Date: Fri 30-Apr-1999

Publication: Bee

Author: JAN

Quick Words:

health-arthritis

Full Text:

Program Focuses On Strategies For Life With Arthritis

(with photo & dropquote)

BY JAN HOWARD

People who suffer the pain of arthritis often claim that their joints can

predict the weather more accurately than any weather person could.

There are more than 100 types of arthritis. Osteoarthritis, the most common

form, afflicts 60 million Americans and accounts for 68 million work-loss days

a year.

Osteoarthritis is a slowly progressive condition in which there is

deterioration of the cartilage in joints, such as knees and hips. It may have

genetic causes or be a result of aging.

Dr J. Albert Diaz discussed "Arthritis & Osteoporosis: Diagnosis and

Treatment" at the April 20 Lunch and Learn program sponsored by Ashlar of

Newtown and the Cyrenius H. Booth Library. About 70 area residents attended.

Lunch and Learn is part of the free, seminar series for mature adults about

living and aging well.

A healthy lifestyle, including maintaining reasonable weight, regular

exercise, a well balanced diet, and a daily multi-vitamin will help prevent

arthritis, Dr Diaz said.

Symptoms of arthritis are pain, swelling, decreased motion, and stiffness in

the joints, he explained. Thinning of cartilage makes the joint space smaller.

With more narrowing, the bone takes more stress and bone spurs may develop.

Severe arthritis occurs when the articular cartilage is worn down and bone is

on bone, with little or no cartilage remaining to act as a cushion.

The lining of the joint becomes very inflamed, which causes a buildup of fluid

and a lot of pain, Dr Diaz said.

To diagnose arthritis, a doctor will look for swelling, painful or decreased

motion, tenderness, and grinding. X-rays will determine the loss of joint

space and cyst formation, he said.

Treatment For Arthritis

Though there is no cure for arthritis, there have been several recent advances

in treatment, Dr Diaz said.

Non-operative treatments consist of physical therapy, medication, and

injections.

Physical therapy is used to strengthen and condition the joints and increase

range of motion. Weight loss is advised, if necessary, to put less stress on

the joints.

Anti-inflammatories, such as aspirin, Aleve, or Advil, reduce inflammation,

but have side effects of stomach upsets or ulcers; 107,000 people are

hospitalized yearly with stomach complications or ulcers and there are 16,500

deaths a year from bleeding ulcers, Dr Diaz said.

A new anti-inflammatory, Cox-2 Inhibitor, is safer for the stomach but does

not eliminate all stomach problems, he noted, advising that all

anti-inflammatories should be taken on a full stomach.

Chondroprotective agents, such as glucosamine and chondroitin sulfate made

from animal tissue, the building blocks of cartilage, may slow the progression

of arthritis. They are sold in health food stores as supplements. There have

been no reported side effects from their use, Dr Diaz said.

"Studies with Cosamin DS from Nutramax Laboratories are encouraging for mild

to moderate arthritis," he said. "The verdict is not in as yet but it's worth

trying."

The supplement should be taken every day. "The effects diminish if you stop,"

Dr Diaz said. The manufacturer of Cosamin DS recommends that it be taken for

three to six months for a positive effect.

"Early reports are encouraging," Dr Diaz said. If a person has severe

arthritis, use of this supplement is probably too late, he noted.

Treatment can include injections of steroids or hyaluronic acid. Injections of

steroids are relatively safe, Dr Diaz said. They should be used judiciously,

he noted, and efficacy and duration of relief vary.

"If used judiciously, they can be effective at decreasing inflammation and

relieving pain," he said.

Injections of hyaluronic acid, which is derived from chicken combs, a building

block of cartilage, have been recently approved, Dr Diaz said. Three to five

injections may decrease the symptoms but do not prevent the progression of

arthritis. The injections have minimal side effects, which may include

swelling, rash or itching.

Operative treatments can consist of arthoscopy, which repairs tears in the

cartilage but does not fix the arthritis, or total joint replacement, Dr Diaz

said.

