Treatment Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but there is no cure for osteoarthritis. Treatment focuses on controlling pain, minimizing joint damage and improving or maintaining function and quality of life. Physical therapy can be an important component in treatment, contributing to pain relief, flexibility, enhanced mobility and an overall sense of wellness. Patient education is considered an essential element of management of osteoarthritis. Effective education programs, such as the Arthritis Foundation Self-Help Program, are designed to teach pain management techniques, help individuals develop an exercise program and manage fatigue and stress, and provide information about effective use of medications. 7 Weight loss Overweight and obesity increases the pressure on the lower back, hips and knees. It doesn’t take much weight loss for benefits to appear. Losing weight is especially significant for osteoarthritis of the knee. One study showed that obese people with osteoarthritis of the knee had a dramatic improvement of function with a rapid loss of 10 percent of their weight. 8 Exercise Exercise is one of the best treatments for osteoarthritis. The right exercise program can strengthen muscles, increase flexibility, help maintain a healthy weight, and improve mood and outlook. However, certain activities, such as running, jogging and tennis, put pressure on affected joints. Alternative exercise activities that put less pressure on the joints are walking, yoga, swimming and water aerobics. Quadriceps strengthening exercises are recommended for individuals with knee osteoarthritis. For elderly individuals with osteoarthritis of the hip or knee, levels of exercise that contribute to cardiovascular conditioning are especially important because of their increased risk for cardiovascular disease. Medicine Drug therapy for pain management is most effective when combined with exercise and weight loss, according to the American College of Rheumatology. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen Physical therapy Critical to the management of osteoarthritis is a lifestyle modification program that includes exercise, weight reduction and pain management. Physical therapy interventions should focus on strengthening all muscles that cross the specific joint affected by osteoarthritis. 16 To date, the focus of the majority of osteoarthritis research pertaining to physical therapy and osteoarthritis has been on quadriceps strengthening in the knee. Other important facets of treatment can include: 16 ● Stretching exercises. ● Interventions to increase range of motion. ● Low-impact exercises that promote aerobic conditioning if weight-bearing joints are affected. ● Aerobic aquatic programs. Tai chi, described as a system of gentle physical exercise and stretching in a slow, graceful style, has been found to significantly reduce pain in some patients who performed 60 minutes of tai chi two times a week for 12 weeks. 16 A less common osteoarthritis problem is arthritis of the ball- and-socket joint of the shoulder. Usually, the affected shoulder has been damaged months or even years earlier. This damage causes the cartilage of the shoulder to wear down abnormally. 17
and naproxen are the most common medications given for osteoarthritis. 9 COX-2 inhibitors, available only by prescription, are another class of NSAIDs. Patients who are already taking medication for osteoarthritis and add the treatment of weight loss or exercise are encouraged to try reducing the dosage of the analgesic agent they are taking to reach the lowest possible level of medication for relief. Glucosamine and chondroitin are dietary supplements that have been widely promoted as a treatment for osteoarthritis. Scientific studies of the efficacy of glucosamine and chondroitin are conflicting, however. A major clinical trial sponsored by the National Institutes of Health found that the combination of glucosamine and chondroitin sulfate did not provide significant relief among all participants, but did seem to be effective in relieving pain for those with more severe pain. 10 If patients wish to use the supplements, they are advised to work with their physician to explore the pros and cons of all treatment options and to be circumspect in purchasing them, because supplements are considered food and are not regulated as rigorously as are drugs by the Food and Drug Administration. Other treatments In addition to the primary treatments of weight loss, exercise and medication, some people use a cane or splint to help take pressure off painful joints. Splints should be properly fitted by an occupational therapist or physician and, to avoid stiffness and weakness in the joints and muscles, should be used only for limited periods of time. Topical creams, gels and sprays, such as the commercial products Zostrix, Icy Hot and Ben Gay, contain ingredients that can work in several different ways. For example, the ingredients may stimulate the nerve endings to distract the brain from the joint pain or block the action of a neurotransmitter called substance P that sends pain messages to the brain. Surgical modalities are sometimes recommended for patients with severe pain that has not responded satisfactorily to medical therapy. 9 Surgery may be done to remove loose pieces of bone and cartilage from the joint, to reposition bones, or for a complete joint replacement. Part of an effective therapy program involves teaching the patient how to reduce stress to the shoulder. Instructions include: 17 ● Be aware of maintaining good posture. Keep shoulder blades down and back. ● Lift objects by keeping them close to the body. ● If an exercise regimen involves lifting weights, be sure to only lift weights that are light, and do not lift weights above the level of the shoulder. ● When swimming, avoid strokes that aggravate the shoulder, such as the backstroke and the crawl stroke. Before exercising or physical therapy, it may be helpful to apply heat to prepare the body tissues for such movement. Research indicates that heating the whole body (e.g., taking a warm shower or bath) before exercise is more effective than local application of heat, although local application may be used as an alternative. 17 Examples of appropriate exercises include weighted pendulum stretching exercises that help to maintain joint mobility and flexibility, passive stretching exercises, and shoulder- strengthening exercises. Examples of shoulder-strengthening exercises include outward rotation, inward rotation and lifting exercises. 17
LYMPHEDEMA
Lymphedema is a painful and debilitating swelling of an extremity. It occurs when lymphatic fluid accumulates in the soft tissues, usually in an arm or a leg. Even though lymphedema afflicts approximately 2.5 million people in the United States, it
is poorly understood, even by medical professionals, and often goes undiagnosed or is misdiagnosed as gout, dermatitis or some other condition.
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