A number of diseases/conditions can affect the joints. The most common problem is osteoarthritis or “wear and tear” arthritis.

Osteoarthritis
While no one really understands what causes osteoarthritis, it is associated with prolonged use due to aging, a prior injury to the affected area, or breakdown of the cartilage due to disease or an inherited weakness. The condition affects the weight-bearing joints - the hips, knees, feet and spine - and also the hands. It most often affects the knees.

The following illustrations show how osteoarthritis progresses in the knee joint.

In the above illustration, the knee joint is healthy. The joint is surrounded by the synovial membrane, which manufactures synovial fluid. The ends of the bones are intact and well-cushioned by the cartilage, which is bathed in synovial fluid.

In the second illustration, the cartilage has begun to wear down and the synovial fluid has become thinner. Cysts (fluid-filled cavities) are forming in the ends of the bones, underneath the cartilage. In response to the loss of cartilage, bone spurs begin to grow into the surrounding tissues, and the end of the bones widen to help bear the increased load. This widening causes limitation of movement.

Eventually, as shown in the illustration above, the cartilage wears down so badly that the ends of the bones grate together. The ends of the bone continue to widen and small spurs of bone may break away, further limiting movement. The thinned synovial fluid may increase in volume, giving rise to swelling and increased discomfort.

Treatment for Osteoarthritis
Treatment for osteoarthritis focuses on reducing the symptoms, increasing joint movement, and helping prevent further damage to the joint. Since symptoms differ from person to person, treatment programs are similarly varied. What works for one person may not work for another.

Weight control: Being overweight puts excess stress on the joints and is a risk factor for osteoarthritis. Reducing weight should help alleviate discomfort.

Exercise: Three types of exercise are particularly beneficial for people with osteoarthritis. Range of motion exercises (stretches) help keep joints flexible. They are best performed after applying heat to the joint or after a warm bath.

Isometric exercises help tone the muscles without moving painful joints. Strong muscles help keep the joints aligned properly and prevent overall weakness of the affected area.

Aerobic exercises help build endurance and cardiovascular strength. Swimming and other movements performed in water are especially gentle on sore joints.

Heat and cold therapy: Applying heat or cold to sore joints can provide temporary relief of pain and stiffness. Heat helps to relax aching muscles and cold helps numb the area. Never use heat with rubs or creams and always use a towel or cloth between your skin and the source of heat or cold.

Medications: Prescription medications can help relieve the pain often experienced with advanced osteoarthritis. NSAIDs (non-steroidal anti-inflammatory drugs and their sub-class, the Cox-2 inhibitors, are commonly prescribed for osteoarthritis pain. Since these drugs may have undesirable side effects (NSAIDs, in particular, can cause stomach bleeding), they should only be taken if other methods of pain control fail.

For milder or occasional pain, buffered or enteric coated aspirin, or acetaminophen may be helpful.

Natural therapies: These include supplements and topical creams/lotions/rubs.

Many natural supplements for arthritis contain glucosamine sulfate and/or chondroitin sulfate. These substances are natural components of cartilage and have been reported by many osteoarthritis sufferers to reduce pain. Glucosamine and chondroitin work by drawing water into the cartilage, helping to boost its cushioning ability. (Where very little cartilage remains, glucosamine and chondroitin have little or no impact on pain.)

Type 2 collagen is another substance found in some osteoarthritis supplements. Type 2 collagen is the primary protein present in joint cartilage. There is evidence that type 2 collagen in supplemental form is utilized by the body to benefit the joints.

A number of herbs and botanicals appear to benefit osteoarthritis sufferers. These include sarsaparilla, yucca, devil’s claw, feverfew, Boswellia serrata and white willow bark. These herbs play a role in inhibiting inflammation and reducing pain.

Topical creams/lotions/rubs containing natural ingredients may also provide relief for arthritis pain. Many rubs contain capsaicin, the substance that makes red chilli peppers hot. Purified capsaicin relieves pain by reducing substance P - a neurotransmitter found at the nerve endings, which is involved in transmitting pain signals to the brain.

Please note: If you are allergic to oral ASA or salicylates, you should not use a topical rub containing salicylates.

An Ounce of Prevention
While nothing can guarantee that you won’t develop osteoarthritis or rheumatoid arthritis, observing the following pointers will reduce your personal risk:

• Stop smoking. A number of studies have shown a link between cigarette smoking and rheumatoid arthritis.¹
• Protect your joints. As soon as you feel pain or discomfort in your joints, stop the activity that is causing it.
• Weight loss can reduce the risk of osteoarthritis. One study found that women who reduced their weight by five kilograms (11 pounds) decreased their risk of knee osteoarthritis by 50 percent.²
• Prompt treatment of a joint injury and proper rehabilitation will help reduce risk of developing osteoarthritis in that joint later on in life.

1.  Hutchinson D., Shepstone L., Moots R., Lear J.T., Lynch M.P: Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA.  Ann. Rheum. Dis. 2001, 60:223-227
2.  From the National Institutes of Health (NIH) review on osteoporosis, published in the October and November 2000 issues of the Annals of Internal Medicine.

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