fullcortex.net

WHAT IS IT?
Arthritis is a name for many joint problems that cause swelling, pain, and stiffness. Two types are common: Osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis, which can be very serious, affects more than 2 million men, women, and children in the United States. It’s a system-wide disease that often inflames the joints but can also get into other organs. Osteoarthritis, from wear and tear in a joint, affects about 21 million people, most of them older adults.You get osteoarthritis when cartilage, the slick tissue that covers the end of each bone in a joint, begins to wear away. The problem shows up most often in the hands and in large weight-bearing joints such as the knees and hips.

Most of us will have at least a touch of arthritis if we live long enough. For most people, its symptoms remain mild and easy to relieve. For some, though, pain and stiffness interfere with daily activities such as walking and doing household chores. At its worst, osteoarthritis can be disabling.

Though it can’t be cured, you can do a lot to cut your risk of getting it. And if you already have osteoarthritis, you can relieve symptoms and sometimes slow or even stop its progress. A first step is to understand what’s going on.
WHAT IS HAPPENING?
In healthy joints, a smooth surface of cartilage allows the bone ends to slide easily. It acts as a shock absorber or cushion between the bones. When you have osteoarthritis, this cushion softens and frays. Sections of cartilage may wear away, and the bones grate painfully against each other. Sometimes knobby growths called osteophytes or spurs form at the ends or sides of the bones. Also, bits of bone or cartilage may break loose and float in the narrow space within the joint. As arthritis gets worse, the bones around the joints may thicken and become deformed, making movement harder and more painful.
WHAT CAUSES IT?
No one can say for sure why one person gets osteoarthritis and another doesn’t, but a number of things can increase your risk. Some of these factors-such as your sex, age, and family history-are beyond your control. But you can do plenty about many other factors.

THINGS YOU CAN’T CHANGE

Gender
Osteoarthritis affects men and women in equal numbers, but men tend to get it at a younger age than women. Also, men are more likely than women to have it in their hips and spine; women are more likely than men to have it in their hands and knees.

Age
Osteoarthritis tends to result from years of repeated stress on the joints. That’s why the first symptoms rarely appear before age 40.

Family history
If one of your parents has osteoarthritis, you’re more likely to get it. That’s because slight defects such as bowed legs, which increase stress on the knees or hips, can pass from parent to child. And some people are born with a gene that makes cartilage more likely to wear out.

THINGS YOU CAN CHANGE

Being overweight
Extra weight adds to the wear and tear on your joints, especially the knees.

Lack of exercise
Your muscles act as shock absorbers to protect your joints from the stresses and strains of moving about. But when you don’t get enough regular exercise, your muscles weaken. Then they have a harder time protecting your joints, which can mean lots more wear and tear on cartilage.

Repeated stress on your joints
Doing the same thing over and over, such as typing or hammering, can be hard on your joints. For example, a ballet dancer who goes up on her toes a lot is extra likely to get arthritis in her feet.

Injury
People who play long and hard at contact sports are often troubled by arthritis, usually in joints they hurt often. So are construction workers and others who take a lot of hard knocks on the job.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to cut your risk of osteoarthritis by making smart choices about your daily activities, exercise habits, and diet. If you already have the disease, you and your doctor can do a lot to ease symptoms and keep it from getting worse. A few suggestions:

Relieve your aches and pains
If you wake up feeling stiff and sore: Take a hot bath or shower to relax your muscles and relieve the pain. Three or four times a day, apply an electric heating pad or hot pack for 20 minutes at a time, or as needed. To make a hot pack, soak a washcloth in warm water, wring it out, and put it in a plastic bag. Or use a hot water bottle wrapped in a towel. Your local drugstore may sell hot compresses you warm in a microwave. A heat lamp is okay, too, as long as you put a towel over your skin to avoid burning.

To numb a sore joint and ease the pain: Cold is the best treatment for acute pain-pain that flares up suddenly-or for swelling and redness around a joint. Use cold packs (sold in most drugstores). Or you can make your own with ice cubes or a bag of frozen vegetables-peas or corn work well-wrapped in a thin towel. Apply for 10 to 15 minutes at a time, three to four times a day, or as needed.

For mild pain: Try over-the-counter pain relievers. Acetaminophen (Tylenol) is best for arthritis in the knees and hips, according to the American College of Rheumatology. Acetaminophen doesn’t reduce swelling like some other pain relievers, but it has fewer side effects. Take it with caution if you have liver disease or if you regularly drink alcohol-check with your doctor.

Other common pain relievers include aspirin, ibuprofen (Advil or Motrin), and naproxen sodium (Aleve). They help reduce both pain and swelling in a joint. The most frequent problem with these drugs is stomach upset, or stomach bleeding after long-term use. To avoid such side effects, your doctor may advise you to use coated tablets or to take your medication with meals. Salsalate and trisalcylate, prescription drugs similar to aspirin, are easier on the stomach than aspirin, even the coated kind. Check with your doctor if you’re using any of these medications repeatedly for weeks at a time.

