From pain to prevention: An osteoarthritis Q&A

We invited Steven Wynder, MD, and Heather Smith, PA, Parkview Physicians Group – Orthopedic Surgery, to answer the most common questions and concerns surrounding osteoarthritis, a condition characterized by the degeneration of joint cartilage.
What are the most common causes of osteoarthritis?

The cause is often multi-factorial. The most common controllable causes are obesity and trauma or "wear and tear." Some diseases can play a role in osteoarthritis, including diabetes, gout and inflammatory diseases like rheumatoid arthritis and psoriatic arthritis. Other causes are not modifiable and include genetics and the most common cause of osteoarthritis, aging.

Does genetics play a role?

We know that genetics plays a role, as we often see osteoarthritis in multiple members of a family. The exact role is unclear, as families often share the same dietary, weight and activity habits. Subtle alignment difference in the knee or hip ("bow-legged" or "knocked-kneed") may run in families. These alignment changes are known to increase the risk of arthritis due to irregular wear patterns.

What are the most common symptoms of osteoarthritis?

The most common symptoms are joint ache, stiffness, swelling, pain and loss of motion.

What preventive measures can we take?

Obtaining or maintaining a healthy weight, engaging in regular physical activity to keep muscles and bones strong, eating a well-balanced diet and avoiding injury.

Once diagnosed, what are some measures we can take, aside from prescription medication, to manage arthritis pain?

Although it sounds counter-intuitive, physical activity is the key to reducing arthritis pain. Studies have shown that gentle, non-impact activity (walking, biking and swimming) decreases pain, improves function and delays disability. Other conservative options include weight reduction, muscle strengthening, the use of ice or heat, physical therapy, wearing well-cushioned and supportive shoes, gel insoles and ambulatory assistive devices such as a cane or walker. Steroid injections or visco-supplementation are also used in more severe cases. 

There is recent interest and research on how the foods we eat affect osteoarthritis. We know that Omega-3 fatty acids decrease inflammation in the body that can lead to arthritis flares. Wild-caught fish, olive oil and flax seed are all rich in Omega-3s. On the contrary, Omega-6 fatty acids -- found in vegetable oil, corn oil and red meat -- tend to increase inflammation in the body. Vitamin D plays a large role in bone health. We get most of our vitamin D from sunshine, but it’s also found in egg yolks, fatty fish like salmon or tuna, and fortified milk and cereal. Other beneficial foods are berries and cherries, which contain anthocyanin. Vitamin C is also beneficial for osteoarthritis and is found in citrus and peppers. Topical arthritis creams containing the Capsaicin pepper have also been shown to reduce arthritis pain.

When is surgery warranted?

There are several criteria that should be met. The patient's X-rays should show end-stage osteoarthritis. Surgery is typically not recommended for mild or moderate arthritis. The patient must have some impairment from the arthritis, like not being able to put on shoes and socks. The patient should have pain that has not resolved with conservative measures and be healthy enough to undergo surgery. The decision for surgery should be a mutual decision between the patient and their healthcare provider.

What are the most common misconceptions about osteoarthritis?
There are several:

1) Osteoarthritis and Osteoporosis are the same.
Osteoarthritis is the wear or gradual loss of the cartilage that cushions the joints, and eventually wears the ends of the bones. Osteoporosis is a decrease in the density of the bone, which may lead to early fractures. One may occur without the other, or they may occur together.

2) Rest is good for osteoarthritis.
Studies have shown the exact opposite – that rest and inactivity are bad for arthritis. Rest and inactivity lead to decreased circulation, diminished joint fluid, weight gain and muscle loss, all of which increase the pain of arthritis.

3) If I can't exercise, I can't lose weight.
While exercise helps with weight loss, how much and what you consume plays a larger role in weight loss.

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