In 1997, there were over half a million joint replacements done, he said.

Ninety to 95 percent of the patients are pain free for ten years following

joint replacement, Dr Diaz said.

Following surgery, patients are walking the first day, out of the hospital in

three to five days, and then undergo three to six weeks of supervised therapy.

Though people with joint replacements must eliminate high impact sports, they

can play golf, doubles tennis, swim, ski, and dance, he said.

For children and young adults with small defects, cartilage transfer or

cartilage reimplantation can be successfully accomplished, Dr Diaz said. In

cartilage transfer, cartilage is taken from another part of the joint and

transferred to the affected area. With cartilage reimplantation, cartilage

cells are taken out, grown in a lab, and then injected back into the joint

where the cartilage grows back.

Osteoporosis

Osteoporosis, often called the silent disease, is the structural deterioration

of bone tissue because of the loss of calcium that increases susceptibility to

fractures. A person can be symptom-free until suddenly experiencing painful

bone breaks or fractures.

Twenty-five million Americans have osteoporosis. It can affect both men and

women Á one out of every two women over 50 and one out of every three men over

75 will be affected.

Dr Diaz said osteoporosis often is the result of people not accumulating

enough bone during formative years and losing excessive bone after maturity.

It can be prevented by weight bearing exercises, such as walking, muscle

strengthening exercises, limiting alcohol, avoiding tobacco, and using hormone

replacement therapy. Practicing Tai Chi to achieve good balance is helpful, Dr

Diaz said, to prevent falls that may result in fractures.

Most physicians recommend about 30 minutes of vigorous exercise about three to

five times per week.

Bone loss begins around the fifth decade when calcium is withdrawn faster than

it is replenished. The greatest risk is to the spine, wrists and hips.

It can be caused by an overactive parathyroid gland, advanced age, and lack of

estrogen in older women. Other risk factors include family history, being of

fair skin and hair and slender build, smoking, and excessive use of alcohol.

Bone density can be determined through a Dexa scan, a dual energy x-ray. It is

recommended for women over 65 or postmenopausal women under 65. It is covered

by Medicare, Dr Diaz said.

Treatment consists of hormone replacement therapy and drugs that limit the

rate of bone loss, such as bisphosphonates and calcitonin.

"HRT does a lot of good things," Dr Diaz said, especially for the heart and

bones. He said it should not be used in cases where there is a risk of blood

clots in legs or a family history of breast cancer or stroke. He said the use

of Raloxifene, a selective estrogen receptor modulator, has a decreased risk

of breast cancer.

Dr Diaz said the positive effects of HRT on the heart and bones outweighs

negative affects for breast cancer.

Dietary recommendations include 1,200 to 1,500 mg daily of calcium and 400 to

800 units a day of vitamin D to prevent bone loss.

"Studies show that all treatments work," Dr Diaz said.

Exercises, such as walking, help to build bone mass, he said.

Dr Diaz said hip replacement is always an end-stage procedure because it is

major surgery.

Books Available

Some books on osteoporosis and arthritis available at C.H. Booth Library are:

Doctor, Why Do I Hurt So Much: How to Combat Your Arthritis or Arthritis-Like

Condition and Start Enjoying an Active Life by Mark Greenberg; Overcome

Arthritis by William Kitay; The Osteoporosis Cure by Harris McIlwain, MD;

Calcium and Common Sense by Robert P. Heaney, MD and M. Janet Barget-Lux;

Eating Well, Living Well With Osteoporosis by Marc K. Drezner, MD, and

Kimberly P. Hobern, RD; Arthritis: Your Complete Exercise Guide by Neil F.

Gordon, MD; Living With Arthritis by Dr A.B. Corrigan; The Arthritis Book of

Water Exercise: A Non-Swimmers' Guide to Water Exercise by Judy Jetter and

Nancy Kadlec; Coping with Rheumatoid Arthritis by Robert H. Phillips, PhD; and

The Encyclopedia of Health: Arthritis by Dale C. Garell, MD.