Creaking knees, hips, and ankles aren't necessarily normal aches and pains that come with age. Your pain might be arthritis. Luckily, medicine has a lot to offer --- from exercise and alternative supplements to medications and joint replacement.
By Jeanie Lerche Davis
Creaky, achy joints. A twinge in the knee. A sharp shooting pain from the shoulder to the elbow. No big deal, right?
Wrong. All too often, we assume joint pain is a normal part of aging that we just have to learn to live with. Nothing could be further from the truth, say experts, pointing to a wealth of treatment options from exercise and alternative supplements to medications and joint replacement surgery.
It's a serious problem, because pain can affect every aspect of your life. "Pain is not only the experience of hurting; it affects how you handle your life, your livelihood, your interactions with family and friends," Raymond Gaeta, MD, director of pain management services at Stanford Hospital & Clinic at Stanford University, tells WebMD.
Gaeta recently published a nationwide telephone survey with some stunning results: Nearly one in five (19%) had chronic pain like that caused by arthritis. Yet nearly half said they didn't know what caused their pain. The vast majority (84%) were taking over-the-counter drugs for their pain.
"The problem is, we're used to the body healing itself naturally, so we always expect that to happen," Gaeta tells WebMD. "With chronic pain, we put up with it, we try pain relievers, but we don't always see a doctor. That's the problem -- people need to talk to their doctors. There are many techniques for pain management out there, but it starts with asking the question - what's wrong?"
"The average person may not be able tell if it's the joint, a torn tendon, or pain in the area of the joint," says Shannon Whetstone Mescher, vice president of programs and services at the Arthritis Foundation. "A physician needs to evaluate you to make sure you do in fact have joint pain and why."
Getting the Right Diagnosis
Arthritis is a catch-all term that simply means inflammation of the joints - but it's not a simple diagnosis. "We now recognize over 100 different forms of arthritis," Robert Hoffman, MD, chief of rheumatology at the University of Miami Miller School of Medicine. "That's why getting the correct diagnosis is important. You need the right treatment."
Another good reason to see a doctor: "Many people have other conditions that can aggravate arthritis," says Jason Theodoskais, MD, MS, MPH, FACPM, author of The Arthritis Cure and a preventive and sports medicine specialist at the University of Arizona Medical Center.
For example, gout is a form of arthritis that can lead to osteoarthritis; hemochromatosis is an inherited disease involving abnormally high iron storage in the body, which causes heart disease, diabetes, and arthritis. Joint pain can also result from cancer that has spread to joints, he notes. "Unless we address the origin of the problem, people won't get the right treatment or pain relief," Theodoskais tells WebMD.
Common pain-related conditions:
Osteoarthritis: This is often called degenerative joint disease and is the most common type of arthritis in the over-50 crowd. As we get older, the rubbery cartilage that serves as a shock absorber to our joints becomes stiff, loses its elasticity, and becomes more susceptible to damage. As the cartilage wears away, tendons and ligaments stretch, causing pain. It can occur in almost any joint in the body - most commonly in the fingers, hips, knees, and spine.
Symptoms include joint aching and soreness, pain, and bony knots in the finger joints. Medications, painkillers, and alternative supplements (like glucosamine and chondroitin) can help relieve the pain. But lifestyle changes like weight loss may also be necessary to reduce stress on weight-bearing joints.
Rheumatoid Arthritis: This form of arthritis is very different from degenerative joint disease. The inflammation occurs in joints on both sides of the body - a symmetry that helps distinguish it from other types of arthritis. However, many of the symptoms sound familiar - joint pain and swelling, joint stiffness, and fatigue. Researchers believe that an external organism - like a virus or bacteria - may alter the immune system, causing it to attack the joints and sometimes other organs.
"Rheumatoid arthritis is not just a benign joint disease," Hoffman tells WebMD. "It can lead to early death. With rheumatoid arthritis, there is quite good evidence that early diagnosis and aggressive treatment can help to maintain function, prevent disability, and improve survival."
