•  Pain and the Elderly •  Rheumatoid Arthritis

Osteoarthritis, by far the most common form of arthritis among older people, is a condition brought on partly by aging and long-term wear-and-tear in the joints. After years of use, the cartilage that cushions the joints can break down until bone rubs against bone. Spurs often grow on the sides of the affected bones, which only adds to the pain.

Osteoarthritis is rarely crippling, but it can have a major impact on a person's life. Many people miss work days or skip favorite activities when the pain flares up. The condition is responsible for more than 7 million doctor visits per year and is the number one reason for joint-replacement surgery.

For most people, it takes several decades to wear down enough cartilage to cause osteoarthritis. The number of cases rises sharply before age 45 in men and after age 45 in women. Once women reach menopause, they are much more likely than men in the same age range to develop arthritis pain. Overweight people and those with a family history of arthritis are also especially vulnerable to the condition.

The most obvious symptom of osteoarthritis is joint pain during or after use of the joint. In severe cases, the joints still ache while at rest or during the night. The joint may become swollen and stiff, limiting range of motion. Osteoarthritis most commonly affects finger joints, especially among women. The next most frequent sites of pain are the knee and hip. Less frequently, people can develop osteoarthritis in the shoulder, elbow, wrist, or back.

The condition doesn't always produce perceptible symptoms. In fact, many people with osteoarthritis of the fingers don't even know they have the condition, even when x-rays clearly show deteriorating cartilage in their joints. Osteoarthritis in the knees and hips, however, usually causes significant pain.

Women with osteoarthritis of the hands often develop bony lumps called Heberden's nodes at the last joints of their fingers. The lumps, seen less commonly in men, may be painful at first but are mainly just a cosmetic problem once the discomfort abates.

Osteoarthritis is a permanent condition, but the pain often fades over time. Although some people develop bone spurs, after the bones rub together often enough to become polished, there's little opportunity for further damage.

When arthritis pain first strikes, the over-the-counter painkiller acetaminophen (the ingredient in Tylenol and similar generic products) is your best choice for relief. But be careful -- although it's perfectly safe for the average person at recommended doses, acetaminophen can cause liver damage at high doses. It's important not to take more than 4 grams -- or 4,000 milligrams -- of acetaminophen each day, and because many products such as cold medicines include acetaminophen in their ingredients, it's not always easy to tell how much you're getting. In fact, the Food and Drug Administration estimates that about 14,000 people a year accidentally overdose on acetaminophen and wind up in the emergency room.

The FDA is considering requiring over-the-counter drugs to list acetaminophen as an ingredient in large print, so it will be easier to keep track of how much you're getting in a day. If you have underlying liver disease, check with your doctor to see what a safe dose for you would be or rely on another painkiller. You should avoid acetaminophen if you routinely have three or more alcoholic drinks a day, though one drink a day is thought to be safe.

Acetaminophen will probably do the job for a while, but many people with osteoarthritis eventually need stronger relief. In the past, that often meant switching to large doses of aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), effective but potentially dangerous remedies. (Again, avoid alcohol while you're taking these painkillers.)

NSAIDs can definitely ease the pain of osteoarthritis, but they also greatly increase the risks of bleeding ulcers, especially in people over 60. Over 100,000 arthritis sufferers are hospitalized each year for serious stomach trouble caused by NSAIDs, and about 16,500 die.

In April 2005, the US Food and Drug Administration issued a health advisory for both prescription and over-the-counter (OTC) NSAIDs, asking manufacturers to beef up warning labels. The FDA requested that warning labels for prescription NSAIDs advise patients about the potential for serious cardiovascular problems and potentially life-threatening gastrointestinal bleeding that is associated with this class of drugs. The agency also recommended that NSAIDs not be prescribed for anyone who has recently undergone coronary artery bypass surgery.

The FDA says that available evidence doesn’t indicate an increased risk for cardiovascular problems with short-term use of OTC NSAIDs. However, the agency has asked manufacturers of these drugs to revise their labels to include more specific information about the potential for cardiovascular and gastrointestinal problems and possible skin reactions.

Powerful drugs called COX-2 inhibitors offered relief for arthritis sufferers until questions about their safety arose. In April 2005, the FDA asked the manufacturer of one COX-2 inhibitor, Bextra (valdecoxib), to withdraw the drug from the market. After reviewing available data, the agency concluded that the risk of taking the drug outweighed its benefits. In June 2005, the FDA asked the manufacturers of all COX-2 inhibitors to add a boxed warning label advising users of an increased risk of cardiovascular problems and gastrointestinal bleeding associated with the drugs. One COX-2 inhibitor, Vioxx (rofecoxib), was voluntarily removed from the market in September 2004 after reports that it caused increased risk of stroke and heart attack in some people.

Whatever medication you take, it should be only one part of your fight against arthritis. Here are some other things you can do to relieve the pain and improve your mobility.

•Exercise. Your joints may ache, but they aren't calling out for rest. A combination of moderate stretching, weight lifting, and aerobic exercises such as swimming and cycling can give you strength, flexibility, and dramatic relief from pain. Your doctor can help you find an exercise program that gives you maximum benefits with little discomfort. There are even special stretching exercises for the fingers.

•Maintain a healthy weight. If you're overweight, shedding a few pounds can help take strain off your joints and reduce pain.

•Get your vitamin D. A healthy supply of this nutrient may help slow the progression of your arthritis, but many older people take in far less than the ideal amount. You can get plenty of vitamin D by drinking two cups of fortified milk each day and spending some time in the sun in early morning or late afternoon, when the rays cause less skin damage. (Your body makes its own vitamin D when exposed to sunlight.) Supplements are also an option; adults should take between 200 to 600 international units per day.

•Watch your posture. Good posture can help ease and prevent osteoarthritis pain in your back, hips, and knees.

•Adapt your environment to your condition. If you have arthritis in your fingers, for instance, you may need shoes that fasten with Velcro instead of laces.

•Find a support group. Sharing your experiences with others can be deeply rewarding. Support groups are also an excellent place to learn practical tips for coping with arthritis.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Further Resources

The Arthritis Foundation provides information on many forms of arthritis and can help you find a support group.

800/283-7800

http://www.arthritis.org

The Arthritis Helpbook, by Kate Lorig, RN, PhD, and James Fries, MD, is full of tips for managing arthritis and fibromyalgia. Perseus, 1995.

References

First published July 25, 2000
Last updated January 23, 2007
Copyright © 2000 Consumer Health Interactive

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