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The pain of arthritis can range from mild to debilitating but there are treatments that can help manage it. Dr. Geroge Kannankeril, of the NorthShore Physical Medicine and Rehabilitation team, answers common questions on how to cope with arthritic pain, from how to slow the advance of arthritis and manage pain nonsurgically to when surgery might be the best option:
Could knee pain after exercise be arthritis? First, it’s important to get a diagnosis. Knee pain can be from arthritis, inflammation of soft tissues, or even from hip or spine problems. Start with ice, rest and an anti-inflammatory cream. If these are not enough, the next steps would be to start an anti-inflammatory over-the-counter medication like ibuprofen or naproxen. However, if you have certain chronic medical conditions like heart or kidney disease you should check with your doctor before taking anti-inflammatory medications. Depending on how long the pain has been going on and whether it resolves itself, see a physician who will likely order an X-ray. If it is arthritis, physical therapy, an exercise program and other interventions, like injections, may help.
What is left for patients who have tried prescriptions, physical therapy, chiropractic work, acupuncture and supplements to manage pain? Chronic pain is very difficult. It usually takes a combination of interventions: medication to restore sleep, pain medication, structured exercise/physical therapy, centrally acting medication to reduce brain "hypersensitivity" to pain, stress management, etc.
It’s also important for a patient and physician to form a relationship of trust, which leads to better patient compliance, a lessening of fears and better outcomes. Many patients with chronic pain due to arthritis are "kinesthesiophobic,” or have fear of movement, so they need to trust that their doctors are not going to hurt them with recommendations of exercise and increased mobility. However, the single best predictor of outcome is a patient's own belief in his or her abilities to overcome difficulties. We encourage a positive belief system through education in classes and by example—patients seeing other patients with the same problems undergoing the same treatment.
Can exercise make arthritis worse? Exercise is the single best treatment for arthritis. It is the only treatment ever shown to change the "natural history,” or deterioration, caused by arthritis. The type of exercise would depend on the individual patient and the joint affected. For knee arthritis, exercises should focus on strengthening the quadriceps, gluteal and abdomina muscles, as well as working on flexibility of the hips and the knees in order to normalize the pattern of walking. A bicycle is a great exercise for hip and knee osteoarthritis. I strongly believe that yoga is the best choice for exercise classes for almost all patients with arthritis. While these types of exercise programs are beneficial, frequent high-impact activities like running and jumping may aggravate arthritis for some people.
Should you wait until pain restricts your activity to consider surgery or have it done before arthritic pain becomes severe? That's a great question. You want to wait until pain is bad enough that it starts to limit your activities, but not so long that you are disabled. People with disabling pain have a more difficult time recovering from surgery. It’s very important to reduce your joint pain before surgery with medications or injections so that you can begin an exercise regimen preoperatively. I like to send my pre-operative hip and knee surgery patients to physical therapy for customized exercise. But, I would say that most people know deep down inside when the time is right for surgery.
What can be done for those suffering from arthritis in their hands and fingers? Unfortunately, there is no known treatment that slows the "natural history" of arthritis of the hands. The best strategies: 1)Keep your hands strong and knuckles flexible; 2) Use a brace for the thumb, especially at night to reduce movement and inflammation; 3) Try a topical anti-inflammatory cream—such as diclofenac cream—up to 4 times a day; 4) Take adequate vitamin D (2000 international units a day); 5) Eat an anti-inflammatory diet, which means avoiding sugars, alcohol and carbohydrates); 6) Keep your hands warm in the winter; 7) And finally, use modified/built up handles on your kitchen tools.
Is long-term use of an over-the-counter anti-inflammatory okay?For many people, yes. I suggest to my patients that if they are taking an anti-inflammatory every day, they need to come in for a visit every six months so we can monitor their blood pressure, look for leg edema, question them about heartburn and get blood tests. Patients who have diabetes, disorders of the kidneys or liver, heart disease, reflux, stomach ulcers, or those who are very frail or elderly, on blood thinners, and those on multiple medications are at high risk for complications and need to re-consider taking daily anti-inflammatories.
For more information on the NorthShore Arthritis Center click here.