Polymyalgia Rheumatica (PMR) and Temporal Arteritis (TA): These inflammatory diseases often occur together and are thought to be related. PMR is a disease involving the larger joints of the body like the hip and shoulders. TA is an inflammation of the blood vessels to the head, including the eyes. Both conditions are caused by the body's immune system reacting against itself.
Pain and stiffness in shoulder and hip joints, fever, weight loss, and fatigue - these are all symptoms of PMR. Often the only symptom is the inability to get out of a chair easily or raising the arms to brush one's hair. The most common symptom of TA is a severe headache - and if not treated, TA can cause irreversible blindness, stroke, or transient ischemic attacks (ministrokes.)
The cause of these disorders is not known, but they seem to occur most frequently in people of Scandinavian or Northern European descent. "Yet once it's diagnosed, the treatment is very straightforward -- prednisone, a steroid," says Gaeta. "But most people have never heard of this form of arthritis. It points to the need to talk to your doctor."
Fibromyalgia: This chronic disorder creates pain and tenderness at numerous points throughout the body, resulting in serious sleep problems and fatigue. The cause of fibromyalgia is poorly understood, but is not related to any muscle, nerve, or joint injury. One theory is that the condition may be related to oversensitive nerve cells in the spinal cord and brain. Or it may be due to an imbalance in brain chemicals that control mood, lowers a person's tolerance for pain, possibly triggering a cycle of restless sleep, fatigue, inactivity, sensitivity, and pain.
Though there is no cure for fibromyalgia, treatment is focused on managing pain, fatigue, depression, and other symptoms in an attempt to break the cycle of sensitivity, pain, and decreased physical activity.
Low doses of antidepressant medication taken before bedtime may offer more restful sleep. Other kinds of sleeping pills are not very helpful for people who have fibromyalgia. Nonsteroidal anti-inflammatory drugs (NSAIDs) -- including ibuprofen and naproxen -- may help decrease pain, but they should be used long-term only under the care of a doctor.
Depression: Sadness is not the only hallmark of depression. There also may be physical symptoms like unexplained aches and pains, studies show. The most commonly cited symptoms are frequent headaches, back pain, joint pain, and abdominal pain - all of which may mask the depression. These physical symptoms may be related to or aggravated by the depression and can linger longer than the emotional symptoms.
Some doctors, like Hoffman, believe that these physical symptoms are really signs of fibromyalgia. "The two conditions do seem to commonly coexist," he tells WebMD. "Also, depression may bring a heightened awareness of pain. Treating the depression is important."
Ask your family doctor for a referral to a specialist who deals with the type of pain you are experiencing, advises Charles Weiss, MD, chairman emeritus of the department of orthopedics and rehabilitation at Mt. Sinai Medical Center in Miami Beach, Fla.
Lifestyle Changes
While there is no cure for joint pain, you can find relief, the experts say. Treatments range from lifestyle changes to medications to surgery -- and should usually be tried in that order.
Lose weight: If you are overweight, the first step is to shed those excess pounds. Whetstone Mescher points to a recent study showing that losing as little as 11 pounds can cut the risk of osteoarthritis of the knee by 50%.
Start exercising: The next step may be to work with a physical therapist to develop an exercise program that's right for you. All too often, pain victims get caught in a vicious cycle: Their aching joints prevent them from exercising, which causes their joints to weaken further and their condition to deteriorate, Whetstone Mescher explains.
"A physical therapist is key, especially if you don't know where to start," she says. "They can tell you which exercises are best -- usually those that improve strength, endurance, and range of motion -- and recommend specific joint exercises designed specifically for pain relief."
Getting 40 minutes of exercise at a time -- three or four days a week -- is generally advised. Some suggestions:
- If you have access to a pool, water workouts are often recommended. The buoyancy of water supports the weight of the body, taking the stress off stiff and achy joints and making it much easier to exercise.
- Biking, walking, and other low-impact exercises that don't put pounding pressure on the joints are also helpful. But high-impact exercises such as jogging should usually be avoided, and never subscribe to the "No pain, no gain" mantra, Whetstone Mescher says.
