http://newoldage.blogs.nytimes.com/2014/01/16/an-osteoarthritis-primer/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1 By PAULA SPAN
An Osteoarthritis Primer
Maybe we should rewrite that quote usually attributed to Benjamin Franklin.Nothing is certain except death, taxes — and arthritis, the leading cause of disability in the United States.
Dr. C. Thomas Vangsness Jr., an orthopedist and chief of sports medicine at the University of Southern California’s Keck School of Medicine, has just published (with co-author Greg Ptacek) “The New Science of Overcoming Arthritis.” I asked him about the most common form, osteoarthritis, in which cartilage wears away, causing joint pain, swelling and stiffness. I’ve edited and condensed our conversation.
Q. It sounds like we’re all headed for osteoarthritis, eventually.
A. Pretty much. If you’re 55 or over, you have a 75 percent chance. By 79, almost everyone has some symptoms.
Q. Do you find that people dismiss it because it’s seen as a normal part of aging?
A. Yes. Besides, it doesn’t kill people. It’s more of an ache-y break-y nuisance, and it doesn’t hit the radar. If a couple of senators’ wives died from this disease, they’d make more effort to fund research.
Q. Why do you say the prevalence of arthritis will get worse before it gets better?
A. The pervasiveness of obesity is one issue — if you’re heavy, it affects your joints. Plus, we’re living longer, so we take more steps and use our joints more, and they wear out over time.
Q. And there’s some genetic component?
A. Absolutely. Some people are predisposed to arthritis. We’ll know more about that in time.
Q. Your recommendations emphasize diet and exercise, which sometimes seem like the prescription for everything.
A. You lose weight by picking the right grandparents or by eating right. Exercise by itself won’t cause weight loss. But exercise is still important.
Every time you do a heel strike, that puts shattering force up through the bones, increasing the wear and tear. If the muscles stay strong, they decrease the force across the joint. They take up some of that pounding, sort of like shock absorbers.
Also, joints like to be lubricated. Movement helps slosh the synovial fluid in your joints around and that nourishes the cartilage.
Q. What kind of exercise do you recommend for people with arthritis?
A. Nothing pounding. I use an exercise bike; you’re still putting weight on your joints, you get the aerobics, but it’s not like a treadmill. Less stress on your knees. Jogging isn’t as good an idea. Swimming is the best — moving your joints in a weightless environment.
Q. Every supermarket sells dietary supplements that claim to decrease arthritis pain. Do any of them work?
A. There’s conflicting scientific evidence. Good, unbiased randomized controlled studies don’t exist. Even for glucosamine and chondroitin, the studies are financed by the manufacturers and they’re flawed. But they suggest that glucosamine and chondroitin can be helpful, and they’re not harmful or expensive.
The scientific rigor I look for as a medical school professor says that the evidence is not there, but my patients tell me they feel better. So I say great, continue taking them — but let’s not kid ourselves. We don’t have F.D.A. regulation for these supplements.
Q. Green tea? Flaxseed? Herbs?
A. Where’s the beef? Show me the studies.
Q. How good are the drug options?
A. I tell patients they fan the smoke away from the fire, but the fire is still there.At this point, there’s nothing we have that can resurface cartilage.
Acetaminophen — Tylenol — just works on the pain. The NSAIDS –- nonsteroidal anti-inflammatory drugs — work on the inflammation. Celebrex is a little different pathway, and it’s safer for your stomach but a lot more expensive.
We have new drugs coming down the road, probably in the next decade.
Q. You’re a surgeon so, not surprisingly, you see surgery as a good option.
A. On younger patients, we can transplant cells or do whole cartilage grafts — harvest cartilage cells, grow and expand them, and replant them. We can also do partial knee replacements, and that’s been a big improvement.
In an older patient, the inclination is to do the definitive single operation, the hip or knee replacement. The risks of surgery are higher with age — blood clots, infections. So, one operation and then they’re done.
Q. Your book sounds very optimistic about stem cells. You did your own double-blind trial using a stem-cell treatment.
A. To me, it’s one of the more promising approaches. We injected stem cells into people’s knees to try to regrow torn and removed meniscus tissue. We had it grow back nicely at the one-year follow-up; at two years, that didn’t hold up statistically.
But we found that the procedure was safe and that people with arthritis had a big response. And that improvement lasted. Now, I’m starting a study of injecting stem cells into the knee for arthritis relief. I hope to start in the next five or six months.
Q. Do you see any role for alternative therapies like acupuncture, chiropractic or meditation?
A. Chiropractic, unproven and unrelated to nonspine osteoarthritis. But to have a health care provider touching patients might make them feel better.
We don’t know how acupuncture works; I wouldn’t rule it out, but I wouldn’t use it for an extended period.
Do I think meditation will decrease inflammation? No, but it may decrease your perception of pain.
I live in California. I advise people to see what works.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
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