Information About Arthritis: How To Relieve Joint Pain?

What is Osteoarthritis?

Osteoarthritis is the most common type of arthritis affecting to millions of people in over the world, especially in middle-age and elderly people. It occurs when the cartilage covers the ends of bones worn down over the time. Osteoarthritis may affect to any joint in the body, but mostly affect to the knees, hips, back, neck, small joints in fingers and toes. This disease is usually developed after many years of osteoarticular operation. The other risk factors of Osteoarthritis may include obesity, joint injuries and family history of OA.

Osteoarthritis and Rheumatoid Arthritis are two different types of arthritis and they have different treatment therapies. Rheumatoid Arthritis is an autoimmune disease that causes joint inflammation due to the healthy tissues being attacked, leading to joint pain, swelling and stiffness, while Osteoarthritis is the degeneration condition of joint cartilage and spinal disc causing joint pain and swelling. However Rheumatoid Arthritis and Osteoarthritis have some similarities – both can occur in the hands, feet and wrists. At the moment, there is no cure for RA or OA but there are several treatment therapies that can help to significantly reduce the symptoms of both diseases.

What are the symptoms of Osteoarthritis?

There are variety of symptoms of Osteoarthritis depending on the affected joints and its severity. However the most common symptoms are joint pain and joint stiffness, especially in the morning or after resting. The affected joints may be swelling up, particularly after having prolonged activities.

Some common symptoms may include:

• Joint pain or stiffness, especially in the hips, the knees, the lower back after a time having no activities or strenuous activities
• Stiff joints, restrict movements.
• The crunched sounds in the joints when moving
• Mild swelling around the areas of joint inflammation
• The pains become worse after having physical activities or at the end of the day.

Osteoarthritis also has several symptoms that affect to different parts of the body including:

• Hips: people with OA will feel pain in the inguinal region or gluteal region, and sometimes inside the knees or thighs.
• Knees: People with OA feel jarring, or hear the crunched sounds when moving the knees.
• Fingers: bones grow on the edge of joints causing swelling, redness and pain in the fingers, maybe pain in the base of the thumb.
• Feet: pain and swelling appear at the ankles or toes

If these symptoms are not being prevented in time, they may interfere in your job, daily life and social activities. You will feel difficult when doing daily activities such as walking, climbing upstairs, holding daily supplies.

How to diagnose

Doctors may diagnose OA partially basing on the signs and symptoms appearing on the patient. In order to diagnose correctly, the osteoarticular experts will ask some questions relating to personal and family history as well as process clinical examinations and require diagnosed tests.

Imaging tests

Images of affected joints may be obtained during the process of imaging tests.

X-ray: the X-ray images may show the lost cartilage, injured bones and bone spurs. In some people, Osteoarthritis may be diagnosed through X-ray images before they experience any symptom.

Magnetic resonance imaging (MRI): MRI technique uses radio frequency waves and a strong magnetic field to creating detailed images of bones and soft tissues, including cartilage. Commonly MRI is not necessary to diagnose Osteoarthritis but it can help to provide more information in some complex cases.

Lab tests

Blood tests or joint fluid analysis may help to diagnose Osteoarthritis.

Blood test: Doctors may require a blood test to rule out the other reasons that have the same symptoms as Rheumatoid Arthritis.

Joint fluid analysis: Doctors may use a needle to prick a little bit joint fluid from affected joints, then do checking and testing the fluid from the joints, from that can define the inflammatory condition and the origin of this inflammation is due to gout or due to infection.

How to treat Osteoarthritis?

Currently, the process of Osteoarthritis basically can not be cure completely. But the symptoms can be controlled effectively if patients maintain a healthy lifestyle, moderate physical activities combining with other treatment therapies such as using medicines or surgery, doing regular exercise and keeping a reasonable body weight are generally the best ways to treat Osteoarthritis.

Use drugs to treat OA

 Acetaminophen:

Acetaminophen is a pain relief ingredient found in some drugs such as Tylenol and generics. Tylenol is the first choice of doctors in Osteoarthritis treatment. Most of people can use Tylenol without having any problem as long as not exceed the recommend dosage. Tylenol is proven to be effective for people with Osteoarthritis having mild pains to medium pains. Using overdosage of acetaminophen may lead to severe hepatotoxicity, so people should avoid. The total dosage of acetaminophen is not allowed to exceed 3-4gram per day.

