Women's Issues
Osteoarthritis Information
by Carolyn Ross, MD

The Many Types of Arthritis

Arthritis, one of the most common of all illnesses, is actually not a single disease, but includes many different conditions, each having its own course and cause. What they all have in common is that they affect the joints in the body.

Osteoarthritis Symptoms

Osteoarthritis, also called degenerative (or 'wear-and-tear') joint disease, occurs when the smooth cartilage and bone beneath begin to break down, being replaced with projections or spurs. The cartilage erodes gradually, finally allowing bone to grate painfully on bone. The initial cartilage deterioration usually goes unnoticed because the nerve endings in the joint haven't yet been affected. Pain appears gradually, commonly after age 40, and may progress in the early stages from discomfort only after the joint is used, to constant pain, even during sleep in later stages. The joints most often affected are the neck, back, hips, knees, feet, the base of the thumb and the middle and end joints of the fingers.

Your Physician or Nurse Practitioner

Your physician or nurse practitioner will evaluate your condition by taking a history of your health as well as onset and symptoms of your condition. This will be followed by a physical exam and special tests, such as x-rays. Interestingly, by their mid-50's, almost 80 percent of women will show some evidence of osteoarthritis on x-ray.

Osteoarthritis Medications

Medications can allow you to be active and mobile, since they control pain and thus allow you to maintain joint movement. This may slow the progression of the disease. The most common medications for arthritis include anti-inflammatory drugs and appropriate over-the-counter pain medications. Work closely with your physician or nurse practitioner to find the drug that works best for you with the fewest side effects. Finally, heat therapy in the form of hot compresses or hot baths or showers may warm up the affected joint and improve diminished flexibility.

Chiropractic Care for Osteoarthritis

Chiropractic care, which especially focuses on your musculoskeletal health, is an important component in your management of osteoarthritis. Your chiropractor will evaluate your particular condition using their unique 'hands-on' approach, and provide the right spinal adjustments, heat or muscle therapy. They can also recommend appropriate range-of-motion or strengthening exercises.

Acupuncture and Traditional Chinese Medicine (TCM) for Osteoarthritis

Your TCM practitioner can provide you with some significant pain relief for osteoarthritis. Acupuncture and herbal formulas help the pain and swelling of arthritis the most in its early stages, since TCM works best to prevent progression of the disease. It cannot reverse actual joint damage. In the early stages, a course of acupuncture will be given twice per week with herbal pills daily for a period of two to three months.

For chronic arthritis, a regular course of herbs normally control pain with treatment after four weeks. TCM can help reduce continued use of medication for pain management, since acupuncture allows the body to create more natural pain-killing chemicals, and increases local blood circulation to reduce swelling.

Stress Reduction

Your attitude and the way you handle stress both play a large part in managing your pain and achieving a good quality of life despite your arthritis. One study showed that people who reported high levels of stress experienced much more pain than those who reported low stress levels. Some simple, stress-relieving exercises performed on a regular basis can bring you a feeling of peace and calm. Following are a few of the many techniques you may wish use or learn more about:

• Massage--a delightful way to relax tense muscles and experience healing touch.
• Deep abdominal breathing--induces a state of peace and relaxation and counteracts the shallow breathing that can often be induced by stress.
• Progressive relaxation--a gradual relaxing of muscles, head to toe, which helps you discover and correct tight muscles.
• Affirmations and visualization--create the mind-body connection to enhance relaxation and natural pain control.
• Meditation--calms the mind and relaxes the body.

Social Support - The Love and Help of Others

Don't overlook the value of social support and 'connectedness' with other people in your life. It is not so much the quantity, but the quality of our relationships that helps us to manage stress and cope with pain. When you express your concerns about your pain or arthritis to friends, relatives or medical personnel, it will enhance their understanding of your needs and help them support you.

