University Times

If your joints don’t ache today, just wait.

Each day, 20 million Americans wake up (assuming they’ve been able to sleep) with joint pain from osteoarthritis (OA), the most common form of arthritis. With an aging and, especially, an increasingly overweight population, that number is expected to top 70 million by 2030.

More bad news: There is no cure for OA. There are no known specific causes (although risk factors have been identified). The pain associated with OA, which is the leading source of disability among over-65 patients, can lead to depression, anxiety and feelings of helplessness, in addition to job limitations, lost wages and significant lifestyle adjustments due to lack of mobility and strength. The progression of the disease in almost all cases eventually leads to joint-replacement surgery.

“But OA is not untreatable,” said Michael Williams, a product sales specialist for Breg, Inc., a California-based manufacturer of knee braces specifically for OA patients. “And treatments can allow patients to lead active, productive lives and delay going under the knife, which most people view as a last resort.”

Those treatments, designed mostly to mitigate OA pain and delay surgery, include: oral medications, ointments, hot packs (or cold packs to reduce swelling and stiffness), direct joint injections, a customized exercise/rest regimen, a positive attitude and using a brace, according to Williams.

There also are non-traditional treatments, such as acupuncture and nutritional supplements, he said. “I am not a physician, and you should always consult your doctor before picking any treatment,” Williams cautioned. “OA also is not limited to the knee; it could show up in the neck, the hip, the hands, the spine — basically any joint.”

Furthermore, the rate of acceleration of the disease, a patient’s response to certain medications and an individual’s pain threshold all vary considerably, so that treatments need to be geared to the individual in consultation with a physician, he said.

Symptoms of OA typically begin at the base of the thumb, with numbness and tingling leading to a sapping of grip strength followed by gnarling of digits and, somewhere along the way, inevitable, relentless, overt pain.

OA that strikes the hip area can be particularly devastating because pain and stiffness can radiate to other areas of the body such as the inner thigh, the buttocks and the spine.

Men under 45 show more OA symptoms than do women in that age group, while for the over-45 group more women on average show symptoms than do men.

While no exact cause is known and no single test has been developed to identify OA, the disease can be diagnosed after tests exclude other diseases with similar symptoms, such as rheumatoid arthritis or gout.

OA’s primary risk factors have been identified as being overweight; natural aging; previous joint injury, and work-related circumstances, such as being on one’s feet or keyboarding for long periods of time. Heredity also is a factor, as a significant percentage of those who get OA are pre-disposed to it by their gene pool, Williams said.

“X-rays are not much help in identifying OA in its early stages, but CT scans and MRIs are much better at identifying the areas where the joint is not in balance, or where there has been cartilage deterioration,” Williams said.

In addition to cartilage, which provides a smooth, silky barrier between bones, joints include ligaments, which connect bones to bones; tendons, which connect muscles to bones, and muscles, which are the bundles of specialized cells that contract to produce movement when stimulated by nerves. The body also produces synovial fluid that lubricates the joints. “Think of it as a good 30-weight oil,” Williams said. “But the body, through re-absorption, can lose some of that synovial fluid, which keeps the cartilage smooth and healthy.”

A non-surgical treatment of injecting hyaluronic acid into the knee joint, which temporarily replaces synovial fluid, recently garnered FDA approval, but is not yet approved for the hip joint, Williams said.

“The knee is the primary weight-carrying joint, so being overweight or obese contributes to OA,” said Williams, whose chief expertise is in the knee joint. “An average person takes a step or bends a knee to sit down about a million times a year,” he said.

That is why weight control and proper rest are important counter measures to sustained joint pain, particularly in the knee and hip.

Breg manufactures “counterforce” knee braces, available only with a physician’s prescription, that are designed to improve gait symmetry and mobility mechanics, decrease OA symptomatic pain and increase activity levels, essentially by re-balancing the knee joint, supporting the internal structure of the knee and taking stress off the joint.

The brace, which weighs about 18 ounces, is adjustable by the patient and can be worn under normal clothing. It significantly reduces the steady, dull pain common among OA sufferers, according to Williams.

Research published in the American Journal of Orthopedics indicates that after eight weeks of brace use, “patients reported statistically significant improvements — substantial reduction in pain, increase in ability to work and to engage in activities of daily living, and substantial reduction in use of oral pain medications.”

“Remember, this is not a cure. It’s not stopping the disease,” Williams said. “But a brace can manage pain levels and postpone surgery for 3-5 years and many times longer,” he said.

“Surgery, of course, is an individual choice,” Williams concluded. “Today’s joint replacement surgical procedures are minimally invasive and hospital time is about three days, instead of three weeks even a few years ago. But people, generally, want to avoid surgery as long as possible, which depends on their pain tolerance.”

—Peter Hart