Arthritis -- specifically osteoarthritis, which is the most common form of arthritis -- has reached epidemic proportions in our country. Currently there are over 50 million estimated arthritis sufferers in the USA. By 2030, one out of every three Americans will suffer from arthritis, so unfortunately, chances are very high for being afflicted with this chronic disease (Center for Disease Control).
The Best News
If you have arthritis pain, the best news of all is that you can become self-empowered to manage your own arthritis pain.
Changing to an anti-inflammatory diet, which eliminates fried foods, reduces processed sugar and focuses on fruits such as blueberries, is the first step. Follow that with a supplement regimen (always check with your primary care doctor first, please), including Curcumin, Boswellia and Vitamin D. And finally, round this out with smart exercises: Walking is best, but aqua therapy and/or using a stationary bicycle are excellent options if you cannot tolerate walking. After all, 30 minutes of walking a day is one of the best ways to keep the doctor away.
The Good News
However, if you're in pain, and self-help remedies, integrative therapies and prescription medications have failed to relieve your symptoms, you can explore these options, which offer relief to many sufferers:
Joint Lavage: This is a simple joint irrigation, and will bring significant relief as it removes cartilage debris that is irritating the arthritic knee joint. I was privileged in my training to do research on joint lavage, and we published reports on our research, which yielded very good results on arthritic knees. The lavage is a 15-minute outpatient procedure that works especially well if you have a lot of swelling and debris in your joint. (Vad et al, Archives of Physical Medicine and Rehabilitation. 2003; 84: 634-637.)
Hyaluronic Acid: In those joints that do not have significant swelling, hyaluronic acid, which is an artificial joint lubricant, will provide relief for up to six months in arthritic knees; data shows that it may also protect the cartilage. This is a simple office-based procedure.
One of my patients, a 68-year-old who currently lives in Upstate New York, was able to put off total knee replacements for over a decade by using hyaluronic acid while she was caring for her elderly mom. However, if you're very obese, the success rate for joint lubrication goes down. Another very good reason to rethink your diet!
Cortisone Shots: In a joint that is significantly swollen, a cortisone injection will work wonders, and while I oppose repeated use of cortisone, it can be a powerful anti-inflammatory in an acutely painful joint. However, I discourage repeated use of cortisone, as it may cause long-term problems. But a couple of cortisone injections a year will do no long-term harm.
To Replace or Not to Replace?
If you fail all these minimally invasive, non-surgical therapies, you may have to consider surgical interventions. You need to be aware of complications of joint replacements such as blood clots, infections and in very rare circumstances, death. However, a total hip replacement is one of the best surgical procedures invented, because 95 percent of the time there's almost full pain relief with full restoration of function. A total knee replacement, on the other hand, is a bit more complicated, and up to 15 percent of patients will still experience residual pain and loss of function even after getting their knee replaced.
This is a personal decision that must be made with help of family and friends and your personal physician. The best way to find a good joint replacement specialist is getting advice from your general doctor or on recommendation of family or friends who have had successful joint replacements.
My only caution is that arthroscopy still has a very limited role in arthritis.
If you happen to have either a meniscal tear in the knee or a labral tear in the hip, but have significant underlying arthritis, the cause of your pain is usually the arthritis and not the tear. Therefore, those tears should be left alone, since removing them arthroscopically will usually not provide pain relief, but will actually accelerate the arthritis, leading you to a total joint replacement sooner that later.
The Future is Bright
The future of arthritis care is very bright. There are medical foods under development that are very effective without causing side effects that are harmful.
Medical food is food formulated to be consumed under the supervision of a physician and is intended for specific dietary management of a disease which has unique nutritional requirements. This isn't food as you would normally eat it; medical food often is delivered in a capsule form. Currently, there are several medical foods that are emerging, including flavonoids, which are derived from plant pigments (the materials that gives plants their color) and have significant beneficial health effects especially in arthritis, by reducing inflammation. I am a big believer that curcumin, which is a turmeric extract, has bright future as a medical food in arthritis.
I'm also excited about the new potent topical creams that penetrate deep and cause sustained pain relief without side effects.
And last but not the least, the revolution of biologics in arthritis holds extraordinary promise. Biologics means therapies that resemble our natural body tissue. The future of stem cells that are derived from your own body may have huge positive implications for arthritis sufferers because, with minimal invasion and minimal risk, we may be able to restore a functional cartilage and thus the potential to actually reverse arthritis. I am personally involved in this research effort, along with many colleagues around the world in this exciting area of utilizing stem-cell therapy in arthritis. And I remain very, very optimistic.
My best advice? Become an educated patient, make a commitment to a healthy diet, proper exercise and supplements, and keep a positive mindset. This will enable you to live better in your body and remain active with arthritis.
Dr. Vijay Vad's new PBS special, Active With Arthritis, premieres nationwide on June 1, 2013. Please check your local PBS station for broadcast dates and times.
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