Most women with arthritis can continue to perform normal activitiesof daily living. Exercise programs, anti-inflammatory drugs, and weightreduction for those who are obese can help reduce pain and stiffness and improve function. The goals of treatment are to provide pain relief,increase motion, and improve strength, thus slowing the progression ofthe arthritis. Treatment includes exercise, medications, surgery, andusing assistive devices.
Exercise has many benefits. It can help keep your body strong and limber, expand your range of motion, and help control weight. Exercises that many women find helpful include strength exercise; aerobic exercises, range-of-motion activities, and neck andback strength exercises. Moderate exercise such as regular walking cankeep the body supple and reduce joint pain and stiffness. Many peoplealso find yoga helpful. Check with your doctor or physical therapist todesign a plan that helps strength your body without taxing it too much.
A wide range of medications can beused to relieve the pain and inflammation of arthritis. Some areavailable over the counter; others require a doctor’s prescription. Each medication has advantages and disadvantages, and it’s important to work with your doctor and health care team to choose the one that’s best for you.
Acetaminophen may be used to control mild-to-moderate arthritis pain, and is often the first medication recommended. It does not relieve theinflammation, however. Instructions on the medication bottle need to befollowed to avoid problems. People who drink alcohol should discuss the use of acetominophen with their physician, as they may be at higherrisk for liver damage.
A large class of drugs called nonsteroidal anti-inflammatory drugs(NSAIDs) is widely used to relieve both the pain and inflammation ofarthritis. The older NSAIDs include aspirin, ibuprofen, and naproxen.These drugs, available over the counter, are known to producegastrointestinal side effects. In some cases, these side effects arelimited to minor discomfort, but they may include gastric bleeding. Itis important not to exceed the recommended doses and to take these drugs with food or milk to minimize their risk of side effects. These drugsshould not be taken for more than 10 days, unless advised to do so by adoctor. If one NSAID causes stomach irritation, you might switch toanother one. Another possibility is to combine the NSAID with a drugthat protects your stomach lining.
Introduced in 1998, COX-II inhibitors are the newest class of NSAIDs. Compared with older NSAIDs, their chief advantage is that they do notproduce gastrointestinal (GI) side effects. They are more expensive, but there is no evidence that they reduce pain and inflammation any betterthan over-the-counter (OTC) products and they became the subject ofconsiderable concern in late 2004 and early 2005 prompting the FDA torecommend limiting the use of both of these drugs. The controversy overCOX-II inhibitors drew wide media attention and caused great confusionamong patients. The best course of action is to work with your physician to determine what drug works best—and is safest—for you.
The current concern over drug safety has prompted may patients toexplore other treatment options. For example, liquid cortisone, injected into the joint, may help relieve pain and swelling temporarily. Topical pain relievers are an option; some contain salicylate, a chemicalrelated to aspirin. Another class of products are the counterirritants,which cause hot or cold feelings that temporarily mask the pain.Finally, some products contain capsaicin, the active ingredient in hotpeppers; they work by interfering in the process by which the nervessend pain signals to the brain.
For persons with moderate arthritis of the knee, injections ofmaterial to improve the joint fluid may improve pain. These materials,termed hyaluronic acid supplements, are injected into the knee once aweek for three to six weeks. These injections are considered a secondline of treatment after oral medications. If an individual’s pain is not improved with medication such as acetominophen or an NSAID, or if theycannot tolerate NSAIDs because of GI problems, they may be a candidatefor a series of hyaluronic acid injections.
Well before the risks associated with COX-II inhibitors came topublic attention, many people were turning to alternative therapies forrelief of arthritis. One such therapy is acupuncture, which has beenshown to reduce knee pain and improve function for people withosteoarthritis when used in conjunction with medical therapy. In thisstudy, people who received acupuncture (the study group) had a 40percent decrease in pain and a nearly 40 percent increase in function,compared to people who received sham treatment (the control group).
Many people with osteoarthritis find relief by taking glucosamine and chondroitin, two natural substances sold as dietary supplements.Laboratory tests have found that both these products can make thecartilage healthier and perhaps even repair it. Large-scale trials ofeffectiveness are ongoing.
If you’re interested in using these or any other complementarymedicines, be sure to talk with your physician first. Herbal supplements may interact with prescription or OTC medications. For example,glucosamine is a type of sugar, and if you have diabetes and take it,you need to monitor your blood sugar levels more frequently. Chondroitin may interact with blood-thinning drugs, and you should not useglucosamine if you are allergic to shellfish, because that’s what thesesupplements comprise.
The effectiveness of many other alternative approaches to arthritispain relief, including wearing magnetic bracelets, has not been provedin scientific studies.
Canes, crutches, walkers, orsplints may help relieve the stress and strain on arthritic joints.Learning how to perform daily activities in a way that is less stressful to painful joints also may be helpful. Certain exercises and physicaltherapy (such as heat treatments) may decrease stiffness and strengthenthe muscles around the joint.
When medicines, injections, and othertherapies are no longer effective in controlling pain and restoringfunction, surgery may be appropriate. Different types of operations that may help a person with arthritis include:
- Operations to realign a joint (osteotomy) and take stress of the worn region of the joint;
- Fusing the joint (arthrodesis) to make it stiff and unable to move (and thus pain-free); and
- Joint replacement (arthroplasty).
Joint-replacement surgery can often provide dramatic pain relief andrestore joint function in persons with severe OA. During this procedure, an orthopaedic surgeon replaces the diseased joint with an implant made of metal, ceramic, plastic, or a combination of these. Like a healthyjoint, the artificial one also has smooth, gliding surfaces. A totaljoint replacement can usually enable a person with severe arthritis inthe hip or the knee to walk without pain or stiffness. The physician and patient choose the type of surgery by taking into account the type ofarthritis, its severity, and the patient’s physical condition.
The decision about when to replace a diseased joint is also based on a number of factors, including the degree of disability, lifestyle, age,and the patient’s ability to withstand the risks of surgery. Manypatients try to postpone surgery as long as they can, and for manyyears, physicians, too, recommended delaying the procedure in patientsover age 60. There is, however, increasing evidence that waiting toolong can make the procedure more complicated, because more bone andcartilage may already be worn away. Increased age puts a patient atgreater risk after surgery, and a patient who has been debilitated byarthritis for an extended period may find recovery more prolonged. Reflecting this growing body of evidence, in 2004, a National Institutes of Health consensus panel reported its conclusion that people with less pain and better function before knee replacement do better followingsurgery than those who were more impaired before surgery.
Joint replacement surgery of the hip and knee may now be done with“less invasive techniques.” These procedures focus on less injury to the skin, muscles, and tendons, and may promote faster recovery. Evidenceto date shows no clear difference in outcomes one year following surgery between patients whose surgery is performed using a minimally invasiveversus traditional approach. It may be more difficult to put in theimplants through a smaller incision and this may compromise how long the joint lasts. Individuals considering joint replacement surgery shoulddiscuss the surgical options with their surgeon.