Frequently Asked Questions
Osteoarthritis
| Q. What exactly is degenerative arthritis and is that the same as osteoarthritis? |
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A. Osteoarthritis and degenerative arthritis are interchangeable terms. Generally both define a form of arthritis where cartilage is wearing down or breaking down. Other names that are used and are sometimes confusing are degenerative joint disease, hypertrophic arthritis (which generally refers to the spurring of the spine), degenerative disc disease (again referring to the degeneration of the discs in between the vertebrae of the spine), and erosive osteoarthritis (which refers to a more destructive process seen on x-rays over the end joints of the hands). The basic problem in osteoarthritis is a breakdown of the cartilage, and thus it is felt to be primarily a disease of cartilage although other parts of the joint may also be involved. |
| Q. What causes osteoarthritis? |
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A. Many risk factors have been shown to be associated with osteoarthritis. Overuse (abuse) of a joint may lead to early breakdown of the cartilage. Injuries to a joint may lead to early osteoarthritis. Obesity best correlates with osteoarthritis of the knee, but other weight-bearing joints including the lumbar spine, hips and feet can be involved with osteoarthritis as well. There is some evidence to suggest an inherited basis for osteoarthritis. |
| Q. What is glucosamine and can it be helpful? |
| A. Glucosamine is a protein that is one of the building blocks for cartilage. In a recent study done in Europe and presented at the ACR Meetings in Boston in November 1999, over 200 patients were evaluated in a double-blind fashion. One group was taking a placebo and the other took glucosamine 1,500 mg per day. By the end of three years, the group taking glucosamine had a 20-25% overall improvement in their symptoms compared to the placebo group and had no joint space narrowing of the knee documented by yearly x-rays as compared to the placebo group. (There is considerable controversy about the way the x-rays were obtained and another study is underway in the U.S. to clarify this.) I generally tell my patients to take it on a trial basis for at least a one to three month period. If it is not helpful at the end of three months, then glucosamine may not be the answer for long-term therapy in their particular case. |
| Q. I have been told that I need to lose weight to help my knee and hip. How can I lose weight without exercising and what type of exercises can I do that will not hurt me? |
| A. Non-weight bearing exercises are probably the best in patients with osteoarthritis of the hip and knees. These include bicycling without resistance such as by using a stationary bicycle. The angle should be appropriate so that a slight flexion of the knees is maintained at its farthest point away from the body when peddling down. Swimming or water aerobics are very helpful. Some weight bearing on the knee may still be necessary but this should be moderate. It has been shown that patients who do a mild to moderate amount of walking with osteoarthritis can experience a reduced amount of pain. |
| Q. Why do I hurt when there is a change in weather or when it gets cold in a room? |
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A. For the most part, the change in the barometric pressure is what a patient is feeling. A patient who does not have arthritis and has an old fracture of a long bone will often feel the same pain with the change in barometric pressure. Tiny nerves that surround the joint that can sense changes in pressure are responsible for the pain. The pain can generally be treated with Tylenol or is best relieved by the use of heat around a joint. A patient can try throwing a towel into a microwave or a drier and heating it up and then putting it over the involved joint. Be careful not to get the towel too hot so as not to burn yourself. |
| Q.What are spurs and can they be removed? |
| A. A spur in a joint is usually the result of bony overgrowth in response to stress on the joint. They generally occur at the margins of a joint and can be seen readily on x-rays. Most spurs do not cause any significant problems, except those that grow into areas of the spine where the nerve exits the spinal cord. In cases where the spur actually compresses the nerve and causes severe symptoms, it may need to be surgically removed. Some spurs also grow in the shoulder joint area and may cause an impingement syndrome by pressing on a tendon when the arm is raised. This may lead to pain on motion of the shoulder and may eventually necessitate surgical removal of the spur. |
| Q. When will I know that I have no other choice other than to have a joint replacement? |
| A. Often the patient is told by an orthopedic surgeon or rheumatologist when he or she is a candidate for a joint replacement. It generally depends on the patient and degree of function. When the joints become so worn out that it becomes painful to perform any type of function such as walking or when your life totally revolves around your joints and there is no longer any quality of life then joint replacement may be necessary. Joint replacement of the knee and hip are common and there is considerable amount of experience and expertise in these areas. The overall risks of a joint replacement need to be firmly addressed with the risks of post-operative infection and future loosening discussed. |
| Q. How long does a joint replacement last? |
| A. On average the life span for a cemented joint replacement of the hip or knee is ten to fifteen years. Newer therapies including the use of nitrogen based bisphosphonates such as Fosamax (alendronate) may help "cement" the joint replacement better. Experimental therapy with tumor necrosis factor binders have shown promise and long-term studies are underway. New techniques by orthopedic surgeons have also been introduced and these may serve to extend the life span of the prosthesis beyond ten to fifteen years. |
| Q. Do I need to take my medicines all the time to treat osteoarthritis? |
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A. No. Not necessarily. In fact, medicines that are used now for osteoarthritis can be taken on an as needed basis. Some patients, however, do better with daily NSAID use, which builds up a maintenance level of medication in the body to control the pain and increase mobility. |