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Coping with the pains of arthritis

Date: 9th December 2008, Source: Althealth News

For millions of people, arthritis limits everyday activities such as walking, sitting, climbing, dressing and bathing


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Arthritis, which is the commonest cause of disability, affects nearly one person in every family and actually refers to a group of over 100 different conditions. It is common after the age of 50, but some forms can affect younger people as well. The elderly generally suffer from ‘osteoarthritis’, which affects hip and knee bones. ‘Rheumatoid arthritis’, which affects more than one joint, is prevalent in women between 20 and 50 years of age. The cause could either be genetic or a weak immune system. In both, the thick pad of cartilage that acts as a cushion between our bones gets damaged. As a result, bone ends grind against each other and cause pain. The only common feature to all types of arthritis is that joints are affected and there is constant pain which gradually increases with time affecting our everyday activities.
According to Dr. Arun Mullaji, consultant arthritis and joint replacement surgeon at the Breach Candy Hospital, although a cure is still not in sight, early intervention and newer technology can certainly ease the pain and suffering, and give patients a fresh lease of life.
He said, “Much can be done to reduce the impact of arthritis on everyday life. The key is early diagnosis to help prevent the joint from further damage followed by a treatment plan tailored to the needs of each individual. Arthritis is diagnosed on the basis of the overall pattern of symptoms, medical history, physical examination, x-rays and laboratory tests. There are many methods of reducing the pain of arthritis. These include weight control, medicines, rest, exercise, physiotherapy, joint protection technique and occasionally surgery. It is vital to keep ones weight under control and lose any excess weight as every excess kilogram accounts for six times its weight on the knee.”
The all important joint cartilage is one of those highly specialized structures that does not get replaced by the body once it is badly damaged. Now there is a glimmer of hope in the form of two substances- chondroitin- glucosamine and diacerin that may help to slow the breakdown of cartilage in osteoarthritis. They have to be taken as tablets and may work better when combined together and along with calcium supplements. Also they are effective if arthritis is diagnosed in its preliminary stages and takes several months before they take effect.
“Hyaluronic acid is normally present in the fluid lubricating the joint. This, when injected directly into the joint, lessens pain and swelling in patients with osteoarthritis. These injections may also help to slow down the breakdown of cartilage. However, they are expensive, and have to be given repeatedly, and may be quite painful. They require the presence of some intact cartilage in the joint at the start of treatment,” he continued.
Also available are drugs such as methotrexate and more recently leflunamide and infliximab, which are targeted at substances that affect the immune response (the body’s defense mechanism) which becomes faulty in patients with rheumatoid arthritis. There are also newer improved versions of existing painkillers and anti-inflammatory drugs, without the side-effects, particularly on the stomach.
Simple exercises like walking, swimming and cycling are beneficial long- term activities that help maintain strength in muscles, reduce stiffness of joints, ease pain and relieve stress from the joint. Physiotherapy includes exercises targeted at specific muscles, pain relieving measures such as diathermy and ultrasound therapy, occasionally traction and splints. Proper footwear is essential to cushion the impact of walking. Also various insoles are available to correct simple deformities such as flatfeet and bowlegs that which can increase knee pain. Joint protection techniques are taught to patients so they can perform their daily chores without straining the painful joints.
At the other extreme, there are people crippled with arthritis. Such individuals with the help of surgery can walk and
lead an active healthy life. Although hip/knee replacement is commonplace today, the decision to opt for surgery cannot be taken lightly. The operation must be carefully selected to suit each patient. But, there are many new techniques that are less invasive and enable quicker recovery.
He goes on to say that unicompartmental knee resurfacing and hip resurfacing’ are advanced joint preservation techniques. Less invasive, these offer immediate pain relief and quick recovery. They are excellent options for those in the early stages of osteoarthritis when damage is restricted. If performed at the right time, the rest of the joint is preserved, and total replacement avoided. Surgical techniques with smaller incisions cause less damage to soft tissues, while the use of lightweight material like titanium for hip implants allow more range of movement to patients.
On the other hand total hip/knee replacement is a great boon to those persons with advanced arthritis affecting the entire joint. Newer techniques of computer-assisted surgery, minimally invasive methods, and better anesthesia and pain management regimes have made painless and rapid recovery from these operations a reality. So successful are these modern operations that many patients opt to get both knees replaced at the same time!
For more information contact Dr. Arun Mullaji at 2385 6161/