Checkup Prevention and early treatment for osteoarthritis
David Zynn of Pine is only 58, but has already had both hips replaced in the past four years.
A combination of hip dysplasia and osteoarthritis from participating in many sports over the years contributed to the degeneration of the cartilage in his hips, allowing bone to rub against bone and causing increasing pain.
His doctor, Tony DiGioia, medical director of the Center for Bone and Joint Health at UPMC’s Magee-Womens Hospital, said that there are two general categories of arthritis. The first is inflammatory type arthritis, such as rheumatoid, lupus and psoriatic. Dr. DiGioia refers to that type as “whole body diseases,” since they are all autoimmune diseases, with synovial inflammation, causing the loss of cartilage and joint pain. The other is degenerative, or osteoarthritis.
Mr. Zynn’s type of arthritis falls into the second category, degenerative or osteoarthritis.
“It’s very important to distinguish the two because the underlying causes for the arthritis, inflammatory versus degenerative, which are very different, determine how you treat it and how you prevent it,” Dr. DiGioia said.
“Osteoarthritis can be diagnosed at any age, but older adults are at higher risk,” said Dr. Todd Franco, clinical instructor of AHN-Primary Care Sports Medicine Fellowship and head team physician for the Pirates.
Dr. DiGioia, who has been in practice for 30 years, said autoimmune arthritis was more prevalent when he began his career, but has since become less common with earlydiagnosis and new medicines that are able to treat the symptoms before complete de generation occurs.
“I always kiddingly say that if our infectious disease colleagues considered osteoarthritis an infectious disease, they would label it as an epidemic because the numbers are just staggering,” Dr. DiGioia said.
Reasons for the increase in these types of cases include longer life expectancies and the increase of obesity in the population, along with the higher expectations of baby boomers.
Baby boomers want to stay active, which is recommended, but there is an added factor to developing osteoarthritis, which is prior injuries.
“When you have an injury, like a cartilage tear in the knee, even a minor one in your 20s or 30s, that area is at an increased risk for developing arthritis,” Dr. DiGioia.
“There is [also] a genetic component to osteoarthritis,” Dr. Franco explained. “Those with relatives who are affected are certainly at a higher risk for development of osteoarthritis.”
That doesn’t mean that you are certain to develop arthritis if you had an injury in your 20s, or if you have a family member who had the disease. But it can help to take measures to avoid it.
Preventive steps
The best ways to prevent osteoarthritis from developing are to watch your weight and to stay active.
“If you already have some level of wear, you want to avoid high-impact activities like jogging or even things like Stairmasters,” said Dr. DiGioia, but there are lots of low impact aerobic exercises you can do.
Focusing on strengthening muscles is important, because they act as shock absorbers for your joints and slow down the wear and tear on the protecting cartilage.
“The whole goal for prevention is really to think about it as slowing down the progression and limit the damage,” said Dr. DiGioia.
If you do have joint issues, be it pain or stiffness, early evaluation is key to getting a treatment plan to intervene and stop the advancement of the degeneration, because, as Dr. DiGioia said, “unfortunately, at this point, once you lose the cartilage, there is absolutely nothing out there to replace it.”
Although there are efforts to grow replacement cartilage through tissue engineering, he said this is only in the research stages. While laboratory-grown cartilage or injections that stimulate cartilage growth are the “holy grail,” he said such solutions are not approved by the Food and Drug Administration, and are not available for the kind of global arthritis that patients have when they need joint replacement.
While joint replacement surgery can be very successful, as it was for Mr. Zynn, many patients would prefer to avoid it.
Treatment options
Treatment for osteoarthritis depends on the amount of degeneration already present. Medications can be used to lessen the pain and inflammation.
Nonsteroidal anti-inflammatory drugs like over-thecounter ibuprofen and naproxen sodium can help with some pain, and prescription-NSAIDs are available for those whose pain cannot be controlled with OTC drugs.
Counter-irritants are rubbed into the skin to lessen joint pain. Many contain menthol or capsaicin and can be purchased without a prescription.
Steroids like prednisone reduce inflammation and are available in both cream form and injections administered by physicians.
“There is constant research ongoing to better manage osteoarthritis and its functional effects,” said Dr. Franco, including injection options including platelet-rich-plasma and stem cell injections.
“Early treatment is the key,” said Dr. DiGioia.