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When Antoinette Katora goes to the store, she parks in the spot reserved for the handicapped -- something she never imagined having to do at age 46. She enjoyed playing basketball in high school and until recently was an avid gardener. After suffering two bad falls while shooting hoops in her teens, Katora began to feel a constant cracking in her knees but ignored it. Kneeling in her garden hurt, too, but "when you're young, you just grin and bear it," she says.
For years Katora continued to put stress on her knees, wearing three-inch heels every day to work as a systems analyst on Wall Street. Her pain worsened during her pregnancy, in 1996, when she gained 50 pounds. She began to suffer from severe back pain after being injured in a traffic accident later that year. Unable to commute into the city, she had to transfer to her firm's New Jersey office near her East Brunswick home.
When Katora finally saw a rheumatologist, at age 40, she learned she had osteoarthritis in her knees, back, and feet. "I feel cheated," she says. "I can't even play with my 8-year-old daughter, because if I sit on the floor, I can't get up." Katora wishes she had paid closer attention to those early aches. "Arthritis sneaks up on you. You don't notice the symptoms at first. They're just an annoyance. Then, all of a sudden, you can't do the things you used to do."
An estimated 21 million Americans have osteoarthritis, which affects more women than men. While the degenerative joint disease is most common after age 65, younger women aren't immune. Thirty-four percent of women ages 45 through 64 and nearly 9 percent of women ages 15 through 46 have osteoarthritis, according to the Centers for Disease Control and Prevention.
And now because pain-relief options may be dwindling -- the drug Vioxx was recalled last fall for its role in raising heart attack risk, and similar questions are swirling around two other prescription painkillers, Celebrex and Bextra -- it pays to take preventive steps. But if you already suffer the telltale pain and stiffness of arthritis, there are new, safe remedies that can help you get moving again.
Not to be confused with rheumatoid arthritis (an autoimmune disorder), osteoarthritis is known as "wear-and-tear arthritis." It occurs when cartilage, a substance that cushions the ends of bones, becomes thin, damaged, or worn away, allowing bone to rub against bone. The result: pain and stiffness, particularly if you haven't used a joint for a few hours. An osteoarthritis sufferer's knees may hurt when she wakes up but then feel better as she moves around, says rheumatologist John H. Klippel, MD, president of the Arthritis Foundation, in Atlanta.
If you have osteoarthritis in your knee or hip (along with the hands, neck, and lower back, the most common places the disease strikes), you may notice stiffness when you stand after being seated for a while or when you've overused a joint -- for instance, after a long day shopping.
But not everyone with osteoarthritis develops pain, and doctors don't know why. Many people show signs of the disease on an X-ray without having suspected something was wrong. Nor do they know why some people are more susceptible than others. Age is a leading risk factor, as is genetics: Having a sibling with knee osteoarthritis may double your risk. People who have knee or hip osteoarthritis, Japanese researchers also recently discovered, have a mutation in a gene that affects cartilage.
You're also more likely to develop osteoarthritis if you've ever had a joint injury. Teenage female soccer players who had torn their anterior cruciate ligament (which helps hold the knee in place) showed signs of knee osteoarthritis as young as age 26, Swedish researchers recently found. Any repetitive joint usage makes us vulnerable. For instance, Chinese researchers found that regular chopstick users were more likely to develop osteoarthritis in the fingers of the hands that held the chopsticks than in their other hands.
Being overweight also puts enormous strain on joints and increases your risk. Obese women have nearly four times the risk of knee osteoarthritis as normal-weight women, according to data from the CDC's first National Health and Nutrition Examination Survey. Other research suggests that metabolic factors, such as hormones associated with obesity, also play a role in the disease.
Even before you feel any pain, it's important to take control of the preventable factors that increase your risk of developing osteoarthritis. Follow these strategies:
Exercise. Since obesity is the top preventable risk factor, maintaining a healthy weight is key to avoiding osteoarthritis. Low-impact exercise will help you shed pounds without stressing your joints. Also, using the weight machines at the gym to build your thigh muscles -- both quad and hamstring -- is a smart preventive measure. The stronger your thighs are, the more they'll stabilize and protect your knees.
