Could Your Joint Pain Be Arthritis?

Some joint pain can be relatively innocuous—perhaps you overexerted yourself at the gym without warming up properly, or overdid the yard work. But constant joint pain may be a sign of something more serious, and should be checked out by your doctor. A number of conditions can result in joint pain, but the most common cause in older adults is arthritis. There are more than 100 types of arthritis, but the two main types are osteoarthritis and rheumatoid arthritis. It’s important that you find out if your aching joints are caused by arthritis because getting diagnosed means that you can learn how to protect your joints from further damage, and find a treatment regimen that eases pain and stiffness sufficiently for you to remain as active as possible.

Osteoarthritis The ends of the bones that make up a joint are covered with cartilage: a smooth, slippery tissue that acts as a shock absorber, protecting bones from the friction of movement. Unfortunately cartilage loses its elasticity and strength as we age. This means it becomes more likely to split and tear under stress, and loses its bone-cushioning properties (see image). This leads to the most common form of arthritis in older adults: osteoarthritis, or “wear and tear” arthritis. “In osteoarthritis, the ends of bones begin to grind against each other as cartilage wears away, causing pain as the bone surfaces chip and decay,” says Michael Bronson, MD, PhD, chairman of orthopaedic surgery at Mount Sinai.

Obesity a Main Risk Factor You’re more likely to develop osteoarthritis if you are obese (obesity also raises the risk that osteoarthritis will progress to become severe within 10 years), have suffered a previous injury to a joint, or your joints come under repeated heavy use. Smokers and people with type 2 diabetes (the type that develops in later life) are at greater risk too. “There also may be a genetic component,” Dr. Bronson says. “Some people are born with a defect in their production of the collagen that is a key component of joint cartilage.” Anatomy also may factor in: Some studies suggest that unequal leg lengths and flat feet may lead to osteoarthritis.

Larger Joints Most Vulnerable The joints most often affected by osteoarthritis include the knees, hips, ankles and spine, but the disease also can affect the shoulders, hands, and feet. The pain initially worsens during activity and gets better during rest, but as the disease advances, pain may occur even when the joint is not being used. The pain of osteoarthritis is generally described as aching, stiffness, and loss of mobility—some people also experience muscle spasms and contractions in the tendons around the affected joints.

Relieving the Pain Many people find non-drug methods of pain relief effective for arthritis. Research suggests that acupuncture can help ease osteoarthritis pain (you can find a local acupuncturist at www.acufinder.com), while massage eases stiffness and preserves range of motion. Heat and ice packs also may help.

If you need to take painkilling drugs, acetaminophen (Tylenol®) is recommended over nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®), which are associated with gastrointestinal bleeding in older adults. Acetaminophen is considered safe, but watch your intake, since too much can harm your liver. Judith Beizer, PharmD, clinical professor at St. John’s University College of Pharmacy and Health Sciences notes that acetaminophen is a common ingredient in many over-the-counter medications (most notably cold and flu remedies) and recommends you check labels to avoid overdosing. The toxic dose of acetaminophen is 4,000 milligrams (mg) per day. “Older adults should limit their intake of the drug from all sources to no more than 3,000 mg unless their doctor prescribes higher doses,” Beizer says.

Important to Keep Moving While joint discomfort can put you off exercising, research suggests that regular moderate exercise may alleviate pain and stiffness, and slow the progression of osteoarthritis. “Exercise strengthens the muscles that provide support to your joints,” says David Thomas, MD, professor of medicine and rehabilitation medicine at Mount Sinai. “Weak muscles provide less support, which increases the stress placed on joints.” Physical activity also can help with any efforts you may be making to shed excess weight, which you should aim to do. A study published in the August issue of Radiology found that overweight or obese adults with knee osteoarthritis who lost 5 to 10 percent of their body weight experienced slower degeneration of their knee joint over four years, compared with people who did not lose weight. If you find exercise especially painful, taking a dose of acetaminophen 30 minutes before may allow you to exercise more comfortably. Also try exercising in water, which offers your joints relief from the weight-bearing impacts that come with other forms of physical activity. Ask at your local pool about senior aquarobics sessions.

If you don’t gain relief from conservative treatment, you may benefit from joint replacement—discuss the options with your doctor (see our October issue for information on hip replacement).

Rheumatoid Arthritis Cartilage is also diminished in rheumatoid arthritis, but it’s for a different reason. Rheumatoid arthritis is an autoimmune disease in which immune system cells attack the synovium: a thin layer of soft tissue that lines joints. “Chemicals released by the immune cells cause the synovial tissue to become inflamed,” explains Olivia Ghaw, MD, assistant professor of medicine (rheumatology) at Mount Sinai. “This eventually damages the cartilage and bone, making the affected joint swollen, stiff, and painful.”

Women are at greater risk for rheumatoid arthritis, though men can develop it too. As with osteoarthritis, obesity and smoking also increase vulnerability to the disease. There is a strong genetic component too.

Smaller Joints Affected First RA typically affects the smaller joints in the hands and feet first, and may progress to the elbows, shoulders, knees, hips, jaw and neck. In most cases symptoms occur symmetrically, developing in the same joints on both sides of the body.

Medications Can Slow Disease Progression There’s no cure for rheumatoid arthritis but painkillers can ease the discomfort. You’ll also likely be prescribed disease-modifying antirheumatic drugs (DMARDs) such as methotrexate  (Otrexup®), which slow the course of rheumatoid arthritis. Other drugs, called biologics, are an option for severe disease that doesn’t respond to DMARDs—options include etanercept (Enbrel®) and adalimumab (Humira®). These suppress the immune system, which lowers resistance to infections, so you’ll be advised to get tested for tuberculosis before taking them.

Try Physical Therapy and Lifestyle Modifications Physical therapy can help you maintain range-of-motion in your joints, and if your hands are affected, occupational therapy can help you find easier ways of completing tasks that rely on manual dexterity. A recent study suggests that it might be worth looking to your diet when it comes to easing symptoms—researchers writing in Arthritis Care & Research, June 21, found that people with rheumatoid arthritis who ate fish twice a week had less swelling and tenderness in their joints than people who never ate fish or ate it less than once a month. “You also should quit smoking if you still engage in the habit, since it can affect your response to treatment,” adds Dr. Ghaw. 

It’s vital to monitor your overall health if you have rheumatoid arthritis, since the disease is associated with a greater risk for cardiovascular and lung disease, blood clots, and possibly atrial fibrillation (a leading stroke risk factor). Follow your doctor’s advice for lowering your risk factors for these conditions, as well as treating them.   

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