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Did you know that more than 43 million people have someform of arthritis? The Center for Disease Control andPrevention estimates that this number will increase to 60 millionby the year 2020. Chances are good you know someonewho suffers from some form of arthritis.
It is important to understand that several types of arthritisdo exist. The most common type is called osteoarthritis, otherwiseknown as degenerative joint disease. This is a diseasegenerally associated with old age. One way to view this type ofarthritis is to think of one’s body as a car. The body, like a car,shows wear and tear with time and starts to deteriorate (evenif you are German engineered).
The next most common type of arthritis is called inflammatoryarthritis. This is a broad category that includes suchdiseases as Rheumatoid arthritis and Psoriatic arthritis. Thesediseases are unique in that the body is actually trying to destroyitself. In patients with inflammatory arthritis, the liningof the joints in their body, the synovium, secretes chemicalsthat destroy the bone. The inflammatory arthritis categoryalso includes gouty arthritis. With gouty arthritis, the bodyforms crystals in the joints. The body reacts to these crystalsby having cells “eat” the crystals. The problem with thissolution is that the cells then burst, releasing chemicals (andthe crystals) back into the joint. The released chemicals candestroy the joint. Another type of arthritis is post–traumaticarthritis. In this type of arthritis, the joint is damaged fromtrauma, either due to the damage from the impaction of thejoint or because of the resultant “unevenness” of the joint becauseof the trauma; the joint wears out more rapidly thannormal. The end result of these types of arthritis is essentiallythe same, bone grinding on bone. Think of a sheet of sandpapergrinding against another piece of sandpaper.
Arthritis is capable of affecting any joint in the body. Commonlocations for arthritis are the hip, knee, shoulder and theback. Most arthritis patients complain of pain with activity inthe joint involved. The pain may be gradual with onset arthritis,or it may develop quickly. Occasionally the involved areabecomes swollen when in use. At other times patients complainof stiffness in the concerned joint and they must “loosenit up” with activity. Almost always the joint pain is worse atthe end of the day.
Usually, arthritis only becomes a problem when it preventspeople from doing what they like to do, whether it beplaying golf or gardening. An x–ray of the joint showing bonerubbing against bone (arthritis) doesn’t necessarily mean thatit’s the arthritis causing a problem for the patient. But whenarthritis does become a problem and prevents daily activities,there are several options to treat it.
There are two means of treating arthritis: surgery andnon–surgery. I recommend that my patients start with theeasier, non–operative treatment options. The non–surgicaloptions include such things as physical therapy, non–steroidalanti–inflammatory medicines (NSAIDS), injections, bracingand shoe inserts. The injections can either be a type of steroidor cortisone or a synthetic joint lubricant like Synvisc,Supartz or other similar brands. The cortisone shot is meantto decrease the inflammation within the joint caused by bonerubbing against bone. The synthetic joint lubricant is similarto putting oil into your car. The principle behind this isthat as we age, the normal lubrication in our joints decreases.The injection supplements the volume with synthetic jointfluid. Physical therapy helps to keep the surrounding musclesstrong and limber, as well as to help maintain balance. If thesetreatments don’t work, certain devices like bracing and shoeinserts may be an option depending on the joint involved. Thegoal of this treatment is to take pressure off the joint, therebyminimizing bone irritation. It is important to know that thesenon–surgical options are great to start with, but they will onlytreat the symptoms. By this I mean that the underlying arthritisis still there, it just doesn’t hurt as much. When a patienthas tried these conservative options and the arthritis is stillbothersome, it is time to discuss the surgical options.
Surgery can range from minimally invasive arthroscopy tocomplete replacement of the joint. The indications for a minimallyinvasive procedure such as an arthroscopy are very limitedfor treatment of arthritis. In arthroscopy, we as surgeonscan do many great things. But unfortunately, nothing we cando in this type of surgery can treat the bone from grindingagainst another bone. More often than not, the type of surgeryinvolved will be some kind of a joint replacement. In thissurgery, the diseased part of the bone is shaved off and a capis placed over the edge of the bone, much like a dentist wouldput a cap on a tooth. Sometimes surgeons can replace justone part of the joint, like the inside of the knee joint. Othertimes surgeons can replace just one bone of the joint, like thethighbone for the hip joint. Ultimately, the surgical optionshould be tailored to the particular problem, and a thoroughdiscussion with the surgeon is necessary to understand all ofthe risks and benefits of surgery prior to embarking on thisjourney.
In the vast majority of cases where people elect to havesurgery, the results prove beneficial and dramatically enhancetheir quality of life. The goal of the surgery is twofold, to reducepain and to restore function. It is a very reasonable expectationfor the patient to return to their lives and activitieswithout the pain from the arthritis.
If you believe you have arthritis, or know of someone whodoes suffer from arthritis, I would encourage you to visit adoctor to discuss suitable options. Arthritis can be a debilitatingdisease, but it shouldn’t keep you from enjoying your dailyactivities.
