Although often used in a humorous context, the underlying truth is all too painfully evident the older we get. Nearly 27 million Americans suffer from osteoarthritis (OA) with increasing incidence rates corresponding to increasing age. This degenerative disease worsens as cartilage between bone and joint breaks down over time.

 

With age, the protein makeup of cartilage degenerates causing that natural cushion to flake away or form small crevasses. In advanced cases, the cartilage can completely disappear between bone and joint, resulting in friction that leads to pain and compromised mobility. For others, repetitive use of worn joints can inflame the remaining cartilage causing swelling and pain. While aging is the most common cause of OA, injury from trauma and genetic predisposition are also underlying causes.

 

Christian Rhea, DO, a rheumatologist with Heritage Medical Associates, said, "It would be great if we could find a way to stop or reverse the progression of osteoarthritis. We've been able to do that with rheumatoid arthritis, but with osteoarthritis, the mechanism is different. We haven't quite unlocked the secrets, yet."

 

Instead, he continued, "You try to control the symptoms; and if there are modifiable factors, you try to modify those."

 

Certainly in the most severe cases, joint replacement surgery becomes an option. For millions, however, it's more a matter of learning to mitigate symptoms.

 

"Joint replacements can be very effective in the right patient," Rhea noted, "but I always start with trying to optimize non-surgical treatments." He added that patients won't die from OA, "but they could have a pretty serious side effect from the treatments" so it's important to closely monitor a patient's tolerance to non-surgical solutions.

 

Rhea said many of the tried and true medications, modalities and lifestyle modifications are quite helpful in relieving symptoms and improving quality of life. In the last decade, glucosamine and chondroitin have become popular buzzwords in treating osteoarthritis. "Those were believed to actually reverse the damage, but most of the data on that is for knee and hip arthritis. It hasn't shown a very robust effect on reversing structural damage on a joint affected by osteoarthritis," said Rhea, who added he still recommends use of the supplements for many patients because they do help with symptom control.

 

He added, one major contributing factor to an increase in the prevalence of osteoarthritis is the obesity epidemic. As the weight of America continues to go up, so does the impact on our weight-bearing joints.

 

With osteoarthritis of the knee, for example, strengthening the muscles around the joint and losing weight can have a significant impact. "If you have strong muscles, it will help offload the pressure that goes through the joint," Rhea said. Similarly, every pound of weight lost has a positive benefit. "When you walk, the pressure that goes through your knee is six times your body weight. Losing weight takes pressure off."

 

For hands, paraffin treatments can offer temporary relief. Locally injected steroids, topical anti-inflammatory medications and other injectable treatments also ease joint pain. "But they are all temporary," Rhea said. "None of them are intended to reverse the effects of osteoarthritis structurally."

 

Bracing, splinting and assisted devices are also quite helpful for certain populations. Rhea said exercises and therapy aimed at improving range of motion and function are also an important part of the regimen.

 

For Ken Spychalski, PT, rehab director at The HealthCare Center at West Meade Place, working with OA patients is a daily event. The center has 120 beds of which half are dedicated to skilled nursing patients with the balance being more traditional long-term care beds. In the last three months, the center has had 135 admissions with 69 percent of those arriving with a diagnosis of some form of arthritis in their medical chart.

 

The facility unveiled a new therapy gym in October 2008. In addition to a busy main area, the new space features two private treatment rooms. Osteoarthritis patients, have a range of options including TENS units (transcutaneous electrical nerve stimulation), which Spychalski said temporarily blocks pain communication as it kicks in an endorphin response. He also leads patients through closed chain and open chain exercises, depending on the person's acuity level. Open chain exercises do not put weight on joints and are typically conducted from a seated position. Once patients are physically able, they move to weight-bearing, closed chain exercises. Ice, ultrasound, free weights, pulleys and cardio equipment are also included in the arsenal.

 

Spychalski said, "There are four components to good therapy –– hand's on (manual therapy), some type of modality (like a paraffin bath), patient education (home exercise programs) and therapeutic exercise."

 

One relatively new therapy option makes the hard work of getting stronger seem a bit more fun. The Healthcare Center at West Meade Place included Wii Sport and Wii Fitness in their new space. "Everyone will gather around, and they'll say, 'Oh, my grandson does that!'" Spychalski noted with a chuckle.