Non-steroidal anti-inflammatory drugs

NSAIDs help to relieve pain and joint stiffness. These drugs have rapid efficiency, often within few hours. You may see the positive signs after using NSAID in one to three weeks, sometimes longer. You may need to use from two to three different NSAIDs to find out the most suitable one for you. But you should be careful, just use one type of NSAID each time.

Cyclo-oxygenase 2 Inhibitors (COX-2 inhibitors)

COX-2 works as traditional NSAIDs but have less side effects to the stomach. COX-2 inhibitors prevent an enzyme that promotes inflammation named COX-2 including: Rofecoxib, valdecoxib and Celebrex, however Rofecoxib and valdecoxib have been removed from US market because of leading to heart attacks and strokes. Celebrex is still being used to treat Osteoarthritis but the doctors will provide low dose and for a short time. In order to reduce the signs and symptoms of Osteoarthritis, the recommended dose of Celebrex is 200mg per day using just one dose per day or 100mg devided twice per day.

Antidepressants

Cymbalta (duloxetine) is an antidepressant approved by FDA and is also accepted to use for Osteoarthritis treatment and chronic pain such as fibromyalgia.

Steroid (Glucocorticoid).

Steroid includes methylprednisolone acetate and betamethasone being directly injected to the joints. They help to relieve pain and inflammation and the efficiencies have been proven in the knees and hip joints.

Nutritious food supplements

The nutritious food supplements contain glucosamine and chondroitine sulfate not only helping to reduce the symptoms of Osteoarthritis but also offering benefits in pain control while having less risks as well as no side effects. However you should stop using glucosamine and chondrointine sulfate if there are no effects after 6 months using. Patients are allergic to shellfish such as shrimp, crab,..should not use glucosamine.

Bioflavonoids is also introduced that it has anti-inflammatory characteristic and help to prevent Osteoarthritis. It can be found in pericarp of citrus fruits, persimmon and black grapes. This substance helps to relieve inflammation by inhibiting cyclooxygease (COX) and lipoxygenase (5-LOX), relieves common pains and has antioxidative characteristic.

Artificial joint fluid

Hyaluronic acid is an ingredient found in the joint fluid working as a lubricant that allows the joints to move easily. In Osteoarthritis, HA may be lost or does not work well. Artificial hyaluaronic acid may be directly injected to the knee joints to relieve pain. Artificial hyaluronic acid is usually used for patients who are unresponsive to normal treatment, can not tolerate drugs, especially Non-steroidal anti-inflammatory drugs (NSAIDs) and people are waiting for arthroplasty.

In addition, a group of researchers headed by a biomedical engineer of Boston University have developed a type of joint fluid named Synthetic Polymer – it has brought the hope for millions of people who suffer from Osteoarthritis. This synthetic polymer is directly injected to the pained joints to supplement natural synovial fluid. This method currently works better than previous treatments.

Non-drugs Osteoarthritis treatment

Do exercise

The researchers indicated that do exercise is one of the best ways to treat Osteoarthritis. Doing exercise helps to improve the mood, relieve pain, and increase the flexibility, enhance your heart, improve the flow of blood and maintain stable body weight. Doing exercise does not take lot of money, if you do moderate exercise, it helps you a lot to gain a good health.  Exercise forms and frequency will depend on the specific disease condition of each patient. Walking, swimming and aerobic are some common types of exercise beneficial for patients with Osteoarthritis. Note that, you should stop and rest when you feel tired or feel joint pain, this is to avoid causing pressure to your joints.

Heat and cold therapies

Heat or cold therapy helps to control the pains, joint stiffness and muscle pain. Heat therapy helps to relieve joint pain and stiffness. You can use hot towels, heat packs, hot bottles water or heat pads. Cold therapy helps to relieve pain and acute spasm. You can use ice packs or sprays to keep cool continuously in a short time.

Transcutaneous electrical nerve stimulation (TENS)

TENS is a technique using a small electrical device to create mild electrical pulses to the nerves under the skin of pain areas. TENS may relieve pains caused by Osteoarthritis.

Massage

Gentel massage or massage the muscles may help to increase the blood flow and bring the warmness for the massaged areas, the painful feelings or discomforts at the joints will be disappeared.

