Smart moves for arthritis
Myths, misconceptions, and outright untruths surround arthritis, America's No. 1 cause of disability and one of the most painful
and frustrating chronic conditions. Anyone can be at risk for developing it, and an estimated one-third of adults eventually
will.
In this section, we'll tell you what treatments actually ease symptoms and which are a waste of your time and money. We'll
provide advice on how to slow the progression of arthritis symptoms or delay their emergence. And for the minority of patients
who can't obtain relief from arthritis pain and disability with milder treatments, we offer the hard-won wisdom of a nationally
representative sample of 1,001 patients who have had hip or knee replacement surgery. Our exclusive survey turned up fresh
insights into issues such as the timing of surgery, the merits of different types of anesthesia and pain relief, and what
to expect during recovery (hint: You'll need patience).
As a chronic disease that can be controlled but not cured, arthritis is tailor-made for confusion. Patients must sort through
a bewildering array of treatment options and advice, from the tried-and-true (pain relievers) to the offbeat (magnets). Here's
the lowdown on five common misconceptions.
Myth
The only way to control arthritis pain is with drugs
Most people will need at least some pain medication some of the time. But other measures can provide relief and may enable
you to reduce or even forgo use of medications. Applying heat to an arthritic joint before exercise can relieve pain and stiffness,
and cold packs afterward can reduce swelling. Some people find alternating between the two works best.
Over-the-counter creams or gels containing capsaicin (generic, Zostrix), an ingredient derived from the pepper plant, are
also proven to help (though they may work better for the hand or knee than the hip, where the joint is deeper). Stabilizing
devices such as braces and wedge shoe insoles may reduce or realign pressures on the joint, easing pain and improving mobility.
Several alternative therapies may also yield substantial relief, without the risks of drugs. Among the most promising:
Glucosamine and chondroitin. They are the only nutritional supplements for which there's good evidence of effectiveness for some patients (see our June
2006 report on joint supplements).
Acupuncture. In the largest clinical trial to date, published in December 2004 in the Annals of Internal Medicine, researchers found that
acupuncture reduced pain and improved joint function, at least in the short term, for people with knee osteoarthritis.
Massage. Two-thirds of readers surveyed for our August 2005 report on alternative treatments who tried deep-tissue massage for osteoarthritis said it helped at least somewhat, and 35 percent found it helped a lot--substantially
higher numbers than for either prescription or over-the-counter drugs.
Counseling or relaxation training. Studies have found that cognitive-behavioral therapy can help control pain by changing negative thoughts and behaviors that
needlessly limit your activity. Meditation, biofeedback, and other forms of relaxation may help by reducing the stress that
contributes to pain.
And what about those magnets? Though widely promoted for relieving musculoskeletal pain of various types, there's no solid
evidence that magnet therapy is effective, and products can cost as much as $500.
Myth
If you're developing arthritis, go easy on exercise
On the contrary, “you probably have to be more active,” says William O. Roberts, M.D., a family doctor and former president
of the American College of Sports Medicine. That's because compressing the joint--through walking or other weight-bearing
activities--squeezes nourishing fluid into the spongy cartilage and helps keep the joint lubricated. Inactivity only breeds
more stiffness and degeneration. Exercise also improves balance, helping to prevent falls. In a study of about 5,700 adults
age 65 or older with arthritis or rheumatism, published in Arthritis and Rheumatism in April 2005, those who didn't exercise
regularly were nearly twice as likely to lose their ability to perform everyday tasks over the next two years. The finding
held up even after the researchers controlled for other factors likely to cause physical decline.
Your fitness program should include not only aerobic exercise but also strength training to build the muscles that support
the joint and stretching exercises, which improve flexibility and help prevent chronically contracted muscles. If your insurance
covers it, ask for a referral to a physical therapist or physiatrist, a doctor who specializes in physical medicine and rehabilitation,
to help you design your regimen.
Myth
If you exercise too much, you risk developing arthritis
Exercising, even vigorously, does not cause arthritis. Studies of runners, for example, show they don't develop arthritis
more often than nonrunners. Being injured during exercise, however, does seem to increase the risk, and significantly. One
study found that medical students who had a serious knee injury, at an average age of 22, more than doubled their risk of
developing knee osteoarthritis by age 65.
Even more striking is how early those problems can surface: Of the estimated 86,000 Americans who tear their anterior cruciate
ligament each year, the majority of them in their teens and 20s, more than half will show signs of degenerative arthritis
within just five years, according to a study published in December 2005 in the British medical journal The Lancet.
That's why it's crucial to take precautions to prevent injuring a joint in the first place. Wear the shoes and protective
gear prescribed for your sport, warm up properly and stop when you're fatigued, and prepare your body for activities you haven't
done in a while. For example, before a ski trip, practice jumping side to side to simulate the leg and hip movements you'll
need to do on the slopes; use yoga or Pilates to condition those muscles. Choose springier surfaces, such as asphalt or wood
chip paths rather than cement pavements, for weight-bearing exercise such as jogging. If you run or walk on the road, switch
sides periodically to avoid uneven wear from sloping pavements.
Myth
Arthroscopic surgery to “clean out” arthritic knees helps relieve pain
The only reason for knee surgery is to correct a specific defect, such as repairing torn cartilage. Evidence suggests that
doing the surgery just to shave off rough areas of cartilage doesn't improve the underlying arthritis or relieve its symptoms.
In a trial published in The New England Journal of Medicine in July 2002, researchers randomly assigned 180 people with knee
arthritis to receive either actual arthroscopic surgery or a fake procedure. During the arthroscopic surgery, the surgeon
inserted a small scope into the knee and flushed the joint with saline or shaved away soft, rough areas of cartilage. For
the fake procedure, the surgeon made three small incisions into the knee and then closed them up without doing anything else.
The patients, who didn't know which procedure they had, all reported a similar, very slight improvement in their knee pain.
After two years of follow-up, the bending and walking of the people who had the real surgery were no better than in those
who had the fake operation. A newer study, published in Arthritis and Rheumatism in March 2006, suggests arthroscopic procedures
might actually contribute to cartilage degeneration.
In contrast, a different procedure, osteotomy, in which the surgeon removes a small wedge of bone to put an uneven joint back
in a straight line, does appear to help in some cases. It's sometimes used as an alternative to total joint replacement, especially
for younger adults.
Myth
The only drugs that really help arthritis are the ones that relieve inflammation
Not true. Although arthritis does produce inflammation in the joint, you don't have to get rid of the inflamation to relieve
the accompanying pain. Acetaminophen (generic, Tylenol), which doesn't affect inflammation, should be the first drug you try
for treating arthritis. Though not effective for everyone, it can often relieve even moderate to severe pain and doesn't cause
the gastrointestinal bleeding that is a serious side effect of the nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (generic, Advil, Motrin) and naproxen (generic, Aleve). (A complete report on pain relievers is available free online
at www.CRBestBuyDrugs.org .)
Nor does having an injection inevitably mean the traditional shot of cortisone, an anti-inflammatory steroid. An alternative
is hyaluronic acid (Hyalgan, Orthovisc), a viscous substance found naturally in and around joints.
Studies suggest that a series of three to five weekly hyaluronic acid injections may relieve knee pain longer than the traditional
shots of cortisone--up to three months, compared with about four weeks for a single shot of cortisone. But hyaluronic acid
can take several weeks to begin showing its effects, meaning that cortisone is still the better choice for sudden flare-ups.
And the medication is costly, about $360 to $700 per course of shots, compared with $1 to $2 for cortisone. (Check with your
insurance company about coverage.)
Also see our reports on hip and knee replacement and arthritis supplements.
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