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Arthritis and activity

By Michael Gordon, MD, Milwaukee Orthopaedic Group, Ltd. Orthopedic Surgery, Sports Medicine Fellowship

Arthritis does not discriminate by age. This equal opportunity disease afflicts almost 40 million people a year in the U.S. Annually, it leads to 315 million physician visits and 8 million hospital admissions. Data published in 1992, estimated that the cost of treatment for arthritis in the U.S. topped $149.4 billion. By 2020, it is projected that 60 million Americans will feel its wrath.

With over 100 different types of arthritic conditions, osteoarthritis has the highest rate of occurrence. This disease typically afflicts the hands, feet, spine and large weight-bearing joints. The most common location for osteoarthritis is the knee joint where it directly causes the breakdown and loss of articular cartilage – the smooth gliding surface on the end of the bones. Symptoms of osteoarthritis include pain, stiffness, swelling and decreased range of motion that can ultimately lead to limits in mobility and an increased risk for falling.

Arthritis doesn't have to put a stop to your activities. There are multiple ways to treat arthritis in the active individual including medications, bracing, physical therapy, injections and surgery. Furthermore, the role of exercise cannot be understated as weight-bearing activity helps to maintain bone density, joint mobility, as well as muscle strength.

Medications include over-the-counter (OTC) options such as acetaminophen, ibuprofen or naproxen, along with prescription drugs such as Celebrex, Relafen and Mobic. While these medications will generally address the symptoms of osteoarthritis, they will not affect the natural history and progression of the disease. Nutritional supplements, such as glucosamine sulfate and chondroitin sulfate, have shown promise in international studies and are currently under extensive review here in the U.S. In addition to being able to help to control the symptoms, these supplements may be able to slow down the degradation of the cartilage.

Bracing and shoe inserts are another non-invasive way to treat osteoarthritis by helping to "unload" (i.e., support) the affected portion of the knee. A simple knee sleeve can also help to keep the joint warm and decrease the sense of stiffness.

Physical therapy can increase range of motion and improve the strength of the surrounding muscles. Most importantly, therapists can help to restore "joint sense" thereby improving stability and decreasing the risk of falling.

Injection therapy includes corticosteroids ("cortisone") and viscosupplements. Cortisone is a potent anti-inflammatory that can quickly quell an arthritic flare. Viscosupplements are like an oil change for the knee; they work by decreasing the level of inflammation within the knee.

The next and final option for patients is surgery. Depending on the individual, surgery can be fantastically successful in helping return a patient to their active lifestyle. Recently, there has been some controversy over the appropriateness of arthroscopy in the arthritic knee; however, it is generally accepted that a patient with a sense of locking and catching or having "mechanical symptoms" will benefit from an arthroscopic procedure. In the case of end-stage arthritis where pain is persistent and activity has been dramatically limited, a total joint replacement can dramatically improve an individual's quality of life.

The goal of physicians treating patients with osteoarthritis is to help them maintain function and activity levels while reducing joint pain and inflammation. I continually encourage my patients to remain active and exercise regularly. The treatments listed above provide a variety of options to meet this objective.

Dr. Michael Gordon, of the Milwaukee Orthopaedic Group, Ltd. is an orthopedic surgeon with a fellowship in sports medicine. For questions, you can reach Dr. Gordon at (414) 276-6000.