Also, pain is not gain. Lessening the stress on a joint when it starts to ache can minimize cartilage damage. If your knees hurt when you jog, for instance, switch to a gentler activity, such as swimming.
Vary your movements. Since repetitive movements can also do harm, Kenneth D. Brandt, MD, professor of orthopaedic surgery at the Indiana University School of Medicine, in Indianapolis, suggests protecting your joints while performing your daily activities. "For people with bad hip or knee problems," he recommends, "it helps to store frequently used kitchen and pantry items at higher levels so they can be reached without bending. Also, a lazy Susan can be very useful."
Opt for sensible shoes. Scientists at the University of Virginia, in Charlottesville, found that wearing heels two inches or taller shifts your body weight, increasing the force on your knees. "This can cause degenerative changes in the joint," says lead researcher D. Casey Kerrigan, MD, chair of physical medicine and rehabilitation.
Squeezing your feet into too-narrow shoes can also spell trouble. A bunion can form when the big toe is persistently pushed inward. Over time this misalignment can cause bone and cartilage in the toe joint to wear away, leading to osteoarthritis, explains Marlene Reid, DPM, a spokesperson for the American Podiatric Medical Association, in Bethesda, Maryland.
Eat well. A diet that's good for your overall health may also be good for your joints. Studies suggest that eating more fish, fruits, and vegetables while limiting refined sugar and flour can ease pain and inflammation. "Making these changes may help with weight loss, which does reduce osteoarthritis pain or your risk of developing it," says rheumatologist Hayes Wilson, MD, medical adviser to the Arthritis Foundation. "Dropping 10 pounds is equivalent to taking 30 pounds of pressure off your knees."
Getting plenty of daily bone-building vitamin D and calcium is also key. You need 400 international units of vitamin D and 1,000 milligrams of calcium (1,500 milligrams after menopause) to stave off bone fractures, which can lead to osteoarthritis if they occur near a joint. Boston University researchers also recently found that people deficient in vitamin D complained of more osteoarthritis pain and disability than those with adequate levels. As their vitamin D levels returned to normal over 30 months, their pain diminished and joint function improved.
If you're worried about the risky heart effects of the still-available prescription medications Celebrex and Bextra, which, like Vioxx, are part of a family of drugs known as COX-2 inhibitors, the good news is you still have plenty of ways to soothe your joints. No single treatment will work for everyone, but for mild joint pain start with acetaminophen, which doesn't irritate the stomach.
If pain persists, an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, may do the trick. To prevent the stomach upset and bleeding associated with regular use of NSAIDs, your doctor may recommend a daily proton pump inhibitor, such as Prilosec, Nexium, or Prevacid, says Mark Fendrick, MD, professor of internal medicine at the University of Michigan at Ann Arbor.
Your doctor may prescribe a pain medication if over-the-counter remedies don't provide relief, or recommend a combination of therapies. "The ideal is to use as little medicine as possible to make symptoms tolerable and give you a good quality of life," says rheumatologist Scott Zashin, MD, clinical assistant professor at the University of Texas Southwestern Medical Center, in Dallas, and author of Arthritis Without Pain (Sarah Allison Publishing, 2004). Here are some options for easing aches:
Acupuncture. Researchers from the University of Maryland School of Medicine, in Baltimore, recently found that acupuncture helped people with knee osteoarthritis perform everyday activities after just two months of twice-weekly treatments. By week 14, patients had reduced their pain by 40 percent. Even though treatment was tapered back to one acupuncture session per month, the benefits lasted for the duration of the 26-week study.
Cortisone injections. A recent Canadian study found that steroid shots in the arthritic joint also greatly relieve pain and stiffness. A major drawback to cortisone injections: "A patient may be tempted to overuse the joint and do further damage," says Dr. Zashin. Given by an orthopedist or a rheumatologist, the shots are usually limited to three per year and are typically covered by insurance.
