November 28, 2023
If you've been diagnosed with osteoarthritis (OA) — also called degenerative or "wear-and-tear" arthritis — you aren't alone. It's the most common form of arthritis, affecting more than 32 million adults.
While there's no cure for arthritis, there are ways to slow it down, according to MU Health Care orthopaedic surgeon, Dr. Ajay Aggarwal.
"Degenerative arthritis and joint pain can develop at any age," Dr. Aggarwal says. "But no matter when it occurs, our primary goal is to diagnose it early and take action to delay the progression."
Dr. Aggarwal walked us through what you can expect after an OA diagnosis:
The first step in treating degenerative arthritis is learning why it developed, how advanced it is and how it’s affecting your life. Doctors characterize OA in one of two ways:
- Primary OA develops slowly with age.
- Secondary OA may include quicker deterioration of cartilage due to some form of mechanical deformity or mismatch in the joint, injury, trauma, overuse or related conditions, such as rheumatoid arthritis or ankylosing spondylitis.
"Once OA sets in, we cannot reverse the cartilage damage," Dr. Aggarwal says. "The status of the cartilage dictates how much time we can buy for patients and which steps we should take to prolong the life of the native (original) joint."
The goals of OA treatment include:
- Addressing symptoms and pain
- Improving joint function
- Stopping the disease from getting worse
- Preventing disability by maintaining a healthy quality of life
To achieve those goals, your health care team may recommend treatment that includes:
Regular physical activity
Exercise is the most effective natural treatment (without drugs or surgical intervention) for people with OA. It helps reduce pain and improve joint movement by strengthening the muscles supporting your joints.
"Muscle strength and flexibility directly impact joint problems, especially for knees and hips," Dr. Aggarwal says. "The more fit you are, the less pain you'll feel. You'll also extend the life of your joint."
But there's a limit to what type of exercise you should be doing. Dr. Aggarwal recommends people with OA avoid high-impact activities, deep squatting and kneeling — which can all speed up cartilage deterioration.
Instead, do regular stretching and 30 minutes of low-impact exercise daily, which may include:
- Elliptical machine
- Swimming and aquatic exercise
If you need help strengthening the muscles in a particular area, your doctor may recommend physical therapy.
Achieving and maintaining a healthy weight
Body mass index (BMI) affects how bad your degenerative arthritis is and how quickly it progresses. The lower your BMI, the less progression or damage to the cartilage. For someone with a high BMI, deterioration can happen quickly once it starts.
"Exercise and weight loss work hand-in-hand to help with osteoarthritis," Dr. Aggarwal says. "Exercise can help with weight loss, and losing weight can make exercising easier. They both help keep your joints healthy."
Dr. Aggarwal adds that in addition to eating a diet of whole foods, some people succeed with intermittent fasting. Weight loss injections can also help with excess pounds, especially for people with diabetes.
"Some people need help losing weight because they have hormonal imbalances or other conditions such as diabetes or hypothyroidism," Dr. Aggarwal says. "It's often worth it to enlist the help of your primary care physician (PCP) or an endocrinologist."
Medication for degenerative arthritis
Inflammation can sometimes cause pain and other symptoms, even if you embrace exercise and dietary changes. When that happens, your doctor may recommend medicines, including:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Reducing inflammation can relieve pain. Effective anti-inflammatory drugs come in two forms:
- Topical NSAIDs: Prescription and over-the-counter patches, creams and liquids can be applied where you have pain. These forms tend to have fewer side effects than oral medication.
- Oral NSAIDs: These drugs — available over the counter and in prescription form — block the enzymes that cause pain and swelling but can pose risks to your heart health if used too much or too long.
Corticosteroids and other injectable anti-inflammatory medications can offer temporary pain relief that lasts weeks or even months. But while injections can help you feel better and possibly delay the need for replacement, they don't stop disease progression.
"Corticosteroid injections can damage the cartilage even further, so we have multiple screening tools to help us determine whether a patient is a good candidate," Dr. Aggarwal says. "We don't recommend more than two or three injections a year (depending on the location), and I try only to use them when the patient is close to needing a joint replacement."
Platelet-rich plasma (PRP) injections are another option for treating inflammation associated with OA. Made from a sample of your blood, PRP is a natural anti-inflammatory. The injections contain concentrated platelets (blood cells) that work like a wet blanket to douse and calm inflamed joint tissue. Unlike corticosteroid injections, PRP shots don't damage your cartilage and are more effective when used for early or mid-grade deterioration.
Joint replacement surgery is typically a last-resort treatment for osteoarthritis. Even if a patient is in pain, advanced imaging must show severe degeneration of the joint.
"We need to have very objective evidence that the joint is bone-on-bone," Dr. Aggarwal says. "If you perform the surgery too early, patients won't get the full benefit, especially if their pain is partly due to high BMI or poor muscle strength."
Dr. Aggarwal stresses the importance of a multispecialty approach. He likes to explore all avenues to ensure there are no other causes of pain — for example, back issues can often cause knee or hip pain.
Before recommending joint replacement surgery, candidates should have:
- A bone-on-bone joint with little to no functional cartilage
- OA that is disabling and affecting activities of daily living
- Tried all possible conservative measures without success
"Surgery is always the last resort," he adds. "The sooner we catch OA, the sooner we can make lifestyle modifications and review all the factors we can change to delay the progression."
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