Lifestyle Changes:

Lifestyle changes can help reduce stress on affected joints.

Occupational Changes

Patients with osteoarthritis should reduce shock to the affected joint. Hammering away at deteriorating cartilage may speed up the degeneration. People in occupations with repetitive and stressful movement should find ways to reduce trauma. Adjusting the work area or substituting tasks that produce less stress on joints helps reduce shock.

Exercise

Joints need motion to stay healthy. Long periods of inactivity cause the arthritic joint to stiffen and the adjoining tissue to atrophy (waste away). A moderate exercise program that includes low-impact aerobics and power and strength training has benefits for patients with osteoarthritis, even if exercise does not slow down the disease progression. Exercise helps:

• Reduce stiffness and increase flexibility. It may also help improve the strength and elasticity of knee cartilage.
• Promote weight loss.
• Improve strength, which in turn improves balance and endurance.
• Reduce stress and improve feelings of well being, which helps patients cope with the emotional burden of pain.

Exercise especially helps patients with mild-to-moderate osteoarthritis in the hip or in the knee. Many patients who begin an aerobic or resistance exercise program report less disability and pain. They are better able to perform daily chores and remain more independent than their inactive peers. Older patients and those with medical problems should always check with their doctor before starting an exercise program.

Three types of exercise are best for people with osteoarthritis:

• Strengthening exercise
• Range-of-motion exercise
• Aerobic, or endurance, exercise

Strengthening Exercise. Strengthening exercises include isometric exercises (pushing or pulling against static resistance). Isometric training builds muscle strength while burning fat, helps maintain bone density, and improves digestion. For patients with arthritis in the hip or knees, exercises that strengthen the muscles of the upper leg are important.

Exercise, such as weightlifting, helps build muscle that is usually lost with age and puts stress on bones, helping keep them strong and healthy.

Range-of-Motion Exercise. These exercises increase the amount of movement in joints. In general, they are stretching exercises. The best examples are yoga and tai chi, which focus on flexibility, balance, and proper breathing.

Aerobic Exercise. Aerobic exercises help control weight and may reduce inflammation in some joints. Low-impact workouts also help stabilize and support the joint. Cycling and walking are beneficial, and swimming or exercising in water is highly recommended, for people with arthritis. (Patients with osteoarthritis should avoid high-impact sports, such as jogging, tennis, and racquetball.)

Physical Therapy

In addition to exercise, treatment of muscles and joints by a trained therapist may be helpful. If patients fail to improve on a home program, a referral to a physical therapist may be beneficial.

Weight Reduction

Overweight patients with osteoarthritis can lessen the shock on their joints by losing weight. Knees, for example, sustain an impact three to five times the body weight when descending stairs. Losing 5 pounds of weight can eliminate 20 pounds of stress on the knee. The greater the weight loss, the greater the benefit. [For more information, see In-Depth Report #53: Weight loss and diet.]

Heat and Ice

Ice. When a joint is inflamed (particularly in the knee) applying ice for 20 - 30 minutes can be helpful. If an ice pack is not available, a package of frozen vegetables works just as well.

Heat Treatments. Soaking in a warm bath or applying a heating pad may help relieve pain.

Mechanical Aids

A wide variety of devices are available to help support and protect joints. They include splints or braces, and shoe inserts or orthopedic shoes. A commonly used brace for knee osteoarthritis that involves only one side of the knee joint is called an offloading brace.

Pain Management

Relaxation techniques such as guided imagery and breathing exercises may help some patients better cope with chronic pain.

Acupuncture, Transcutaneous Electric Nerve Stimulation (TENS), and Massage

Some patients use acupuncture to reduce osteoarthritis pain. The technique is painless and involves the insertion of small fine needles at select points in the body. Some studies have found that acupuncture can help provide short-term pain relief.

Transcutaneous electric nerve stimulation (TENS) uses low-level electrical pulses to suppress pain. A variant (sometimes called percutaneous electrical nerve stimulation, or PENS) applies these pulses through a small needle to acupuncture points. A review of trials reported that both methods were better than placebo (sham treatments) in treating osteoarthritis of the knee, although additional well-designed studies are needed.

Massage therapy may also help provide short-term pain relief. It is important to work with an experienced massage therapist who understands how not to injure sensitive joint areas.

Herbs and Dietary Supplements

Glucosamine and Chondroitin. Glucosamine hydrochloride and chondroitin sulfate are natural substances that are part of the building blocks found in and around cartilage. For many years, researchers in the U.S. have been studying whether these dietary supplements really work for relieving osteoarthritis pain. Earlier studies indicated a potential benefit from these supplements.

However, several recent high-quality studies involving large numbers of patients have indicated that, in general, glucosamine and chondroitin do not seem to provide any more help than a placebo for the symptoms of osteoarthritis. Some doctors recommend a trial period of three months to see if glucosamine and chondroitin work. If the patient does not experience any benefit, the supplements should be discontinued.

S-adenosylmethionine (SAMe). S-adenosylmethionine (SAMe, pronounced "Sammy") is a synthetic form of a natural byproduct of the amino acid methionine. It has been marketed as a remedy for arthritis, but scientific evidence supporting these claims is lacking.

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.