Best Ways to Make Arthritis Pain Disappear
Roland Moskowitz, MD
Case Western Reserve University
Arthritis is a major cause of disability in the US, and the numbers are rising fast. About 21 million Americans suffer from osteoarthritis (the most common form of the disease), and the total number of arthritis patients is expected to double in the next few decades as baby boomers reach the highest-risk years.
In late 2004 and early 2005, patients lost access to two of the most popular arthritis drugs - Bextra and Vioxx, both COX-2 selective inhibitors ("coxibs"). They were withdrawn because of concerns about their connections to heart disease risk... but patients still have many effective options.
Bad to the Bone
In osteoarthritis, the cartilage that cushions the ends of bones gradually roughens and breaks down after decades of pressure and friction. Bone ends start to "grab" instead of glide, causing pain and inflammation.
Weight-bearing joints in the hips and knees are most susceptible because they're subjected to daily pressure - especially for people who are obese, have joint injuries or engage in high-impact activities, such as running.
There isn't a cure for osteoarthritis, but most patients can significantly reduce pain and maintain full mobility with a combination of medical and lifestyle approaches. Best strategies...
Exercise is one of the best arthritis treatments. I recommend two types - targeted, which builds up muscles surrounding painful joints, and aerobic. Most patients should engage in both types several times a week.
Targeted exercise, which can be done with weights or isometric (muscle contraction) movements, strengthens muscles and improves joint stability. It also provides almost as much pain relief as simple analgesics such as acetaminophen or low-dose NSAIDs.
Example: A patient with knee osteoarthritis might be advised to strengthen the quadriceps (thigh) muscles with leg lifts or isometric exercises in which the thigh muscle is tightened for 30 seconds, then relaxed. Strengthening thigh muscles helps support the knee joint.
Work with a physical therapist or trainer. Doing exercises incorrectly or too vigorously can exacerbate joint damage and pain.
Aerobic exercise elevates levels of endorphins, pain-killing chemicals that are produced in the brain. It also increases the flow of nutrients to the joints. Good choices include biking, swimming, fast walking, etc. Ask your doctor which is best for you.
Obesity increases the pressure on - and subsequent damage to - the hips, knees and ankles. The National Health and Nutrition Examination Survey found that obese men are about five times more likely to develop knee osteoarthritis than men of normal weight. For obese women, the risk is four times higher.
Every extra pound can increase joint pressure by a factor of three or four. Example: A woman who weighs 160 pounds experiences 80 pounds of pressure on each leg when standing still. When she's walking, all of her weight is intermittently transferred from one leg to the other - and the actual pressure can quadruple. If she is 10 pounds overweight, the stress on each knee increases by an additional 30 to 40 pounds.
Most patients who exercise regularly, watch calories and eat nutritious foods can lose at least 10 pounds. Often, that's enough to significantly decrease the pain as well as the frequency of arthritis flare-ups.
Applications of heat, cold and/or medicated ointments can be helpful.
Cold packs (or ice wrapped in a washcloth or towel) cause blood vessels to constrict and help minimize inflammation during flare-ups.
Heat is better than cold for improving range of motion. Heat increases blood flow and is helpful when the joint is a little achy - but it can increase inflammation during acute flare-ups. In general, patients do better with heat than with cold.
Moist heat works well for many people. Try a hot 15-minute shower or bath. Or ask your doctor or pharmacist about moist heat appliances, such as heating pads.
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