Although there is no cure for osteoarthritis, you can manage it in a way that minimizes symptoms. Your treatment regimen will focus on relieving pain, improving joint movement, and maintaining quality of life.
Call your doctor if your joint pain is accompanied by fever. If this happens, you may have infectious arthritis, which can result in permanent disability if left untreated.
Exercise is one of the most effective treatments for osteoarthritis Table 02. Exercise can help reduce pain, increase flexibility, strengthen muscles, and improve overall function of the affected joint. The type and amount of exercise you get will depend on which joint is affected and the severity of your condition.
Seek the advice of your doctor or nurse before beginning an exercise program. Your health care provider may recommend that you work with a physical therapist who can evaluate how your joints are moving and help you to develop a safe, personalized exercise program. In addition to suggesting the exercises that are best for you, the therapist will show you how to warm up safely, when to stop exercising, and when to rest an affected joint. Regularly scheduled rest is an essential part of an osteoarthritis treatment plan.
The three types of exercise most important to osteoarthritis management are: 1) range-of-motion (flexibility) exercises Figure 04; 2) aerobic conditioning; (defined as 20 minutes or more of increased heart rate); and 3) targeted muscle-strengthening exercises.
Figure 04. Knees, hips, and lower back stretch
Figure 05. Hand stretch
Figure 06. Hip stretch
Figure 07. Assistive devices
Aerobic conditioning exercises improve overall strength and fitness, and help to control weight, which reduces the stress on your joints. The type and extent of your aerobic exercise program will depend on a variety of factors, including your general health and the location of your affected joint. Good aerobic activities for people with osteoarthritis include swimming and walking. Some people with osteoarthritis are able to pursue more strenuous aerobic activities, such as running, biking, and cross-country skiing.
Muscle-strengthening exercises can help protect joint cartilage from stress and further degeneration, increase joint function, and reduce pain. Studies have shown that several weeks of strengthening the muscles surrounding the knee, for example, can sometimes be as effective as taking nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing osteoarthritic pain in that joint.
Maintain a healthy weight to prevent extra stress on weight-bearing joints. Regular exercise will make this an easier goal to attain, but you should also watch what you eat and keep your portions small.
If you have osteoarthritis of the knees or hip, avoid kneeling and squatting, as well as standing for long periods of time.
However, you should not keep your joint totally motionless. If you don't use your joint, the muscles surrounding it may shrink and become weaker (atrophy), making movement even more difficult.
Never exercise a joint that is tender, injured, or severely inflamed. Be sure to stop exercising as soon as you feel pain. If the pain lingers for more than two hours after ending the exercise session, you have probably overworked the joint. Take an over-the-counter pain reliever and rest the joint until the pain subsides. Next time you exercise, reduce the length or intensity of your workout.
If you have severe osteoarthritis of the knee or hip, you may benefit from using a cane when walking. The cane helps to reduce the amount of body weight that is loaded onto the affected joint, thus reducing pain. If both knees and hips are involved, you may need to use crutches or a walker.
Assistive devices may help you perform everyday activities that your sore joints may have difficulty with, such as buttoning your shirt, putting on socks or using the bathroom Figure 07.
Try wearing insoles or cushioned shoes to reduce stress on the knee joint. Splints or braces can also offer extra support for weakened joints. Your doctor or physical therapist can help you get properly fitting shoes, splints, and braces.
Applying heat or cold to the affected joint may help reduce pain and stiffness. For heat, you can use warm towels, hot packs, or take a warm bath or shower. You can make a cold pack by wrapping a bag of ice or frozen vegetables in a towel; you can also purchase a commercial cold pack and store it in your freezer. Do not use cold packs if you have circulatory problems.
Table 2. Self-care Checklist
Exercise regularly Maintain a healthy weight Rest joints periodically throughout the day Use good posture to relieve stress on joints Control pain through medication and other measures Apply heat or cold to joint to help reduce pain and stiffness Wear cushioned shoes, splints, or braces to support weakened joints
Your doctor is the best source of information on the drug treatment choices available to you.
Physical therapy is often recommended for treating osteoarthritis. Such treatment may include massage or manipulation of the joints by a trained therapist. Your doctor may also recommend water exercises (hydrotherapy), preferably in a heated pool; the water allows you to exercise the joints without putting undue stress on them.
Although most people with osteoarthritis never need surgery, some limited procedures may help to relieve the pain and disability of the condition.
Surgery is performed to shave or smooth out the cartilage, or remove loose pieces of bone or cartilage from the joint.
Arthroscopy is a surgical procedure where a small fiber optic television camera is inserted into the knee joint through a very small incision that is only about ¼ inch long.
The surgeon can then move the camera around inside the joint while watching the pictures on a television screen. The structures inside the joint can be poked and pulled with small surgical instruments to see if there is any damage and to clear a joint of loose bone and cartilage fragments.
Because this procedure involves only a small incision, you won't need to be admitted to hospital for an overnight stay. You will probably be feeling fine and moving around normally within a few days.
Another surgical procedure for osteoarthritis is called osteotomy. During this procedure the surgeon cuts and resets bones to realign the joint. Osteotomies are usually performed on knee and hip joints, and are generally recommended only for active, younger patients who are involved in vigorous physical activity. Studies have shown that the procedure can decrease pain and delay by several years the need for total joint replacement.
Surgeons sometimes recommend arthrodesis, or “joint fusion,” when joints are seriously damaged. During this procedure, the joint is surgically fused so that it is no longer capable of movement. Arthrodesis is most commonly done on the ankles and the wrist.
If all other attempts at treating your osteoarthritis fail, your doctor may recommend that you have surgery to replace a damaged joint with an artificial joint. Although this procedure, known as arthroplasty, can be performed on any joint except those of the spine, it has been proven most successful on knee and hip joints. For many patients, total joint replacement provides significant relief of pain and restores the affected joint to almost full mobility within weeks of the surgery.
Calcium supplements can help keep bones and joints strong. Older women, who lose considerable bone density after menopause, should be especially vigilant about getting enough calcium. Because too much calcium can lead to kidney stones, you should talk to your physician about what dosage is right for you.
Some people have found acupuncture to be effective in reducing joint pain caused by osteoarthritis. Remember that only a licensed acupuncturist should do the procedure and its effectiveness has not been proven.
Alternative therapies should never be used as a substitute for a doctor's care. Be sure to get your doctor's approval before using alternative treatments.
Osteoarthritis is a disease that generally gets worse over time and it cannot be cured. However, the pain and stiffness associated with the disease frequently responds to medical treatment and self-care techniques. Unlike other forms of arthritis, osteoarthritis does not spread throughout the body. It can, however, affect more than one joint.
The progression of the disease varies from one person to another. Osteoarthritis does not always become disabling. Some people whose disease shows up on x-rays never experience noticeable symptoms.
If symptoms worsen, call your doctor.
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