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Paging Dr. Frischer - Degenerative joint disease
WRITTEN BY :   By Dr. Alan Frischer

We weren’t designed to last forever: given enough time and use, many parts of our human bodies wear out. One part in particular, the smooth piece of cartilage that sits between the bones in our joints, is particularly subject to wearing thin over time. When this happens, an extremely common condition known as degenerative joint disease occurs. Most of you know this condition as osteoarthritis.
There are over 100 types of arthritis, and osteoarthritis is the most common. It is primarily a disease that comes with age, and at least 20 million adults in this country suffer from it. For some, it is visible on x-rays, but doesn’t display symptoms. If we live long enough, we will all develop OA to some degree, in one or more joints. The most common joints involved are the hands and the weight-bearing joints: the knees and the hips. It is also quite common for OA to affect the spine, from the neck on down to the lower back.
The cartilage in our bodies is tough, elastic, and made up of collagen and water. It can become frayed, injured, torn, or even wear out completely. When this happens, the bone surface on one side of the joint rubs directly against the bone on the opposite side of the joint. Over time, this constant bone-on-bone contact leads to bone surfaces becoming hardened, a narrowing of the joint space, and ultimately deformity of the joint.
The symptoms of OA often begin with stiffness in a joint that lasts more than 15 minutes, usually following activity. Pain may grow steadily over time, or wax and wane over the years. As the disease advances, the pain may be made worse with activity and weight bearing, but relieved with rest. As a rule, symptoms are better in the morning and more pronounced as the day progresses, and both sides of the body are not affected equally. By the time it becomes advanced, walking or performing regular daily activities may become quite difficult. Fluid may accumulate (an effusion) as a result of the soft tissue reacting to the OA by providing lubrication to make the joint surface smoother. This gives the joint a swollen appearance.
The development of osteoarthritis can usually be attributed to heredity, injury, fractures around a joint surface, and overuse. Obesity is also a risk factor (most commonly for women) for osteoarthritis in the knee and hip joints: Every extra pound carried above the knee puts four times the pressure on the joint when walking, and ten times that pressure when running. Participation in competitive contact sports increases the risk of OA, because repetitive impact on a joint increases injury. When cartilage in a joint is injured, it does not regenerate.
The diagnosis of osteoarthritis is based on a medical history, physical examination, and x-ray findings. Lab tests can be run to rule out other types of arthritis.
Treatment of OA will differ depending on age, activity level, degree of symptoms, x-ray findings, and other medical conditions. Treatments include:
•Acetaminophen (Tylenol); NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve); and glucosamine-chondroitin
•Over-the-counter topical creams that act as counterirritants (containing menthol, eucalyptus, or oil of wintergreen), salicylates (similar to aspirin), or capsaicin
•Topical heat and ice preparations
•Injections of steroids and hyaluronic acid
•Bracing of unstable joints
•Surgery may be recommended for severe osteoarthritis in the weight-bearing joints. Total and partial knee and hip replacements can be extremely effective. (Arthroscopy is less commonly used for OA of the knees then it once was, and is now primarily used to repair damaged cartilage.)
As many of you know, I am a long-distance runner. Am I risking OA? I am well aware that there may be an increased risk of injury and osteoarthritis due to overusing, wearing out, or traumatizing my joints. However, the most current evidence suggests that exercise, at least at moderate levels and when done properly, does not accelerate development of OA in the knees. There is, in fact, evidence that being physically fit might have a protective effect against joint degeneration, and that the strengthening of the muscles and ligaments helps to maintain the use of all joints. As much as this may sound like rationalization, I’ve concluded that for me, the potential risks of running are far outweighed by the tremendous benefits of this activity to the other body systems, including reducing my risks for heart disease, hypertension, diabetes, obesity, and bone density loss.
Most of us in the medical community agree that while OA can’t be completely prevented, the severity can be lessened by practicing good health habits. In mild cases of OA, walking, swimming, cycling, and other forms of exercise can be very helpful to strengthen the muscles, tendons, and ligaments that surround the joints. If one method of exercise is painful, try a variety of other activities. Remain active and exercise the muscles and joints regularly in order to nourish cartilage. Remember that maintaining an ideal body weight is tremendously important in order to slow the wear and tear of joints, as well as to reduce existing symptoms.
There is an exciting future in store for osteoarthritis treatment, and it lies in the technology of growing cartilage cells outside the body, then transplanting them back into joints. On a limited basis, this is being done already, in localized areas of cartilage loss. We will be hearing more about this, and hopefully in the near future.
Good health and agility to you all!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: October 13, 2011 – Volume 10 – Issue 26



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