Wear correct footwear: "Buy soft cushiony shoes that provide an extra layer of protective padding," advises Letha Griffin, MD, bone expert and team physician at Georgia State University in Atlanta.
If you smoke, quit. It's been shown that smoking has an effect on both bone health and response to treatment.
Painkillers Can Spell Relief
If lifestyle changes don't ease your pain, medication is often prescribed. For mild pain, a simple painkiller can often help, such as acetaminophen (Tylenol), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). A newer class of NSAIDs known as Cox-2 inhibitors includes Vioxx, Celebrex, and Bextra.
In September 2004, Vioxx was voluntarily withdrawn from markets worldwide by Merck, the drug's maker. The decision followed news that a clinical trial showed an increased risk of heart attack and stroke.
In April 2005, the FDA asked that Celebrex carry new warnings about the potential risk of heart attacks and strokes as well as potential stomach ulcer bleeding risks. At the same time, the FDA asked that Bextra be removed from the market because its risks of heart, stomach, and skin problems outweighed its benefits
Also in April 2005, the FDA asked that over-the-counter anti-inflammatory drugs -- except for aspirin - revise their labels to include information about potential heart and stomach ulcer bleeding risks.
For people -- particularly seniors -- who are taking multiple medications for other conditions such as high blood pressure, the doctor may ultimately decide which painkiller to prescribe based on which is safest for you. High doses of acetaminophen, for example, can damage the liver, so they probably wouldn't be recommended for someone with liver problems.
That's why it is so important that a senior never self-medicate, Weiss stresses. "Always ask your doctor before taking drugs, even if they are sold over the counter, without a prescription. Tell him what other drugs have been prescribed to you by other physicians. And be sure to ask about dosage, which can vary according to age."
Whichever type of painkiller is prescribed, seniors should be checked for liver and kidney problems; any loss of blood; and any change in blood pressure, he says.
Other Ways to Relieve Pain
Heat or cold therapy can often provide temporary pain relief, Whetstone Mescher says. "Some people prefer heat packs, others ice packs," she says, "so try both, and see which works better for you." Neither should be kept on the joints for more than 20 minutes at a time, she adds.
For other patients, "creams such as Ben-Gay that are associated with a warm, peppery feeling can help," Weiss says. "Rubbing the cream stimulates the skin around the joint, reducing pain."
Joint fluid supplements. For patients who have not gotten relief from lifestyle changes and pain medications, a newer approach known as joint fluid supplements -- called viscosupplements by doctors -- may be recommended.
The supplements contain a synthetic form of hyaluronic acid, a natural chemical that acts as a lubricant and shock absorber in the joint. Not all doctors agree about this treatment: Some say the benefits are modest at most and may not be worth the discomfort of the injections.
Steroid shots. Corticosteroids are yet another option. Shots of steroids -- artificial versions of the body's natural hormones -- into the joint can reduce inflammation, thereby reducing pain, Weiss says. But though injections are fine as a short-term fix, long-term use is usually not recommended because of potential side effects.
Alternative supplements. In recent years, several studies have shown that glucosamine and chondroitin sulfate can help relieve pain from osteoarthritis. In addition, research has shown that these supplements, particularly glucosamine, can slow, or even stop, progression of osteoarthritis. Most research has been done on knee osteoarthritis, but experts suspect that other joints would benefit as well.
Derived from crustacean shells, glucosamine supplements are thought to replace missing fluid and promote the growth of cartilage, thereby helping to repair joints, Weiss says. Chondroitin sulfate, often taken in conjunction with glucosamine, may help cartilage from breaking down. Both supplements are safe and effective but are slow-acting, requiring several weeks to months of treatment to get relief.
Joint replacement. If all else fails to relieve your pain and disability, your doctors may recommend surgery in which an arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis. These artificial joints, fashioned out of metal and plastic, can be as good as the real thing, restoring movement and function.
"Joint replacement is extremely successful, lasting over 20 years for more than 90% of patients," Weiss says. But there is some risk: Some patients develop complications, and a small percentage die, with the elderly at greatest risk. "But new sophisticated software helps doctors to better navigate the area of the joint; we can achieve maximum benefit with minimal risk."
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