Hyaluronic Acid      

Arthritis sufferers face painful movement daily

Date: 9th December 2008, Source: Hyaluronic News

We used to think of it as an old person's complaint -- achy, swollen joints, stiffness upon rising and knees that can predict the weather. Today, osteoarthritis (OA), the most common form of arthritis, affects nearly 21 million people in the United States. It usually comes with age and most often affects the fingers, knees and hips. Sometimes osteoarthritis follows an injury to a joint.

Anyone beyond the age of 45 can find themselves going through analgesics faster than they used to. OA typically manifests itself in men before they reach 55, however women quickly outpace the men in incidents of OA by the time they pass 55. According to the Arthritis Foundation, it is the female's broader hip structure that puts additional stress on the knees.

A joint effort

Physical therapists prescribe exercises, drugs for pain relief

Arthritis sufferers were left looking for relief when two out of three of the newest osteoarthritis (OA) medications were recalled.

In September, 2004 Vioxx was taken off the market. Last month, the Food and Drug Administration requested that Pfizer suspend sales of Bextra in the U.S. With FDA mandated side-effect warnings plastered on both prescription and over-the-counter medications, what's left to suppress the aches?

COX-2 inhibitors like Vioxx, Bextra and Celebrex were developed because they were safer for the stomach, said Dr. Karen Kovalow-St. John, of the Lakeshore Bone and Joint Institute.

"The one choice (of COX-2 inhibitor) is Celebrex because there have not been studies that indicate that it causes heart attacks," she said. "We have other alternatives." She has gone back to using older drugs and prescribing stomach protecting medications to counteract their gastrointestinal side effects.

For knee osteoarthritis, Kovalow-St. John said a cortisone-like medication can be injected into the joint. The treatment, called vicosupplementation, involves a series of injections of hyaluronic acid, which is a substance found in the body that gives joint fluid its viscosity. It's a temporary fix, and only can be administered in the same joint three or four times a year. "I tell my patients, 'I'm not sending you back in to play football,'" she said. "Sometimes when it gets to be bone on bone, the only thing that will help is a new knee."

For prevention as well as for mild OA cases, Kovalow-St. John suggests taking vitamin C, which is good for cartilage. Calcium and vitamin D also are important. "Glucosamine and Chrondroitin can help with pain," she said, adding that because they are not FDA regulated, you have to be careful, as the quality and constitution of these supplements varies.

The next step in treatment for OE is Tylenol. "If you have osteoarthritis and have chronic pain, take Tylenol two or three times a day," she said. "Then go to nonsteroidal."

NSAIDs or nonsteroidal anti-inflammatory drugs reduce inflammation and swelling and aid in pain relief. They are recommended for people who have moderate to severe pain and signs of inflammation associated with OA. Examples of NSAIDs include aspirin, ibuprofen, ketoprofen, naproxen, naproxen sodium and meloxicam. Kovalow-St. John reminds her patients that no medication is without side effects. "We always keep in mind the ups and downs (with each patient)," she said. "In terms of the cardiovascular risk, you have to be educated about your real risk and decide from there."

When taking any medication, whether over-the-counter or prescription, it is important to make sure mixing them is not detrimental.

Patients of Dr. Larry Brazley of Merrillville are asked to bring all of their medications in when they make an appointment. "We take the history and physical information to determine if the patient is at risk (for side effects of certain medications)," said Susan Fisher, RN. Fisher has worked alongside Brazley, who specializes in Adult Rheumatology, Internal Medicine and Geriatrics, for the past 19 years.

"When they come to see us it's not just a matter of 'take this pill,'" she said. "It's a lifestyle change, an adjustment." Weight is a huge factor because excess weight puts more stress on the joints. Exercise is important because you need to have your muscles carry your weight, not your joints, Fisher said.

Barbara Rohe, of Rohe Physical Therapy Services, said her patients range in age from adolescents to 80-year-olds. But whether they come in for OA or sports injuries, she said they all want to take their health into their own hands as much as possible. In some cases, she said, the loss of Vioxx and Bextra pushed patients toward physical therapy. "Some will have to continue taking medications but given recent events, they're looking to augment their arsenal," Rohe said. "The slack can be made up by strengthening the muscles."

Rohe recommends water aerobics, preferably in a heated pool with stairs instead of a ladder, making it easier to get in and out of. She suggests having a dialogue with your doctor about exercise. "It's much easier to take a medication in the morning than to see a physical therapist and follow through on the exercises," she said. "I think most doctors would be open to prescribing physical therapy."

For many OA patients, she said, it's not necessary to go to a therapist several times a week. It is common for a patient to see a therapist for an evaluation and be given exercises they can perform at home. "If the exercises start to get too easy or you get bored, sometimes it's a matter of upgrading or changing the activity," Rohe said. "The beauty of working with a physical therapist is that it's a very individualized program. We can determine mechanically where the trouble is."

Another way in which physical therapy can be helpful is in guiding lifestyle changes. Karen Cagen, occupational therapist, certified hand therapist and owner of Northwest Indiana Hand & Physical Therapy, sends OA patients home with instructions. "We give them information about the right way and the wrong way to do daily living activities," she said. They add flexibility exercises and instruction in modality like when to use cold and when to use heat for pain relief.

Therapy guided exercise requires motivation on the part of the patient. "I like to call physical therapy a participatory sport," Rohe said. "I think most doctors would love to see patients more actively managing their health in that way."

Protect your joints

Osteoarthritis is the most common form of arthritis, with nearly 21 million Americans living with it today. No longer considered just a consequence of aging, researchers now have several candidates when looking for a cause: musculoskeletal defects, genetic defects, obesity or injury and overuse.

While you may not be able to control a genetic trait or knock knees, there are some definite actions you can take to protect your joints and help prevent OA.

* Maintain your ideal body weight. The more you weigh, the more stress you are putting on your joints, especially your hips, knees, back and feet.

* Move your body. Exercise protects joints by strengthening the muscles around them. Strong muscles keep your joints from rubbing against one another, wearing down cartilage.

* Stand up straight. Good posture protects the joints in your neck, back, hips and knees.

* Use the big joints. When lifting or carrying, use largest and strongest joints and muscles. This will help you avoid injury and strain on your smaller joints.

* Pace yourself. Alternate periods of heavy activity with periods of rest. Repetitive stress on joints for long periods of time can accelerate the wear and tear that causes OA.

* Listen to your body. If you are in pain, don't ignore it. Pain after activity or exercise can be an indication that you have overstressed your joints.

* Don't be static. Changing positions regularly will decrease the stiffness in your muscles and joints.

* Forget the weekend warrior. Don't engage in activities for which your body isn't prepared. Start new activities slowly and safely until you know how your body will react to them. This will reduce the chance of injury.

* Wear proper safety equipment. Don't leave helmets and wrist pads at home. Make sure you get safety gear that is comfortable and fits appropriately.

* Ask for help. Don't try to do a job that is too big for you to handle. Get another pair of hands to help out.

Source: The Arthritis Foundation