Relief of Joint Pain Depends on Particular Cause

All it took was a sudden stop in an ambulance to mess up Michael Meek's knee.

Meek -- then a firefighter EMT for the Rio Rancho, N.M., Fire Department -- braced himself for impact and tore his meniscus.

Twelve years and three surgeries later, Meek, 48, has arthritis in that knee but has found some relief from knee injections.

"There are certain things I can't do. I can't pivot my knee, so there's no basketball or baseball," says Meek, now a deputy chief. "But I can jog, and I play beginner hockey once a week."

Meek is among nearly one in five adults -- 46 million people -- who have arthritis or chronic joint symptoms, according to the national Arthritis Foundation. And baby boomers are at prime risk: More than half of those affected are younger than 65.

Arthritis refers to more than 100 diseases that affect areas in or around joints, and it plagues more women than men.

The Centers for Disease Control and Prevention estimates that the number of arthritis cases will jump by nearly 40 percent by 2030. And by that time, some 25 million Americans will be forced to limit their daily activities.

Half of Americans with arthritis don't think anything can be done to help them, according to the foundation. While there's no one-size-fits-all solution, a range of treatments is available, according to local physicians.

The first step in figuring out the best treatment is a good diagnosis on what is causing the aches and pains, says Dr. Brian Shelley, assistant professor of Integrative Medicine at the University of New Mexico School of Medicine and medical director of the Center for Life.

One of the most common diagnoses is osteoarthritis, in which the pounding force from routine activities begins to grind away cartilage, the protective tissue that covers the ends of bones and acts as a shock absorber. Osteoarthritis commonly affects the joints of the fingers, knees, hips and spine.

According to the Arthritis Foundation, osteoarthritis affects about half of those age 65 and older, but millions of others most likely have the disease and just assume their joint pain is part of aging.

"For osteoarthritis, we definitely recommend Tylenol, glucosamine and chondroitin sulfate," Shelley says.

Studies have shown that people with mild to moderate osteoarthritis who take glucosamine and chondroitin sulfate supplements felt pain relief similar to that of aspirin and ibuprofen. Some research also shows that the supplements might slow cartilage damage.

Causes of Pain
While osteoarthritis pain stems from friction, pain from rheumatoid arthritis is due to inflammation, and fish oil in high doses can be helpful in treating it, Shelley says.

After a diagnosis, the next step may be physical therapy to strengthen muscles, particularly for physically active patients who want to try to continue their activities, or those with old injuries, says Sean Hassinger, an orthopedic surgeon with Presbyterian High Resort in Rio Rancho, N.M.

If patients aren't on an antiinflammatory medication, he'll suggest one.

When needed, Hassinger proposes weight loss or lower-impact activities. For instance, if a runner complains of knee pain, Hassinger tries to steer him or her toward swimming and cycling. "We want them to stay active, but we're trying to choose activities that aren't as high impact," he says.

For runners not ready to give up their chosen sport, sometimes trying custom arch supports or modifying their running routine can help.

"Simple things like good running shoes can sometimes make a difference," Hassinger adds, "and they should try and avoid running up and down hills because it puts more stress on the kneecap."

Hassinger occasionally prescribes Celebrex, but because it isn't a generic drug, it's expensive, he says.

A prescription nonsteroidal anti-inflammatory drug, Celebrex advertises that for many people, one 200-milligram dose provides 24-hour relief from arthritis pain, stiffness and inflammation.

Medications such as Celebrex can ease arthritis symptoms but "don't have any impact on the progression of the disease," says Dr. Jarrett Galbreth, a sports medicine and family practice physician.

The Next Step
Once patients have tried glucosamine and chondroitin sulfate, Hassinger may talk with them about viscosupplements or knee injections. A series of three injections of Synvisc, one of several brands of viscosupplements, eased fire chief Meek's knee pain for about six months, and he recently had a second series of shots.

The joint fluid therapy involves injecting a substance called hyaluronan into the knee, a natural substance similar to the fluid found in particularly high amounts in joint tissues and in the synovial fluid that fills the joints. The body's own hyaluronan acts as a lubricant and shock absorber in the synovial fluid of a healthy joint.

As a last resort, knee replacements have become more common in boomer-age patients because implants are better and last longer than they did years ago, Hassinger says.

Patients are beginning to ask about partial knee replacements, a new surgical intervention, Hassinger says. Also called unicompartmental knee replacement, the procedure removes the most damaged areas of cartilage and replaces them with metal and plastic. "It feels much more natural and it's much less invasive," he says.

But the procedure has some strict criteria: The arthritis must be confined to a limited area and the patient must have all of his or her ligaments, so someone who has had a torn ACL isn't a good candidate, for instance, he says.

Nothing can be done about aging, but lifestyle changes early on can offer the best shot at avoiding or limiting disability caused by arthritis, experts say.

Ignoring the pain doesn't make it go away, and "if you're having swelling, something is going wrong in there and needs to be seen as soon as possible," Galbreth says.

"We want to keep people as active as we can," he says. "It's important that they try to achieve a more ideal weight and be active, regardless of the level of osteoarthritis."

Source: Albuquerque Journal. Provided by ProQuest Information and Learning. Powered by Yellowbrix.