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Arthritis is basically a packaging problem. Your joints, remarkable and elaborate hinges, are cushioned by cartilage. They're held together with various other tissues, including muscles and tendons. Lubrication is in the form of some oily goop called synovial fluid, which is released by the synovial lining of the joints.
If you have osteoarthritis, the kind that most frequently coincides with aging, the cartilage around the joints starts to thin down or disappear. That's not your fault. What's more, it's not always preventable, either. Overuse may be the root of the problem. "It is caused by years of wear and tear or overuse of the joints," says Arnold Katz, M.D., rheumatologist at the Overland Park Regional Medical Center in Overland Park, Kansas. Obesity may contribute to the development of osteoarthritis in weight-bearing joints.
The runner-up, rheumatoid arthritis, is far less common, more mysterious, and equally pain producing. Rheumatoid arthritis is an inflammatory disease. With some people, the onset begins between the ages of 30 and 40, but more often it starts when people are between the ages of 40 and 60. For reasons that aren't fully understood, your body's immune system attacks your own joints, which start to suffer dire consequences.
For osteoarthritis, there are many tactics that can help hold off pain and maintain mobility. Some of these strategies might help people with rheumatoid arthritis as well. It all hinges on staying active, Dr. Katz emphasizes.
Move those joints. To keep the pain of arthritis from getting an even tighter grip on you, get yourself on an exercise program, says Dale L. Anderson, M.D., coordinator of the Minnesota Act Now Project in Minneapolis and author of Muscle Pain Relief in 90 Seconds. "Folks who are suffering from osteoarthritis must stay active; otherwise, the already-affected joints will get weaker and the people's overall aerobic capacity will drop," he says.
If you're over 60, start with low-impact aerobic activities such as 20-minute walks or exercises in a swimming pool at least three or four times per week, says William Pesanelli, physical therapist and director of Boston University's rehabilitation services. Any aerobic exercise program should be matched to your physical capacity, says Pesanelli. "If a person has been inactive for a period of time, then we're not suggesting that he go out and try to run the Boston Marathon. Instead, start with something like a five-minute walk a couple times per week, and then slowly start to increase your distance as you feel more comfortable."
Pepper yourself. You may not like hot peppers on your sandwich, but you might like hot-pepper cream for arthritis relief. Capsaicin cream, made from the active ingredient in hot peppers, has been shown in studies to ease arthritis pain when used regularly, according to Jeffrey R. Lisse, M.D., professor of medicine and director of the division of rheumatology at the University of Texas Medical Branch at Galveston. You can buy this cream over the counter. Follow instructions on the label, wash your hands thoroughly after application, and keep this stuff away from your eyes and other mucous membranes. It can really burn.
Take the plunge at your local Y. The Arthritis Foundation sponsors water exercise programs in community centers, YMCAs, and YWCAs all over the country. "Many senior citizens enjoy the social interaction and camaraderie of participating in a group setting," says Dr. Katz. "And if an exercise program is made to be fun, then people are more likely to stick with it."
Ease the burden. Arthritis gets worse more rapidly in overweight individuals, according to Dr. Anderson. "If you lose 5 to 10 pounds, it considerably lightens the load on all of your weight-bearing joints--hips, knees, ankles, and feet," he says.
When to See a Doctor
If any of the joints in your body appear red or swollen or if tenderness in them persists for several weeks, you should see a doctor, suggests Robert Swezey, M.D., medical director of the Arthritis and Back Pain Center in Santa Monica, California. Also, be sure to schedule an appointment if your hands are bright red and swollen and you can't grab things properly. "Whatever you do, don't put off seeing a doctor if you're in pain," says Dr. Swezey. "An early, accurate diagnosis will help you immensely."
Vary your terrain. Walking is always recommended but it's important to not get into a rut. "If you walk the same exact path every day, then you're landing on the same part of your foot each and every day and you're putting stress on your knees and hips the exact same way every day," says Dr. Anderson. For the sake of interest as well as exercise, seek out new terrain like hills, fields, and pathways as well as flat road or sidewalk.
Walk softly. Dr. Anderson believes that there are two types of walkers in this world: soft walkers and hard walkers. Soft walkers glide across a room like Gene Kelly and don't put their heels, ankles, feet, or knees through much stress. Hard walkers are in the habit of hitting the ground with their heels or the soles of their feet.
