Osteoarthritis

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

September is Arthritis Month! The Arthritis Society would like Canadians to be more aware of Arthritis and its impact on Canadians. Osteoarthritis is the most common type of arthritis and it affects about 10% of the Canadian population. In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.

First, let’s talk definitions. Arthritis literally means “inflammation of the joint”. As the Arthitis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused. Osteoporosis is NOT a form of arthritis. It can be debilitating and painful, but it does not directly effect the joints. Osteoporosis is when the bones get weak and break easily. We will leave osteoporosis for another article. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.

In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article, is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. A doctor may confirm the diagnosis of OA with X-rays.

What symptoms might I have if I had osteoporosis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.

How is OA treated? Osteoarthritis treatment is usually a combination of non-drug and drug treatments. Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other. Drug treatments can be roughly divided into pain killers, steroid injections, and synovial fluid replacements.

One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol). If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen. These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure. Because of problems with stomach upset and ulcers, the COX-2 inhibitors were developed. They have names like rofecoxib (Vioxx) and celecoxib (Celebrex). The COX-2 inhibitors bother the stomach less, but still have a risk of increasing blood pressure. There are also topical or rub on forms of NSAIDS to try to get the NSAID to the joint without bothering the stomach. Although they can be effective, we have to assume they have the same side effects as oral NSAIDS.

Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working. They are mostly done on knees, and should be limited to 3 injections per year.

Synovial fluid replacements or hyaluronans can also be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive.

Glucosamine and chondroitin are natural products that are generally well tolerated and have side effects similar to placebo. It is difficult to determine if they actually work because of the limited study on them, but it does seem that even the proponents say you need to use them for at least 1 month for there to be any good effects.

For more information: see the Arthritis Society’s website : www.arthritis.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.