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The healthy joint versus the damaged joint A joint is any place in your body where bones connect. Freely movable joints such as the finger, shoulder, hip and knee are surrounded by a finely tuned network of muscles, ligaments, tendons and nerves that give support and enable motion. The ends of the bones at a joint are covered by a smooth tissue called cartilage and lubricated with special fluid, allowing them to slide against each other painlessly. If the cartilage becomes roughened, however, the friction causes stiffness, swelling and pain. The most common culprit is degenerative arthritis, also known as osteoarthritis. Affecting many people after age 60, arthritis can become progressively worse and steadily decrease the quality of life by making even simple daily activities difficult. Fortunately, there are a number of ways to take control of arthritis.

Non-surgical treatments for arthritis

The first step begins with you. Low-impact exercise like walking and swimming helps discourages joint stiffness and helps keep surrounding muscles and ligaments strong; combined with a healthy diet, it can reduce the stress on your joints by controlling your weight. Exercise also helps combat the stress that plays a role in virtually all illnesses. Mild joint pain that arises from general activity usually diminishes with rest, topical ointments and over-the-counter medications, such as aspirin or ibuprofen. When it does not, you should consult your doctor. Other signs that it is time to see a doctor include pain that interferes with normal daily activities, occurs even when you are not moving or actually awakens you from sleep. A doctor can provide a number of treatments to ease these symptoms.

• Medication: Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) such aspirin or ibuprofen to reduce pain and inflammation. Prescription-strength NSAIDs are also available. Side effects have traditionally included upset stomach and increased chance of ulcers, but newer NSAIDs have been developed to reduce the frequency of these problems.
• Steroid injections: If NSAIDs are ineffective or cause disruptive side effects, your doctor may inject a corticosteroid directly into the joint. Injections typically relieve pain and swelling for several weeks to one year, but cannot be used too frequently because they weaken the bones and cartilage.
• Hyaluronic acid injections: A recently developed treatment typically used for the knee involves hyaluronic acid, which is made from a substance found in normal joint fluid. The fluid is injected directly into the joint to coat the damaged cartilage. Injections must be given three to five times one week apart before alleviating symptoms. Relief can last for several months.
• Use of a cane: The use of a cane during walking can relieve pressure on weight-bearing joints like the hip and knee. A cane can be used in conjunction with other treatments.

There are several natural and alternative treatments that can help alleviate arthritis symptoms. Although they do not replace conventional medicine, you may use them to complement the care you receive from your doctor.

• Topical applications: Applying cold or heat to a joint is a basic remedy for pain and swelling. Cold numbs the painful area, while heat relaxes the tense tissues surrounding the joint. Many over-the-counter ointments exist for joint and muscle pain as well, but do NOT use them with cold or heat, which may damage the skin.
• Glucosamine sulfate: This over-the-counter nutritional supplement, taken in pill form, contains a protein that occurs naturally in cartilage. Although it has not been widely researched in the United States, the German counterpart of the FDA has endorsed glucosamine sulfate for the relief of joint pain and swelling. Glucosamine sulfate has been more widely tested than the varieties containing chondroitin or hydrochloride, and has shown better results. Those who benefit from glucosamine must continue taking it to enjoy the relief of symptoms.
• Magnetic therapy: Some individuals have reported that placing magnets on an affected area helps relieve pain. These claims have been supported by a few small studies. Although the pain-relieving effect is not understood, observations show that that placing a magnet on an area of the body increases blood flow to that region. The medical community generally agrees that although more extensive research of magnetic therapy is necessary, it may be helpful for some people with arthritis.
• Relaxation and stress relief: Because arthritis is aggravated by stress and also creates stress, learning to relax with deep breathing exercises, meditation or yoga can be very beneficial. Massage and acupuncture can also promote muscle relaxation and may bolster the immune system by increasing the flow of blood and lymph fluid.

When surgery is necessary A severely damaged joint may require surgery. Surgery is usually considered only when arthritis symptoms seriously interfere with the activities of daily living, the pain frequently awakens you from sleep and non-surgical treatments do not provide relief. There are three common procedures for surgery of damaged joints.

• Bone fusion: This procedure, which is used for smaller joints such as the finger, involves fusing the bones of the joint together. Bone fusion eliminates pain by removing the affected joint, but because it results in permanent loss of mobility, it is only used in cases of advanced arthritis that do not respond to other treatments.
• Arthroscopic surgery: This procedure, which can be used for the shoulder, knee, elbow or ankle, involves removing damaged cartilage. The physician inserts miniature camera equipment and surgical tools through several small incisions and watches his work on a monitor. Arthroscopic surgery can improve the function of the joint by smoothing roughened cartilage and removing debris. Recovery from this procedure usually occurs within weeks.
• Total joint replacement: In this procedure, most commonly used for the knee and hip, the damaged joint is removed and replaced with an artificial joint of metal alloy or strong plastic. Because it is major surgery, it is only considered in cases where pain that has not been relieved for a period of six to 12 months, seriously hinders your ability to perform normal daily activities and diminishes the quality of your life. Total joint replacement typically requires general or spinal anesthesia and a hospital stay of five to seven days. Your recuperation in the hospital is assisted by a physical therapist. Patients usually experience significant pain relief and improved function; most can walk using only a cane within a few months. Patients are recommended to continue physical therapy during recovery.

The outlook for patients with joint pain

Although surgery provides the only permanent end to joint pain, the process of degenerative arthritis can be slowed by early medical intervention, and the symptoms can be controlled by a number of self-help measures and treatments provided by your doctor. Talk to your doctor to determine which course of action you should take to control your arthritis and maintain a full and healthy life.

Copyright:

William D. Abraham, MD

Tri Rivers Surgical Associates

West Hills Bone & Joint Center
Moon Township
935 Thorn Run Road
Moon Township, PA 15108
412-299-0809
fax: 412-269-2303

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