Weight loss and exercise. According to a May 2004 report in Arthritis & Rheumatism, a combination of dieting and working out can reduce arthritic knee pain by 30 percent in overweight or obese people. Just 30 minutes of walking and 15 minutes of muscle-strengthening leg exercises three days a week were enough to deliver benefits. And the subjects lost only a modest 10 to 12 pounds. "That's certainly manageable for most people," says study leader Stephen Messier, PhD, a professor of biomechanics at Wake Forest University, in Winston-Salem, North Carolina.
Dietary supplements. Many arthritis sufferers swear by the dietary supplements glucosamine and chondroitin sulfate, which are usually sold in combination. Trials have found that glucosamine (which is extracted from crab, lobster, or shrimp shells) and chondroitin (which comes from animal cartilage, including shark) not only may relieve pain but also actually maintain and repair cartilage.
A study recently published in the journal Menopause found that postmenopausal women with knee osteoarthritis taking 1,500 milligrams of glucosamine a day experienced less discomfort and less narrowing of the spaces in their knee joint (which occurs as cartilage breaks down) than the control group. Glucosamine and chondroitin aren't FDA regulated, so their content and quality can vary widely. Talk to your doctor before using them, since glucosamine can be risky if you have a shellfish allergy and it also can raise blood sugar. In addition, chondroitin can thin blood.
Hyaluronic acid. Some studies suggest that weekly injections of hyaluronic acid, a chemical that lubricates the joint, for three to five weeks may ease arthritic knee pain for up to one year in a limited number of patients. The treatment is FDA approved and typically covered by insurance. French researchers, however, recently found that shots of hyaluronic acid had the same mild benefit as placebo injections.
Topical remedies. Applying over-the-counter heat wraps, ice packs, or topical analgesic creams to the joint can also soothe mild aches by increasing blood flow and thus decreasing pain.
Magnet therapy. A British study of 194 people with hip or knee osteoarthritis found that those who wore a standard-strength magnetic bracelet for 12 weeks had a greater reduction in pain than individuals who wore a weaker version of the bracelet or a dummy bracelet. Scientists don't know, however, whether the positive results were due to the magnets or to a placebo effect, or how long the perceived benefits might last.
While these measures won't provide the dramatic pain relief of a prescription pill, taken together, they might help you fight arthritis aches -- and win.
Many patients insist their aching joints can predict weather changes. And there may be some scientific truth to the claim. Researchers at Tufts-New England Medical Center, in Boston, asked more than 200 patients with knee osteoarthritis to keep online pain diaries for three months, then compared each patient's pain report with her city's weather conditions, including temperature, barometric pressure, precipitation, and dew point.
It turns out that periods of increasing barometric pressure (which usually precede changes in weather) coincided with greater joint pain. The mechanics here are a mystery, says Timothy McAlindon, MD, study leader and chief of rheumatology. But, he adds, "the colder the weather, the more pain people had." Participants who lived in areas with an average temperature of 36 degrees or below had two to three times more knee pain when barometric pressure rose, compared with those living in warmer climates.
While no one recommends that you move, "figuring out how the weather affects joints could help arthritis sufferers better plan their activities and decide if and when they'll need an analgesic," Dr. McAlindon points out.
Knee aches shouldn't stop you from being active. To stay fit, limber, and pain-free, swap your usual jog for these kinder, gentler workouts (calorie burn based on 30 minutes of exercise by a 140-pound woman).
Activity Calories Burned Cross-country skiing 361 Elliptical trainer (moderate intensity) 361 Cycling (12-14 mph) 277 Stationary bike (moderate intensity) 223 Swimming (moderate intensity) 193 Walking (4-mph pace) 164 Tai chi 127 Water aerobics 126
Originally published in Ladies' Home Journal magazine, May 2005.