Acupuncture

Some people have found out a solution to relieve pain, it is acupuncture. The scientists said that acupuncture needles stimulate the release of natural painkillers produced by the nervous system.

Surgery

For many people, surgery helps to relieve pain and avoid being disability caused by severe Osteoarthritis. Surgery is necessary to replace or repair damaged joints in severe cases.

There are some types of surgery including:

• Arthroscopic: to remove bone debris and cartilage shards from the joints
• Osteotomy: to adjust or alter the position of associated bones
• Arthroplasty: to replace total or a part of degenerative joint by an artificial joint.

Deciding to use surgery depends on several factors including the patients’ age, the job, level of disability, the pain intensity and the extent of arthritis interfering in their lifestyle. After the surgery and rehabilitation, patients usually feel less pain and swelling, and they can move easily.

Complications may occur due to Osteoarthritis

The joint diseases in general and Osteoarthritis in particular often develop silently. When the signs and symptoms manifest outwardly, the disease condition has been severe and may cause injuries and complications to other organs such as the stomach, kidney, cardiovascular or more severe is complete disability.

The preventive measures

It is not very difficult to prevent Osteoarthritis. When you are young, let do exercise regularly, avoid being obesity, so strong movement, especially the sudden movements that may deflect joint axes and spinal column. You also need to adjust your eating habits, reduce salt and sugar and fat while increase the levels of calcium, vitamin C and vitamin D.

Some advices for patients with Osteoarthritis

Patients should have regular physical activities that help blood and oxygen circulating easily and firm muscles as well as help bones to avoid being under pressure. To protect osteoarticular, you need to have moderate activities, do not stand or sit too long. Should keep straight in shape, do not hunch or incurve when sitting or standing.

During the cold weather, patients need to keep the body warm, especially fingers and feet, limit going out when it is too cold.

In some severe cases, the physical therapists recommend that patients should have supportive devices at home such as raised toilet seats, power-lift chairs, canes, walkers, and bathroom shower/tub bars to make their daily life activities become easier.

The patients’ mentality directly affects to their physical condition, so it is esstial to have positive attitudes, keep comfortable mentalilty and stay away from stress.

What is Gout disease (Gouty Arthritis)?

Gout disease is one of the types of inflammatory arthritis caused by purines metabolic disorders (a colorless crystalline compound with basic properties, forming uric acid on oxidation) belonging to metabolic disorder disease group. This disease occurs when there is too much uric acid accumulating in the body. This acid causes the formation of needle-shape crystals in joints, especially in the big toe leading to soreness, redness and swelling. The horrible pains may cause people who are sleeping have to immediately wake up.

What are the symptoms of Gout?

The first signs of Gout are the sudden pains, swellings and stiffness commonly occurring in joints at the big toe, the knees, the ankles and the small joints in hands. These initial symptoms may be lost completely after one to two weeks. Over the time, these symptoms may occur more frequently and last longer.

If the Gout can not be treated early and instantly, there is a large amount of crystallized uric acid called tophi accumulating around the joints that destroy or deform the joints.

How to diagnose?

In order to diagnose the Gout disease, firstly doctors may ask patients about the recent signs and symptoms, family history related to osteoarticular diseases. Then, doctors will process clinical examinations and necessary laboratory tests such as: blood test (to measure the levels of uric acid in the blood), X-rays, CT and MRI (to check the lesions of soft tissues and bones), joint fluid test (to identify there is crystallized uric acid in the joint fluid or not, this is the most definitely way to diagnose Gout disease)

How to treat Gout?

Doctors treat Gout disease according to several principles including: prevent recurrent gout, prevent the deposition of uric acid in the joints and prevent complications through the treatment of hyperuricemia syndrome. 

Here are several drugs to treat acute gout:

• Colchicine: it has anti-inflammatory characteristic and helps to relieve pain in acute gout attacks. Do not use high dose Colchicine because it may cause side effects such as diarrhea, nausea, and abdominal cramps. It is recommended to use 100mg per day.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): can use one of the following drugs: Indometacin, Naproxen, Ibuprofen, Ketoprofen, Piroxicam, Diclofenac, the group of selective COX-2 inhibitors (meloxicam, celecoxib, etoricoxib…). Note that these drugs may cause peptic ulcer and kidney failure. This drug can be used alone or combined with Colchicine.
• Corticosteroid: it is used for patients who are contraindicated with two above drugs or can not get effects from these drugs. Corticosteroid helps to relieve joint pain and swelling due to acute gout attacks. Corticosteroid can be used in pill form or can be injected directly to inflammatory joints. However it can cause some side effects such as mood changes, high blood sugar level, and high blood pressure.