Osteoarthritis Diet

• A balanced diet that includes fruits and vegetables, whole grains, calcium-containing foods and appropriate amounts of lean protein is your best basic plan in dealing with osteoarthritis. This will help get you the majority of nutrients you need from your food.
• Be sure to drink plenty of fluids and water.
• Managing your weight is also extremely important. Excessive weight puts unnecessary pressure on your joints, thus worsening osteoarthritis.
• If you have questions concerning an appropriate caloric intake for you, you may wish to consult with a nutritionist or dietician. In addition, following are more specific recommendations:
  • Get adequate calcium (see below).
  • Eat fish containing omega-3 fatty acids (herring, mackerel, salmon).
  • Get adequate protein (through whole grains and beans or 5 oz. of lean meat, chicken, fish, etc. per day)
  • Eat high-quality complex carbohydrates (fruit, vegetables, whole grains and legumes). To avoid getting too many carbohydrates, limit your consumption of sugars and processed flours.
  • To ensure adequate intake of vitamins C and E and zinc, eat foods containing these nutrients.
    • Vitamin C- citrus fruits, strawberries, cantaloupe, dark green vegetables, tomatoes, etc.
    • Vitamin E- plant oils, green and leafy vegetables, wheat germ, whole-grain products, liver, nuts and seeds.
    • Zinc- meats, fish, poultry, grains, vegetables.
  • Take pain medication with food to avoid stomach irritation.

Special Note on Calcium

The average American woman falls short of the 1,200 mg RDA for calcium, taking in only about 400 to 500 mg. Both the National Osteoporosis Foundation and the National Institutes of Health recommend that postmenopausal women take 1,500 mg daily to compensate for calcium loss. If your diet is already rich in calcium, you may wish to take 1,000 mg per day. These dosages are safe for the majority of women; however, check with your physician if you have a personal or family history of kidney disease.

Not all calcium supplements are equally well absorbed. An acidified form of calcium called calcium citrate is best, followed by the less expensive calcium carbonate. Calcium lactate and calcium gluconate are quite poorly absorbed. Take calcium pills with meals and in divided doses to further enhance absorption.

Osteoarthritis and Exercise

You may have wondered about physical activity and osteoarthritis. If the damage is partially caused by wear and tear on the joints, won't exercise make that worse? The answer is a definite "no"--but you must choose the right activities, ones that protect your joints. In fact, the saying "use it or lose it" really applies to your arthritic joints. Maintaining mobility through use of the joint is vital in preventing stiffness and eventual immobility. The kinds of exercise that will benefit your arthritis include range-of-motion, muscle strengthening and aerobic activity.

• Range-of-motion exercises are designed to take each joint through its full movement pattern. Routine daily activities normally do this, but arthritis sufferers unconsciously favor tender joints. So make the commitment to choose daily exercises to gently stretch and move affected joints. Start by repeating each exercise 2 or 3 times twice a day and progress to 10 repetitions 4 times per day.
• Muscle strengthening exercises are important to help prevent the weakened muscles so common around affected joints.
• Weight training which involves movement of the joint against resistance should be undertaken only under the supervision of a physical therapist. You can safely do isometric exercises (contracting the muscle without moving the joint) on your own.
• Finally, select a moderate low-impact aerobic activity to avoid any trauma to your feet, knees and hips. Activities that qualify include walking, biking or stationary cycling, or water activities in a pool heated to at least 80 degrees. Try to accumulate about 30 minutes of aerobic activity most days of the week, but make it a goal not to drop below four days.

General Guidelines for Exercising with Osteoarthritis

1. Coordinate your medication to receive maximum benefit during your exercise session.
2. Prior to exercise, use a warm bath, shower or hot pack to increase flexibility; apply cold to reduce joint pain.
3. Check with your physician before beginning an exercise program.
4. Start slowly and gradually increase your repetitions for range-of-motion and strength exercise and duration for aerobic sessions.
5. If you experience pain, stop to rest, then resume at a slower pace.
6. Cut back on your sessions if joints are more painful the following day or are still painful two hours after exercise.
7. Always warm up before exercising. Gently move the joints and muscles you'll be using to lubricate the joint and increase muscle circulation.
8. Never exercise to strain or exhaustion.
9. To increase your enjoyment, exercise with a friend, accompanied by music or in a beautiful setting.