What Osteoarthritis (OA) Does to Your Body

Over 20 million Americans suffer from osteoarthritis (OA) with pain as a central feature. If you suffer from OA, it is important to know how to go about your daily life with the least disruptions.

You might have questions and concerns about OA, such as how the disease progresses, how your daily activities might be limited, treatments that might help you cope with OA, and their costs. The information below is provided in order to help you better understand what osteoarthritis is and which treatment is best for you.

What Osteoarthritis Can Do

• Joint damage: As the cartilage wears away, there is less cushioning to prevent bones from rubbing together. Bone spurs put pressure on nerves and sensitive tissue.
  
  
• Muscle strain: As the joint becomes distorted, the muscle tissue surrounding the joints becomes strained and painful. This leads to disuse and weakness.
  
  
• Inflammation: OA is not considered to be an inflammatory form of arthritis, but like rheumatoid arthritis, there are periods when some degree of inflammation can occur. In these cases, blood vessels widen, and blood and other fluids collect at the injured site to begin repair. Unlike normal immune responses, with arthritis, the inflammation may not subside. Over time, continued inflammation begins to further harm the joint.

• Self-management: The first line of treatment is to learn how to control your own pain. People who manage their symptoms report the most significant decreases in joint pain, fewer doctor visits, higher levels of physical activity, and improvements in daily life. You should help your doctor in documenting your condition and treatment, and invite your family, physical therapists, rheumatologists or even support groups to be a part of the process.
  
  
• Weight and exercise: Excess body weight means more pressure on already painful joints. Losing weight, when appropriate, may prevent or slow the development of OA in weight-bearing joints that are not yet affected. Also, the healthier you are, the better you will be able to deal with the pain. Low-impact exercises like swimming and walking increase flexibility, strengthen muscles and increase endurance while improving cardiovascular fitness.
  
  
• Additional nonmedication therapies: Additional nonmedication therapies may be helpful, including shoe inserts, braces and splints, walkers and canes, heat and cold pads, and assistive devices for easier completion of daily activities. Relaxation and distraction are also useful methods to help people with OA manage their pain more effectively. Also, make sure to tell your doctor if you are using complementary therapies such as herbal supplements, acupuncture or massage, as it might affect your treatment plan.

Acetaminophen is the first drug recommended by OA treatment guidelines for mild-to-moderate pain due to its availability and cost effectiveness. Acetaminophen dosage should not exceed 400 milligrams per day.

Topical analgesic creams including methylsalicylate and capsaicin are useful for people who do not respond to acetaminophen and who do not want systemic therapy (drugs given by mouth or injection that affect the whole body). Capsaicin cream should be applied to the affected area four times daily.

Traditional NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen and naproxen/naproxen sodium are successful at relieving pain, and at higher doses also relieve inflammation caused by OA. However, traditional NSAIDs have been shown to increase the risk of gastrointestinal (GI) bleeding in older patients with continued use. Counteracting this side effect may require the use of expensive GI protective medication, such as a proton pump inhibitor or misoprostol.

COX-2 inhibitors are prescription NSAIDs that provide the pain reduction of traditional NSAIDs, but have less risk of causing severe GI bleeding. Though they are not effective for all patients, these drugs have had large success in treating OA pain.

However, these COX-2 inhibitors must be used with extreme caution, as recent studies have shown that prolonged use of the drugs may increase the risk of heart attacks and other dangerous side effects. As many as one-third of OA patients taking these treatments need additional medication to counter adverse reactions. Be sure to discuss prescription NSAIDs very carefully with your physician.

For more information on COX-2 inhibitors and their risks, please visit:

• The Arthritis Foundation
  
• The American College of Rheumatology

The Alliance for Aging Research acknowledges the support of McNeil Consumer & Specialty Pharmaceuticals, which provided an educational grant for this program.

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