If you suffer from arthritis and are a hard walker, try out a softer, more gliding style. Try to place your feet when you walk, rather than plunk them. Or imagine that you're gliding on a layer of air or that attached to your head and shoulders you have puppetlike strings that straighten you up. "You'll feel like you're walking on air, and it will save serious wear and tear on your weight-bearing joints," promises Dr. Anderson.
Go fish. Eat more salmon or other cold-water fish such as herring and sardines, and you just may take some of the sting out of rheumatoid arthritis, says Dr. Katz. That's because these fish are high in omega-3 fatty acids, a type of fat that actually eases the aches and swelling of an arthritic joint.
Managing Your Meds
Anti-inflammatory drugs can certainly help you deal with arthritis pain. But anti-inflammatory medicines like aspirin and ibuprofen may aggravate certain pre-existing gastrointestinal conditions, notes David Richards, M.D., orthopedic surgeon at the Lexington Clinic Sports Medicine Center in Lexington, Kentucky. Be sure you talk to your doctor about taking these medications if you have the following symptoms.
¥ Ulcers or intestinal bleeding
¥ Any inflamed bowel disorder
¥ Aspirin allergy
Also, exposure to toxic drugs such as hydroxychloroquine (Plaquenil), which is prescribed for rheumatoid arthritis, can cause anemia.
Ask for alternative oils. If you're not a fish-eater, Dr. Katz recommends a visit to the nearest health food store. Look for either evening primrose oil, flaxseed oil, or fish oil. All contain the same omega-3 fatty acids found in cold-water fish. If you take one teaspoon of any of these each day, it may lightly ease some of the inflammatory aspects of arthritis, Dr. Katz says. If you decide to take capsules, follow the manufacturer's instructions on the label.
Try a cold pack. If you have swelling, especially after any physical activity, put some ice with a thin towel wrapped around it on the area around the affected joint, says Keith Jones, head trainer for the Houston Rockets basketball team. "Ice the area for 15 to 20 minutes after exercise to reduce the discomfort and also minimize the amount of swelling," Jones says.
Or as an alternative to ice packs, Pesanelli recommends applying a package of frozen peas to the affected area because they can contort to the shape of the hurting joint. After you've used the peas once, you can just toss them back in the freezer compartment, get them iced, and use the same bag again. But since bacteria can quickly multiply in food that has been thawed and refrozen, make sure to clearly label them so that you don't accidentally try to serve them for dinner.
Give yourself a hot wax. A hot-wax treatment can provide soothing relief if your hands are aching from arthritis, says Dr. Katz. The treatment is available at many hospitals, he points out, but it's less expensive to treat yourself at home. A professional therapist should instruct you on its appropriate use before you try this at home.
For a hot-wax or paraffin treatment kit, call an orthopedic supply store to check availability. These units are also available from mail-order companies, such as Comfort House, 189-V Frelinghuysen Avenue, Newark, NJ 07114-1595. "Heat the wax in the heating unit, apply it to your hands, and wrap them in plastic gloves for 10 minutes. You should feel some relief," says Dr. Katz. Professional units are also available for home use.
The beauty of the at-home hot-wax treatment is that the wax can be reused for several weeks. Just be careful when you're using it around children, cautions Dr. Katz. "You don't want to do a hot-wax treatment with lots of kids around, because they could quite easily knock over the heating unit and burn themselves," he says.
Immobilize the achy area. Buy a splint and use it to immobilize the joints affected by arthritis. The splint will keep the area from being bumped or moved, says David Richards, M.D., orthopedic surgeon at the Lexington Clinic Sports Medicine Center in Lexington, Kentucky. But Dr. Richards cautions that a splint, sling, or other protective device shouldn't be used for more than a couple of days. If you start to rely on the splint, your muscles could weaken quickly. If the symptoms persist after a couple of days, see your doctor.
Give high heels the boot. To ease the impact on your hip, leg, ankle, and foot joints, invest in a pair of walking shoes, advises Dr. Anderson. Because these shoes have softer heels, walking will be easier on your arthritis. Leather-soled shoes and high heels are out if you do a lot of walking, he says.
Plan for weather changes. Unless you live in a climate that's balmy throughout the year, plan for weather changes before they occur. If you start a walking program in summer, for example, consider how you will modify it before winter sets in. With some planning, you don't have to miss a single day. That's important because once you stop, it is much harder to start up again, says Alice G. Friedman, Ph.D., associate professor of psychology at Binghamton University in New York.