Rub-on pain relievers (topical analgesics): Unlike drugs that are swallowed or injected and affect your entire body, these creams and gels work only on the area they are rubbed into, so they have fewer side effects. One type of rub-on painkiller contains capsaicin, an extract of cayenne peppers. Spread on a joint, it disrupts pain signals before they get to the brain. The cream may sting slightly at first, but the stinging goes away after a few weeks of use. Other products contain menthol, oil of wintergreen, or camphor. These stimulate nerve endings, distracting the brain’s attention from joint pain.

Exercise often
Gentle exercise may help cut your risk of getting osteoarthritis, or keep it from getting worse. Exercise works by strengthening the muscles that protect your joints. But be careful not to overdo it, and make sure you do what’s right for you. The wrong activities can cause arthritis, or make it worse.

How do you know what’s right? First, if an activity hurts, you need to back off or find something else that doesn’t. Never try to “work through the pain.” This is often the cause of joint problems, and it certainly can make them worse. Also, watch for pains that seem to get more intense about two hours after you’ve stopped exercising-they’re a sign you’ve overdone it and need to take it easy next time.

Low-impact exercises such as swimming, walking, and cycling (if they don’t bother your joints) are best. Aim for at least 30 minutes three times a week, but any amount will help.

Also, do range-of-motion and strengthening exercises for a few minutes every day. For example, rotate your shoulders and bend your legs.

When you exercise, wear loose, comfortable clothes, and shoes made from nonslip material. Put shock-absorbent insoles in your shoes to make things easier on your feet and knees.

Control your weight
If you’re overweight, drop those extra pounds. Taking off weight may sound daunting, but it doesn’t have to be. The best approach? Combine smart eating with exercise. Here’s how it works:

Extra calories-those you don’t need for energy right away-pack on the pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 more calories than you take in. That’s because one pound of fat has 3,500 calories. (A typical fast-food lunch of a burger, fries, and a shake is loaded with about 1,700 calories; by contrast, an apple has only 80.)

Here are some tips for a program that works:

Check with your doctor to find out how much you ought to weigh.
Be realistic. Don’t aim for a weight you can’t reach and maintain.
Be as active as you can. A brisk half-hour walk burns about 150 calories. Take the stairs instead of the elevator if it doesn’t bother your knees. Park in a far corner of the lot when you go to the market. Or simply walk the dog each night after dinner.
Cut some fats from your diet. Fats have the most calories of anything we eat. Two pats of butter, roughly a tablespoon of pure fat, have about 100 calories. Choose low-fat foods such as nonfat dairy products, fish, and lean cuts of meat.
Eat more vegetables, fruits, and grains. They have what your body needs for energy and good health, and they’re low in fat and calories. Prepare them the low-fat way-steamed or sauteed in water or broth.
Limit sugar and alcohol. They have lots of calories, but few of the vitamins and minerals you need for good health.
Take Vitamins
People with arthritis have long hoped that changing their diets would bring relief. And over the years one diet scheme after another has been put forward, such as staying away from tomatoes. Now research shows that what you eat really can have an effect on osteoarthritis. High doses of vitamins C and D-at least 120 milligrams of C and 400 IU of D-may keep the disease from getting worse.

Researchers think vitamin C helps by scavenging free radicals that may cause arthritic bone changes. Free radicals are highly charged atoms that damage cells. Vitamin C may also help repair collagen (part of the cartilage cushion between bones). Cartilage decays and roughens when you have osteoarthritis. And you need plenty of vitamin D to help keep bones strong.

Protect your joints
Learn to move with less stress on your joints:

Reduce or avoid any activities that make your joints hurt.
Use splints, such as wrist splints, to support and protect painful joints, but have them fitted by a health professional. Splints can make joint pain worse if they’re too tight or worn too long.
If you play a contact sport-football or basketball, for instance-use protective gear such as kneepads. Make sure gear fits well.
Avoid going on too long with repeat motions such as sawing or hammering. Take rest breaks every 20 minutes. Even a minute or two will help; 5 to 10 minutes is better.
When you stand, use good posture. Your body should look as if a straight line connects your ears, shoulders, hips, knees, and heels. If you have to stand for a long time, put one foot up on a low stool to ease the strain on your lower back.
When you sit, keep your knees, hips, and ankles at 90-degree angles, and support your back with a pillow or rolled-up towel. Try not to slouch.
Stretch to relax if you’re feeling tired or your muscles are tight.
Make everyday activities easier
There are lots of ways to conserve your energy and use your joints wisely. If you have arthritis….

