Two years ago, Willow Femmechild, 52, a nurse in Portland, Maine, started to feel knee pain when she went for a long walk or was on her feet more than usual at work. She had twisted one knee while lifting a patient 19 years earlier, and broken the other in the late 1980s–but since then, both knees had felt fine. The new discomfort was frustrating: Femmechild had put on 50 pounds over two years and was trying to get back in shape. “The more pain I had, the more sedentary I became; and the less exercise I got, the more weight I gained,” she says. Finally, she saw her doctor and learned that she had osteoarthritis (OA) in both of her knees.
Like Femmechild, nearly 21 million Americans suffer from OA, the most common form of arthritis. The numbers in the UK echo the US, says Gary Swanson of Arthritis Care Scotland. The disease affects joints–primarily the hips, knees, spine, and fingers–causing pain and swelling and making it tough to do everyday activities such as walking or grasping a pencil.
Though OA usually strikes people 50 and older, younger individuals aren’t immune. And as baby boomers age, the number of OA sufferers is expected to mushroom. Here are some commonly asked questions about this condition and information on what you can do to lower your risk of developing it.
What exactly is arthritis, and why do people get it?
Two of the most prevalent types of arthritis are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis, an autoimmune disorder that affects about two million people, is often debilitating. It can come on suddenly, be accompanied by sickness and fatigue, and cause inflammation in the lining of the joints. By contrast, osteoarthritis is known as the wear-and-tear arthritis. It occurs when cartilage–the cushioning around the joints–wears away and changes occur in the surrounding bones.
Heredity plays a big role in whether you’ll develop either type of arthritis. But weighing more than you should can raise your risk for OA, as can a past injury or a history of overusing a joint.
Experts aren’t sure why some people develop OA and others don’t. Most people in their 50s have worn or disappearing cartilage in their knees; yet only some complain of pain and stiffness. “Eventually we may learn that OA is several diseases with common symptoms,” says John Klippel, M.D., medical director of the Arthritis Foundation in Atlanta.
Who is more at risk for arthritis–women or men?
Seventy-four percent of OA sufferers are female, according to the Arthritis Foundation And they’re especially prone to OA in the knees and hands. Because many women develop OA after menopause, researchers suspect that the drop in estrogen that occurs during this time may be partly responsible. The Framingham Heart Study (which, for more than 50 years, ha examined the risk of heart attack, and other diseases in residents of Framingham, Massachusetts) found less knee and hip osteoarthritis in women who had taken hormone replacement therapy–though estrogen’s effect on osteoarthritis is not yet understood.
Another reason women may be more prone to OA: basic female anatomy. Because a woman has a wider pelvis than a man, her legs angle more, exerting more stress on her knees. Also, women generally have less muscle than men, so their joints have less support as they grow older and muscle mass declines. Finally, high heels take a toll on knees, reports a recent Harvard Medical School study.
What’s the connection between a person’s weight and osteoarthritis?
OA tends to strike weight-bearing joints, so the more you weigh, the more you stress your joints. For example, each pound you gain translates into two to three additional pounds of stress on your knees. Generally, carrying around just ten to 15 extra pounds makes you more vulnerable to OA of the knees, hips, and spine. The good news? Researchers for the Framingham study found that women who lost an average of 11 pounds reduced their risk of knee OA by 50 percent.
If exercise is good for you, why do so many athletes have arthritis?
That’s because injuring yourself also raises your risk for OA. Last year, researchers at the Johns Hopkins University School of Medicine and the Veterans Affairs Medical Center, both in Baltimore, reported that graduates of the med school who had previously injured their knees ended up with higher rates of knee OA than classmates who had not been injured; some in the first group developed OA as early as their 30s. But you don’t have to be an athlete to be prone to OA. The type of work you do–especially if it requires heavy lifting, kneeling, squatting, or repetitive motions–can also raise your risk. Researchers found that female textile mill workers in Virginia who had to make a pinching movement with their thumb and index finger had much higher rates of hand OA than workers who didn’t use that motion.
At the same time, not being active can also make you susceptible to osteoarthritis. The trick is to find an athletic activity that works for you, and progress slowly to build strength and endurance, advises Ann Babbitt, M.D., an orthopedic surgeon in South Portland, Maine, who treats many women with knee OA. If you do get injured, see a physician–preferably an orthopedist or a doctor who specializes in sports medicine. She can determine the extent of your injury and outline a course of treatment. And don’t rush through recovery. “If you return to stressful activities too soon, you may do further damage,” says Marian Minor, Ph.D., an expert on arthritis and exercise at the University of Missouri, in Columbia.
How is osteoarthritis diagnosed?
The main litmus test is pain: Your doctor will want to know when it first came on and how often it bothers you. Typically, the discomfort of OA builds over time, and follows a distinct pattern. You may experience stiffness and achiness in the morning; then the pain subsides as the joint limbers up. But at the end of the day, when you’re tired, it returns. You may notice swelling as well. Your doctor will also ask about past injuries, may examine your joint fluid for pieces of bone, and may order X rays or magnetic resonance imaging to check for cartilage damage.
What’s the best way to treat osteoarthritis?
Because there’s no cure, you may need an over-the-counter or prescription painkiller (see “The OA Medicine Chest,” page 66) as well as physical therapy to strengthen and stretch the muscles surrounding the joint. Strong muscles absorb shock, support joints, and protect against injury, and stretching increases your range of motion.
Willow Femmechild learned exercises that helped to strengthen the muscles in the front of her thighs, which stabilize the knees. She also signed up for a water exercise class, so she could get a low-impact cardiovascular workout. “When you’re midchest in water, you reduce the weight on your knees significantly,” Minor explains. Pushing against the resistance of water also builds muscle; and the buoyancy of the water increases your range of motion. Another crucial part of Femmechild’s rehabilitation program: Over the course of a year, she lost the 50 pounds she’d gained.
Can surgery help?
When other treatments fail, surgery allows many people to resume everyday activities. The least invasive option is arthroscopic surgery, which is primarily performed on a knee or shoulder. By inserting a special tool with a viewing device through small incisions in the skin, the surgeon can assess joint damage and remove any pieces of bone that may be causing pain. In another procedure–usually reserved for people with mild osteoarthritis of the hip or knee–the surgeon literally repositions the bone. In severe cases, the joint may be replaced. This surgery is primarily done on hips and knees, though shoulders, elbows, and knuckles can also be replaced. But the operation carries risks, including infection; it’s expensive; and rehabilitation can be arduous. Plus the artificial joint may have to be replaced in ten to 20 years. “Personally, if I had osreoarthritis and there was something I could do to delay or, ideally, prevent joint replacement surgery, I would do it,” Dr. Klippel says.