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New ways to beat osteoarthritis pain

MAY 2013

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Just over the horizon, therapies are being developed to relieve osteoarthritis. But there's a lot you can do to feel better today.

There's a 50-50 chance that, at some point in your life, you'll develop osteoarthritis (OA). Not great odds, considering how much this joint condition can hamper your activity.

The pain and limited mobility in OA occur as the cartilage that cushions the space between bones wears away with age and overuse. Left bare of their padding, bones rub painfully against each other—particularly in the hands, spine, knees, and hips.

For years, treatments have focused on relieving OA symptoms—nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen to control pain, steroid injections to bring down inflammation, and viscosupplements to replace the joint's natural lubricant. Today, the treatment outlook is changing.

"We're beginning to understand that osteoarthritis is a disease of the entire joint," explains Dr. Antonios Aliprantis, director of the Osteoarthritis Center at Harvard-affiliated Brigham and Women's Hospital. "Much of the research over the last 20 or 30 years has focused on cartilage as the target. But we're beginning to realize that there are important changes happening in the bone underneath the cartilage, and in the joint lining itself—the synovium. As we begin to understand osteoarthritis as a disease of the entire joint, new treatment targets will emerge."

Disease-modifying therapies

One of the treatments in development isn't new at all. It's an osteoporosis drug called strontium ranelate, which has been used to treat bone loss in Europe; it's now finding a new purpose for knee OA. "Strontium is thought to inhibit the activity of cells called osteoclasts, which break down bone. How this drug works in OA is not clear, but it might protect bone under the cartilage," Dr. Aliprantis says.

At the American College of Rheumatology annual meeting in November 2012, researchers presented the results of a three-year study testing strontium ranelate. People with mild-to-moderate OA who took this drug had less narrowing of the joint, indicating a slowing of disease progression. Although the difference in joint narrowing wasn't huge, it was "encouraging," Dr. Aliprantis says. Other medications that target changes to the bone under the cartilage may also prove useful.

Stem cells, which are able to transform into many different types of cells, also show potential for treating OA. The hope is that injecting stem cells into damaged joints might help regenerate healthy tissue.

Dr. Aliprantis says that because OA is a localized disease, its ideal treatment would be injected directly into the joint, to avoid the bodywide side effects of current OA drugs.

Established treatments

While it may take time for these new therapies to come to fruition, there are several options women can try to relieve OA pain.

"When I see patients with OA, I try to take a multidisciplinary approach to their care. I might inject their knees with cortisone; I might use viscosupplements; if they're overweight, I'll encourage them to lose weight," Dr. Aliprantis says. "A lot of these little things together can make a big difference."

Your doctor might recommend one or more of these OA treatments:

  • oral pain medications such as acetaminophen and NSAIDs (ibuprofen, naproxen)

  • topical pain-relieving creams and rubs applied to the skin over the painful joints

  • corticosteroid injections into the affected joints to temporarily relieve pain

  • hyaluronic acid injections (viscosupplements) to replace the fluid that naturally lubricates the joints.

Other ways to relieve joint pain

There are also many simple measures that can help relieve arthritis pain and stiffness:

Heat and cold. Take a warm bath, apply cold compresses, or wrap some frozen vegetables in a towel and hold them to your painful joints. Heat, cold, or alternating the two can be very effective at relieving pain.

Massage. Gently rubbing the joints can increase blood flow to the affected area and ease sore spots. Because arthritic joints can be sensitive, see a massage therapist who specializes in treating people with arthritis.

Glucosamine and chondroitin. Although these nutritional supplements have been "fairly debunked as a potential disease-modifying therapy," Dr. Aliprantis says, they may improve arthritis pain in some people. However, he points out, "if these supplements are not helping your pain, you should not continue to spend your money on them."

And don't forget about exercise—it's one of the most effective ways to treat OA. Exercise can reduce pain, improve flexibility, strengthen the muscles that support the joints, and help you lose some of the weight that's straining your joints. "I think it's pretty clear that exercise is important for maintaining joint health and decreasing pain in patients who have OA," Dr. Aliprantis says. Swimming and riding a stationary exercise bicycle are good exercises for people with OA, because they don't put undue stress on already painful joints.

"I think the important thing if you're embarking on an exercise program is to start slowly and increase slowly, under the watchful eye of a physician or physical therapist, to make sure your muscles are properly balanced," advises Dr. Aliprantis.

Foods that fight inflammation

No one food can relieve arthritis, but eating—or avoiding—certain foods can help combat inflammation throughout the body.

What to eat

  • Omega-3 fatty acids from cold-water fish, such as salmon and tuna

  • Beans

  • Flaxseeds

  • Walnuts

  • Green leafy vegetables

  • Canola and olive oil

  • Green tea

  • Margarine and butter

What to limit

  • Omega-6 fatty acids from egg yolks and red meat

  • French fries and other fried foods

  • Packaged cookies, crackers,
    baked goods, and other processed, sugary foods

  • Fruit juice

Surgical options

If these treatments don't work, your doctor might suggest a joint resurfacing or replacement procedure. However, the thought of surgery immediately sends some OA patients into a panic. "Most patients come in thinking, ‘If I need a joint replacement down the road, it's going to be the end of the world. It's going to take me months to recover and I won't be able to care for myself,'" Dr. Aliprantis says.

Women in particular are reluctant to get a damaged joint replaced, "to their detriment," Dr. Aliprantis says. Instead of fixing the problem, women may just accommodate to their increasingly limited mobility. He says that if your pain is interfering with your daily life, you should discuss a joint replacement with your doctor. "The reality is that when joint replacements are done by an experienced surgeon, most patients do quite well," he says.

The future of OA treatment

Unlike rheumatoid arthritis, OA hasn't had any major breakthroughs that have dramatically improved its medical treatment. Drug development for this type of arthritis has been slow because the disease itself follows a slow process. It takes time to track whether a treatment can halt joint damage when that damage occurs so gradually. "Joint replacement surgery has been successful, but medical treatments for OA have been limited," Dr. Aliprantis says.

Hopefully, strontium or another disease-modifying therapy will prove its merit in future studies. But it could be several more years before any approach revolutionizes the treatment of this condition. "I think we're just starting to understand OA," Dr. Aliprantis says.