Managing Osteoarthritis and Maintaining Your Mobility

As we age, one of the most common health problems we will all face is chronic joint pain and stiffness due to arthritis. As the nation’s most common cause of disability, an estimated one in five adults in the United States report having doctor-diagnosed arthritis, and it’s estimated that 67 million will be affected by 2030.

The most prevalent type of arthritis affecting Americans is osteoarthritis. Currently, it affects more than 12 percent of the U.S. population (ages 25 and older). Known as the “wear and tear” disease, osteoarthritis most often affects the hands, hips, knees and spine with symptoms ranging from mild to disabling. The disease causes cartilage in the joints, the cushion between the bones that allows for mobility and movement, to slowly deteriorate and eventually leaving bone to rub against bone.

While there is no cure for this chronic illness, according to Manisha Kumar, DO, rheumatologist with Scripps Clinic, patients can find relief from a variety of treatment options and therapies.

“Individuals with joint pain and stiffness that interferes with daily activities of living should consider seeking an evaluation,” said Kumar. “We’ve found that early intervention is the key to slowing the progression of pain and disability related to osteoarthritis. Progression of this disease may not necessarily mirror x-ray changes and may be influenced by a patient’s other medical conditions as well.”

Not only for the elderly

Osteoarthritis usually develops after many years of use, but the disease is becoming more prevalent in younger populations due to obesity and repetitive wear and tear from high impact activities which can cause injuries.

“The misnomer is that osteoarthritis is an ‘old person’s disease,’ but with obesity on the rise in the United States, this is no longer the case,” said Dr. Kumar. “Although most of those diagnosed are over the age of 60, we see patients in their 20s and 30s developing the disease, whether it is weight-related, due to injury, or even secondary causes in individuals with other medical conditions such as rheumatoid arthritis, gout, and hemophilia.”

Studies have shown that maintaining a healthy body weight and being physically active can decrease the progression of osteoarthritis. In fact, for every one pound of weight loss, there is a four pound reduction in the load exerted on the joints. Losing 15 pounds can cut knee pain in half for overweight individuals. And in combination with physical activity, joints will become more flexible and will improve in muscle strength.

Exercise is beneficial for osteoarthritis patients, but Dr. Kumar cautioned that certain exercises should be modified if they provoke pain. This could mean switching from high-impact activities such as running to low-impact exercises such as cycling and swimming. Patients also should protect the joints from injury during exercise by wearing appropriate exercise gear and shoes to prevent unnecessary injury that can lead to further damage.

In addition to life-style changes, many physicians will prescribe acetaminophen, non-steroidal anti-inflammatory drugs and other pain medications to reduce stiffness and pain symptoms that often hinder movement and reduce activity level. Many patients also derive benefit from cortisone injections or injections of hyaluronate given directly into affected joints by rheumatologists or orthopedic surgeons.

Practicing an integrative approach

At the Scripps Center for Integrative Medicine (SCIM), some patients are finding relief with complementary treatments. Robert Bonakdar, MD, FAAFP, director of integrative pain management at SCIM and a member of the Arthritis Foundation Medical Advisory Committee, incorporates complementary options such as acupuncture, herbal medicine and stress reduction techniques in order to provide optimized, integrative care for chronic conditions, such as osteoarthritis. Often Drs. Kumar and Bonakdar will collaborate with patients to develop a comprehensive treatment plan that encompasses lifestyle management, complementary treatments and dietary supplements.

“Supplements can play a huge role in a person’s ability to combat disease – especially if there is a deficiency. We think that all supplements are equal, but they’re not. The thousands of brands that supposedly aid arthritis prove this is not true. There is no one magic pill,” said Dr. Bonakdar. “With our patients, we try to identify their deficiencies and prescribe various supplements that will meet their individual needs, whether it’s a Vitamin D, a magnesium deficiency or a well-researched brand.”

Exploring surgical options

If early treatments and therapies do not stop the pain or if they lose their effectiveness, surgery may be a viable consideration for those with advanced osteoarthritis. However, the recommendation to treat surgically depends on age, activity level, condition of impacted joints and the progression of osteoarthritis.

Joint replacement and arthroscopy are two of the most common surgical treatments provided to those patients suffering from the disease. While arthroscopy is minimally invasive, replacement is usually done as a last resort when physical therapy and other surgeries have failed.

Searching for a cure

Although there is no one cure for patients suffering from osteoarthritis, with hundreds of clinical trials taking place across the country, scientists at the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic believe they are steps closer to finding a cure for future generations of sufferers.

A multidisciplinary team of experts at SCORE are finding promise in the use of stem cells in the treatment of osteoarthritis. They are using laboratory experiments and animal models to determine whether adult stem cells and embryonic stem cells can be coaxed into cartilage-generating cells and successfully transplanted. The research is a part of a $3.1 million grant from the California Institute of Regenerative Medicine.

“We’d like to develop stem cell therapies with the potential to repair focal cartilage lesions and arthritic cartilage. In the laboratory, we have already succeeded in repairing defects in articular cartilage,” said Darryl D’Lima, MD, PhD, SCORE’s laboratory director. “Our ultimate goal is to use these stem cells to repair joint wear-and-tear and stop the progression of the disease. It looks very hopeful.”

Their research is a few years from clinical trials, but Dr. D’Lima and colleagues believe their work could one day be used to alleviate pain, disability and cost associated with the disease.