This is not going to be a pretty story. Arthritis is nothing to sneeze at and it can be a painful, incapacitating disease with little to look forward to but immobility or surgery. It’s not just something that affects your grandma; athletes get it, and even young people can have it. “About 27 million people in America have osteoarthritis. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genetics.” (arthritis.org) But you can fight back, if you have the tools and commitment to do so.
I first started noticing there was a problem when I experienced weakness in my knees; soon I was losing strength in my knees and occasionally falling down. My joints started aching frequently, and then I began to feel pain in my hands and lose a lot of the coordinated movement. I dropped things a lot and began to have trouble walking and staying on my feet for long periods of time. A trip to the doctor and a few x-rays later, I had an answer. The fluid in my knee joints was completely gone, and the cartilage had worn away; the bones in my knees were now scraping against each other, causing the terrible pain I was experiencing. “Bone on bone” they call it; excruciating pain I call it. If you have ever felt (and sometimes heard) your bones scraping together, it’s awful and extremely painful.
A trip to a hand doctor, and then to a neurologist (who administered a painful nerve conduction study) confirmed carpal tunnel, trigger finger and severe arthritis. My hands had begun to belong to some evil puppet master. I couldn’t control them at times; they would release their grip and drop bottles and jars on the floor. They would cramp up and I had trouble getting my fingers to straighten up. My wrists and the area around my thumb joints, as well as half-way up the inside of my arms, up to the elbow, began to ache terribly. Heat seemed to soothe these areas somewhat, but not completely.
I felt like I had lost all my mobility. I found moving around difficult and cooking was a painful experience (especially the next day, if I’d done a lot of lifting of pots and pans or mixing). Doing laundry is agony; reaching in to pull clothing out of the washer and folding it is difficult. I had to buy detergent and bleach pods because lifting the containers of detergent and bleach was becoming impossible. I was feeling pretty useless and the immobility was causing me to gain weight, then the weight made the pain in my knees even more incapacitating. It was truly a vicious cycle.
In a normal joint, the ends of the bones are covered with cartilage and there is a secretion of synovial fluid that creates an additional cushion. Both the cartilage and fluid absorb the shock of pressure to the joint experienced with normal motion and activity. The fluid also lubricates the joint and helps keep it mobile. Often with age, or with deterioration caused by other illness or disease, the cartilage wears down and the fluid eventually disappears, leaving nothing to reduce the pain caused by exertion with activity or the pressure put on the joints with walking or running. A lessening in activity due to pain can cause you to gain weight and put even more pressure on the joints, until it’s literally almost too painful to move normally. “The pain and stiffness of more severe osteoarthritis may make it difficult to walk, climb stairs, or perform other daily tasks.” (arthritis.org) There are treatments available to sufferers of osteoarthritis, such as exercise, physical therapy, knee injections and drugs to control severe pain. If loss of mobility and pain become too limiting, then surgery may be indicated.
The only option open to me, for exercise and joint mobility, is swimming. Luckily, my daughter has a swimming pool, and I try to exercise in it when I can. It is so much easier to move around in the water because your buoyancy lessens the stress on your joints and the effort to move through the water doesn’t cause the same pain as moving on land. You feel like you can really get a good workout in the water, and then there’s always the hot tub for relaxing those joints afterward. In the hot tub you can still move around and relax at the same time. The warm water really soothes the joints too.
One possible method of treating knee pain is through the injection of Hyaluronan into the knee joint. “Hyaluronan is a substance that doctors inject directly into your knee joint, where it may help supplement the knee joint’s natural synovial fluid, relieving pain and improving your ability to use the knee. This treatment is also called viscosupplementation.” (Web MD) These can be given in a series over several weeks or months. When I first began these injections, it was a miracle. They relieved the pain almost completely. The first day I experienced soreness, but after that, the pain was almost completely eradicated. Hyaluronan occurs naturally in healthy joints. Hyaluronan acts like a shock absorber and lubricant in your joints; it allows the surfaces of the bones to glide upon each other smoothly.
The problem with the knee injections is that it is not a cure and the effects will lessen with time. There can also be some side effects associated with its use. Those with allergies to bird products, such as feathers, eggs or poultry, are not candidates for treatment with Hyaluronan. Patients with swelling or infection in the legs should not receive these injections. Injection sites can become swollen or painful, but this should be temporary.
Surgery – The Last Resort
According to Web MD, “By 2030, nearly 3.5 million Americans will undergo total knee replacement surgery every year, and more than half a million will get total hip replacements.” But not everyone is a candidate for knee replacement. Unless you are facing severe limitations to your mobility and completing the tasks of daily life, you should probably put surgery off for as long as possible. Several factors can make surgery risky, including the following:
· Obesity. Your doctor may ask you to lose some weight before undergoing surgery, which will both lessen the risks of surgery (such as infections, bleeding, and problems with anesthesia) and give your new hip or knee a better chance of success.
· Age. If you’re in your 90s, your doctor may discuss with you whether or not the risks of surgery are greater than the long-term benefits you may get from a new joint.
· Bone density. Severe osteoporosis needs to be considered and treated before undergoing joint surgery.
In the case of arthritis in the hands and finger joints, use of hand splints can help with pain and mobility. There are drugs available to help with pain too. Cortisone injections can be a treatment of choice for improving movement of the joints. If the pain and lack of mobility can be attributable to carpal tunnel syndrome, there is a surgical alternative to restore flexibility of movement. My doctor indicated that there are even joint replacement alternatives available for severe deterioration of hand joints, although this is not yet widely used.
Only your physician can recommend the treatment that is right for you. If you can benefit from Hyaluronan injections, physical therapy, cortisone injections, medications or other alternatives to surgery, that is the best course. Surgery should be put off for as long as possible. But there is no reason, with the number of courses of treatment available today, to suffer in silence. Don’t let osteoarthritis rob you of the right to enjoy your life.
Arthritis Foundation, “Osteoarthritis,” http://www.arthritis.org/conditions-treatments/disease-center/osteoarthritis/
Eustice, Carol, “Hyaluronan Injections for Knee Osteoarthritis,” Sept 28, 2012, http://osteoarthritis.about.com/od/osteoarthritistreatments/a/hyaluronic_acid.htm
Web MD, ” Hyaluronan Injections for Osteoarthritis of the Knee,” http://www.webmd.com/osteoarthritis/hyaluronan-injections-for-osteoarthritis-of-the-knee
Web MD, “Your Guide to Joint Replacement for Osteoarthritis,” http://www.webmd.com/osteoarthritis/guide/joint-replacement