Easing the ache

Osteoarthritis pain can be debilitating. Strategies can help get you moving again.

Pain from osteoarthritis is more than just a nuisance. Knee pain, in particular, can not only keep people from exercising, but also have a chilling effect on their ability to participate in social activities, especially those that involve walking or traveling, says Elena Losina, the Robert W. Lovett Professor of Orthopedic Surgery at Harvard Medical School and co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital.

"In fact, the quality of life of a person with persistent pain due to knee osteoarthritis is similar to quality of life in women with metastatic breast cancer controlled by therapy," she says.

Arthritis can produce a range of symptoms from pain to stiffness. "The patterns of pain differ from person to person, but it often comes in waves or flares," says Losina. "Also, evolving data show that while pain may fluctuate between flares, a relative minority — 10% to 15% — of knee osteoarthritis patients experience a steady worsening."

Arthritis symptoms and causes

Osteoarthritis is the most common type of arthritis, affecting nearly half of all Americans over 65. It results from the deterioration of the cartilage that acts as a cushion between the bones in a joint. A number of factors can cause cartilage to break down, including general wear and tear from friction and pressure on the joint over time, injuries, and even your genes, as osteoarthritis tends to run in families. Obesity is also a risk factor for osteoarthritis.

As the cartilage padding wears thin, the bones begin to rub together, causing pain and in some cases spurring, an overgrowth of bone as it attempts to heal. All this can lead to inflammation and tissue damage in the surrounding area.

Symptoms of arthritis typically develop over time and may include

• pain and swelling after activity
• joint stiffness in the morning
• a grinding sensation with movement.

Life with osteoarthritis

Living with arthritis pain can be a challenge, but there are numerous strategies you can use to manage it. There is not yet a treatment that can reverse the underlying joint damage caused by osteoarthritis, Losina says, although several pharmaceutical companies are pursuing disease-modifying agents.

Current treatments for osteoarthritis instead focus on relieving symptoms. They fall into three categories:

Nondrug therapies. These include exercise (one of the most effective treatments currently available) and physical therapy, says Losina. Regular exercise can reduce stiffness, pain, and fatigue. But it can be a challenge to get moving if you aren't exercising regularly already. Try starting off slow, with simple activities such as regular walks.

Drug therapies. Doctors often treat osteoarthritis with nonsteroidal anti-inflammatory drugs, which relieve swelling and pain. Examples include ibuprofen (Advil) and naproxen (Aleve). "There is also evolving research on the role of the antidepressant duloxetine [Cymbalta] and muscle relaxants," says Dr. Losina.

A strategy that has come under scrutiny in recent years is the use of corticosteroid injections to treat pain. This treatment, in which a doctor injects a strong anti-inflammatory medication into the joint, is often used to temporarily relieve pain in people who aren't responding well to other medications or nondrug strategies.

"Recent data suggest that pain control from corticosteroid injections is limited to the short term," says Losina.

These injections may actually lead to more damage to the joint. This means that while you may alleviate pain in the short term, you're making the joint worse in the long term, which could make it harder to control symptoms over time.

Surgery. Joint replacement is sometimes an option for people who aren't seeing success with other strategies. A total knee replacement, for example, can be used to alleviate pain for people with severe knee osteoarthritis.

"It is shown to be effective, leading to substantial pain relief in about four out of five recipients," says Losina. Having this procedure can help many people with severe osteoarthritis regain function in their joint. The replacement can last for 15 to 20 years.

To find the best treatment for your condition, you should discuss your options with a primary care physician or a specialist, such as a rheumatologist, physiatrist, or orthopedic surgeon.

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