In your hands, wrists, or fingers:
Use a buttonhook, made for people with arthritis, to button clothing.
Use nonstick pans or line pans with foil before you cook so you won’t have to scrub hard when you wash them.
Use lever faucets you can turn on and off with your palm.
Brush with an electric toothbrush.
Wear slip-on shoes or shoes with Velcro closures instead of hard-to-handle laces.
Write with felt-tip pens-they need less pressure than ballpoints.
Put padded grips on utensils and tools.
Try a wrist rest on your computer keyboard.
In your knees, shoulders, back, hips, or feet:

If standing is painful, sit on a stool in the kitchen, laundry room, or wherever you usually have to be on your feet. Use a bath stool in the tub or shower.
Use a sponge mop with an “easy squeezer” and a long-handled feather duster so you don’t have to bend or stretch so much.
Put grab bars around the tub and toilet.
Wear shoes with orthopedic inserts or shock-absorbing insoles to ease the strain on your feet and knees.
Limit your lifting. Ask others to help you.
In your neck:
Use a wide-angled mirror in your car if you have trouble turning your head.
Try sleeping with a cervical pillow, which helps keep the neck straight. You can get one from your doctor or health aid store.
Try acupuncture
Studies by the National Institutes of Health and others have found that acupuncture relieves chronic arthritis pain. Be careful when choosing who will give you treatment, though. If you’re considering a nonphysician, make sure the practitioner is certified or licensed either by your state or by the National Certification Commission for Acupuncture and Oriental Medicine. Finding a good physician-acupuncturist can be tricky because most states allow doctors to practice acupuncture without proof of training. Select a physician who is a member of the American Academy of Medical Acupuncture.

Stay positive
You may feel depressed or frustrated if you have arthritis. But this can make your pain even worse. Some helpful tips:

If you have to cut back on some favorite activities, focus on what you can do. Discover new things to do that give you pleasure.
Confide your frustrations to family and friends so they can support you.
Join an Arthritis Foundation support group. Studies show that these groups help people reduce pain and remain active. To find one in your area, call the foundation; it’s listed in the white pages of your phone book.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor can help you understand your risks for osteoarthritis, check the health of your joints, and discuss which approaches-medications, lifestyle changes, or both-are best for you.

Prescription NSAIDs
Several nonsteroidal anti-inflammatory drugs (NSAIDs) are available by prescription for joint pain and swelling. These include nabumetone, etodolac, diclofenac, and others. Like aspirin and other milder over-the-counter versions, they’re good at reducing both pain and swelling-but they can also cause stomach upset or stomach bleeding. Another product, Arthrotec, combines an ulcer-preventing drug with an NSAID.

COX-2 Inhibitors
In early 1999, the FDA approved Celebrex (celecoxib) for treatment of rheumatoid arthritis and osteoarthritis. Another drug, Vioxx (rofecoxib), was approved soon after. These drugs are COX-2 inhibitors, a new type of painkiller. They seem to ease pain as well as NSAIDs do, but without the same risk of stomach problems. However, it’s still too soon to know about the side effects of long-term use of COX-2s, and some questions have already been raised about safety.

Glucocorticoids
Drugs called glucocorticoids can help relieve severe pain. You take them orally, or your doctor can inject them into the joint. Glucocorticoids are similar to cortisol, a natural hormone that reduces inflammation and speeds healing. These drugs are very effective, but injections should not be given more than three or four times a year, since more frequent shots may increase your risk of joint damage. Glucocorticoids may have side effects such as weight gain, osteoporosis, thinning of the skin, and cataracts if taken in high doses for a several months. Work with your doctor to find a dose that’s effective, but that’s low enough that it doesn’t cause side effects.

Other Pain Relievers
If you have severe pain and your arthritis is not very inflamed, or if NSAIDs cause too much discomfort, your doctor may prescribe narcotic analgesics (propoxyphene hydrochloride, acetaminophen with codeine, or tramodol). These drugs help ease pain, but they do have side effects such as constipation, dizziness, nausea, and tiredness. If you take them for a long period, you may become physically dependent on them.

Physical Therapy
Physical therapy, including heat treatments, massage, and exercise, can help relieve stubborn aches and stiffness.

Surgery
Arthritis is sometimes treated with surgery. Surgeons can cut and reposition deformed bones, smooth the roughened ends of bones, remove painful bone spurs, and even repair damaged cartilage.

Joint replacement is another option for people disabled by osteoarthritis. The joints most commonly replaced are those of the hip and knee, but shoulder, elbow, and finger joints can also be replaced.

Estrogen replacement therapy
Estrogen replacement therapy is often used to treat symptoms of menopause. And we know it cuts a woman’s risk of osteoporosis-thinning of the bones-and perhaps heart attack. It may also reduce the risk of osteoarthritis of the hips and knees, or keep it from getting worse. However, estrogen therapy worries some people. That’s because long-term use may slightly raise your risk of breast cancer. Your doctor can help you decide if it’s right for you.