Here are some medications to lower blood’s uric acid level:

• Allopurinol: has been used widely to reduce uric acid levels in blood, lower the production of uric acid and it may help to dissolve the uric acid crystals in tophi. The daily dose is depended on uric acid levels in blood. The starting dose is 100mg a day within one week, and then can increase to 200 – 300mg a day. Do not use Allopurinol for the acute gout attacks, just use when the arthritis condition was in remission after one to two weeks using colchicine. But note that Allopurinol has some side effects such as fever, vomit, nausea, headache, rash, allergy…It is necessary to closely monitor in the first days or even one to two weeks using this medication.
• Probenecid: helps to reduce uric acid in the body by increasing excretion in urine. This medication is contraindicated for patients have kidney failure, nephrolithiasis or chronic gout and elderly people.
• Febuxostat: reduces blood’s uric acid levels in patients with gout. It inhibits xanthine oxidase enzyme (a type of enzyme that helps to transform Purin into uric acid) to lower uric acid level in the blood. This helps to prevent gout; however it requires to use for a long term and must monitor exactly the using process. Febuxostat may cause some side effects including liver stimulation, nausea, joint pain and rash.
• Pegloticase: is used when the gout has become chronic and severe. Pegloticase helps to lower uric acid levels rapidly. It is injected once per two or four weeks by the infusion into a vein – intravenous therapy (IV). The side effects may include nausea, bruises, sore throats, constipation, chest pain and vomiting.

Surgery:

A surgery to resect tophi is indicated in case of gout with ulcerative complication, surinfection tophi or large size tophi that affect to movement or due to aesthetic reason.

Complications caused by Gout

In severe stage, the tophi may deform the joints and restrict the joint movement making patients feel difficult in moving, even causing disability in some serious cases. The tophi may burst and that makes bacteria entering to joints and causing joint inflammation, infection and blood infection that seriously threaten the life. The chronic gout may cause deposition of urate salt in the kidney leading to kidney stones. Therefore it may increase the risks of fluid retention causing kidney failure and high blood pressure. In some cases, urate compound is also deposited under the skin causing lumps and pain.

Preventive measures:

People should have healthy eating and scientific working habits to prevent Gout. Uncontrolled eating habit is the major factor that promotes Gout appearing and occurring back.  The safety principles in the dietary for patients with gout are included:

• Reduce protein intake
• Reduce fatty foods
• Lose weight (if you are obese)
• Drink more water (about 1.5-2 liters per day)

Some advices for patients with Gout

Dietary habits:

• People with Gout should not eat foods rich in protein especially animal protein such as meat, fish, prawn, crab…Should eat low-purine foods such as egg, milk, cheese, fresh cheese, bread, cereal, broccoli, potatoes, pumpkin, and kinds of bean…
• Absolutely no drinking alcohol, beer and other alcoholic beverages.
• Eat more fresh vegetables and fruits
• Drink lots of water helps to alkalize urine and support to excrete uric acid out of the body favorably

 Workouts and living modes:

• Do exercise regularly and moderately. Do not take too much and too hard exercise because it makes the pains in hands and feet becoming more severe.
• Avoid freezing rain or sudden cold shower
• Stay away from stress and anger. It is a good idea to keep comfortable spirit and should not stay up late.
• Before going to the bed, soak the hands and feet in warm water in about 20-30 minutes. This method helps to soften and relax the joints, it also restricts the acute pains caused by Gout, therefore can help to restrict joint deformation.

Medications usage:

• Should take medications regularly and must exactly follow the dosage prescribed by doctor.
• Do not abuse or arbitrarily use painkillers when having phenomenon of painful or swollen joints. Only use painkillers, anti-inflammatory drugs when having arthritis pains. Note that, taking too many antibiotic medicines is not good for your health. Limit using it as much as you can.