptoms of osteoarthritis.

There are a number of risk factors for osteoarthritis. Obesity is a major factor in the development and progression of OA because it imposes additional mechanical stresses on weight bearing joints. Post menopausal women appear at greater risk for OA and tend to be more severely affected than men. Certain occupations and sporting activities that involve kneeling, squatting, climbing stairs, or lifting heavy objects are associated with higher rates of knee or hip OA. Trauma (e.g. sports injury) or inflammatory arthritis (e.g. rheumatoid arthritis, gout) can predispose a joint to OA.

Risk Factors for Osteoarthritis

• Postmenopausal women
• Obesity
• Family history
• Certain occupations and sporting activities
• Trauma
• Inflammatory arthritis

The initial symptoms of OA are painful and mildly stiff joints. Some people feel a "grating" or "catching" in the affected joints. People with arthritis experience pain in the joint with any movement as well as diffuse cramps in the muscles around the affected joints. Often the pain is worse at night.

Symptoms of Osteoarthritis

• Pain and stiffness in the affected joins during or after use
• Occasional swelling
• Joint pain may occur with change in weather
  

While the symptoms of OA in older adults are similar to those of younger individuals, the elderly may be more at risk for other problems as a result of OA. A painful hip may alter the gait of an older person and put them at a greater risk for a fall, which may result in a hip fracture with devastating consequences.

Management of Arthritis

The pain associated with arthritis often results in deconditioning, restrictions in motion, and disability. Individuals need to be educated about exercising, eliminating risk factors, protecting their joints, and including rest periods. Arthritis is effectively managed using a combination of the following.

1. Pharmacologic therapy.

The mainstay of drug therapy arthritis is: Pain Medication.

Acetaminophen is usually the first line of defense for the pain of OA.

Aspirin and Non-steroidal anti-inflamatory drugs are useful in reducing both pain and inflammation. Unfortunately, aspirin or NSAIDs cause an upset stomach in 30% of patients and with long-term use can cause gastrointestinal bleeding or ulcers.

The COX-2 inhibitors are new. These "super aspirins" relieve pain and inflammation with fewer stomach side effects. They are quite expensive and can cost up to $900 a year.

2. Heat and cold. Soaking joints in warm water or using hot packs or electric heating pads can increase circulation, ease pain and relax tense muscles. Applying cold compresses such as ice packs can dull the pain during the initial day or two of a flare-up.

3. Exercise and Rehabilitation. Many of the problems that people with arthritis encounter are attribute to the progression of the disease when, in fact, they are the consequences of prolonged inactivity. People with arthritis tend to have higher rates of inactivity that those in the general population (MMWR, May, 1997). Older adults who limit their activities for prolonged periods are at risk for deconditioning, muscle atrophy, and contractures. People with arthritis can exercise safely and achieve significant benefits.

Physical and occupational therapy is key to educating older adults on how to maintain their functioning by maintaining muscle tone while protecting their joints. An evaluation for assistive devices should be done. A cane or walker can help decrease the stress on the joint by up to 40% and reduce the risk of a fall. Simple tools (e.g. door openers, jar openers) can dramatically improve the independence of individuals.

The Arthritis Foundation has developed a group exercise program called People with Arthritis Can Exercise (PACE) which is designed specifically for people with arthritis. It includes specially designed exercises to help increase joint flexibility, range of motion, maintain muscle strength and increase overall stamina. The program can help reduce pain, stiffness as well as lowering feelings of isolation and depression.

4. Counseling. Arthritis causes chronic pain, deformity and disability which can lead to depression. Counseling may be needed to help individuals cope with the disease.

5. Weight loss. Weight loss can prevent or slow the deterioration of the joints by relieving stress.

6. Surgery. Surgical interventions are one of the major advances in treatment of arthritis. An arthroscopy with joint debridement (e.g., removal of cartilage, loose bodies) is sometimes beneficial when conservative measures don't work. Patients with severe arthritis may need a total joint replacement (e.g. hip, knee). These prostheses can dramatically restore function and range of motion. Intensive rehabilitation is necessary after a joint replacement and the best results are obtained with patients who actively participate in their therapy.