Article # 268. The link between intense physical activity and a healthy body weight

The link between intense physical activity and a healthy body weight

Physical activity is related to health and lifestyle status and should be part of everyone’s daily routine. With growing rates of obesity and its associated health problems, physical activity is now more important than ever.

 

It is well known that the amount and type of exercise that an individual takes part in plays a significant role in health and weight. Excess body fat is harmful to the body in that it puts more strain on the joints and surrounding tissues, and it increases the risk of certain cancers (including bowel, breast and kidney cancer), diabetes and heart disease. Consequently, those individuals who exercise regularly can not only maintain a healthier weight but also reduce their risk of developing chronic diseases and have healthier bones and joints.

Healthy body weight

Body weight can be categorised into underweight, normal, overweight or obese based on the Body Mass Index (BMI). The BMI is calculated by dividing body weight (kg) by the square of body height (m²). For example, an individual who is 1.82 m tall and weighs 75 kg will have a BMI of 75/(1.82)² = 22.64 kg/m². This figure is then used to assess where the individual sits on a scale of body sizes.
The categories of BMI for adults are as follows:

BMI	Category
< 18.5	Underweight
18.5 – 24.9	Normal
25 – 29.9	Overweight
30+	Obese

An important point to remember when using BMI is that it does not take into account how much of the individual is muscle or fat. Those who are physically fit with a large amount of muscle mass could in fact be classified as obese while their higher weight is actually due to having more muscle as opposed to high levels of body fat. Researchers tend to agree that body fat rather than total weight is a better indicator of health status and disease risk. That is why the BMI can be complemented by measuring waist circumference, which gives an indication of abdominal body fat. Abdominal fat is closely related to various diseases. The higher the amount of abdominal fat, the higher the risk of getting type II diabetes, hypertension (increased blood pressure) and coronary heart disease. A healthy male should have a waist circumference below 96 cm whilst a healthy female should have a waist circumference below 80 cm.

Adipose tissue and physical activity

.Adipose tissue is made of fat cells. Due to hormonal influences, males are more likely to accumulate excess body fat around their waist area, whereas females are more likely to store excess fat in a thin layer under the skin and in the hip and thigh regions. The more excess body fat that is accumulated, particularly around the waistline, the higher an individual’s risk of developing health problems.
The physical activity level (PAL) of an individual is calculated as the ratio of their total energy expenditure and their resting energy expenditure over the course of a day (24 hours). In short, the more active an individual, the higher their PAL. A low PAL is defined as <1.49, a medium PAL is ~1.5 and a high PAL is >1.9.

Being involved in vigorous physical activity is clearly linked to weight stability.^1,2 Vigorous exercise is any type of exercise which elevates the heart rate and breathing rate (feeling out of breath) and requires a substantial effort. Examples of vigorous activities are: running, fast cycling, aerobics and competitive sports such as football, hockey, and volleyball.

Children and adolescents who participate in relatively large amounts of physical activity have lower levels of body fat than those who do not. European children aged 9-10 years who engaged in vigorous physical activity for more than 40 minutes a day had lower levels of body fat than those who only engaged in 10-18 minutes of vigorous physical activity a day.

Studies suggest that a PAL of ~1.8 is needed for minimising any weight gain. This PAL of 1.8 is consistent with moderate activity, i.e., predominantly standing or walking work such as that seen with housewives, salespersons, waiters, mechanics, and traders.^5,6 To equate this with the World Health Organisation (WHO) recommendation of 30 minutes of physical activity on most days of the week, most individuals need to include some extra physical activity in their day. Those who vigorously exercise will have a higher PAL as they are expending more energy.

In contrast, it has been shown that low and medium PALs are significantly related to an increase in body fat in both males and females. Accordingly, an individual may need 60-90 minutes of walking (briskly) or an equivalent amount of activity a day to expend enough energy for weight stability.1 Although reducing calorie intake may also help maintain energy balance, it does not provide the health benefits associated with physical activity.

In conclusion

To reduce levels of body fat and to get the health benefits seen in those who exercise regularly, we should try to make physical activity a part of everyday living. The WHO recommends at least 30 minutes of regular, moderate-intensity physical activity on most days to reduce the risk of cardiovascular disease and diabetes, colon cancer and breast cancer. More activity may be required for weight control.

Article # 226. Nuts Good for Some With Diabetes

Nuts Good for Some With Diabetes

Eating about 2 ounces of nuts daily in place of carbohydrates may be beneficial to people with type 2 diabetes by lowering bad cholesterol levels and improving blood sugar control, a new study shows.

“There are two important factors in caring for diabetes: blood sugar control and heart health,” study researcher Cyril W.C. Kendall, PhD, of the University of Toronto, says in a news release.

Nut Study Design

The study involved 117 people with type 2 diabetes who were randomly assigned to one of three groups. One group’s members ate about 2 ounces of mixed nuts daily, another a healthy muffin, and the third half nuts and half muffin.

Researchers say those whose diet included 2 ounces of nuts showed better results after three months in both blood sugar and LDL "bad" cholesterol levels than participants in the other two groups.

The nuts consisted of a mixture of unsalted and mostly raw almonds, pistachios, walnuts, pecans, hazelnuts, peanuts, cashews, and macadamias.

The muffin was concocted to be a healthy whole wheat product, sweetened with apple concentrate but with no sugar added. The muffins had similar protein content to the nuts from the addition of egg white and skim milk powder. Calories from monounsaturated fatty acids (MUFAs) in the nuts were the same as the carbohydrate calories in the muffin, the researchers write.

During the three-month study, participants were asked to maintain their oral diabetes medications.

Blood Sugar Improvement

The main outcome researchers looked for was change in a marker of blood sugar control called HbA1c.

Kendall described the results of the study as “a very exciting and promising finding about the treatment” of type 2 diabetes.

The researchers write that the reduction in the HbA1c level was significantly more in those in the nuts-only group than participants in the other groups.

The reduction of LDL "bad" cholesterol was also significantly greater in those who ate 2 ounces of nuts compared with the group eating muffins.

“We conclude that mixed, unsalted, raw, or dry-roasted nuts have benefits for both blood glucose control and blood lipids and may be used to increase vegetable oil and protein intake in the diets of type 2 diabetic patients as part of a strategy to improve diabetes control without weight gain,” the researchers write.

The study is published in the August issue of Diabetes Care.

One of the supporters of the study was the International Tree Nut Council Nutrition Research and Education Foundation, which represents almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios, and walnuts, and also the Peanut Institute.

Both Kendall and David J.A. Jenkins, MD, also of the University of Toronto and author of the study, acknowledged receiving honoraria from the Almond Board of California, the International Tree Nut Council Nutrition Research and Education Foundation, and Unilever Canada.

Article # 223. THE DISADVANTAGES OF SALTING FOOD

THE DISADVANTAGES OF SALTING FOOD

While everyone requires a certain amount of salt to stay healthy, it's easy for people to eat far more salt than they need due to a diet of fast food, processed snacks and produce that has been salted as a preservative or for flavor. High salt intake has been linked to serious health issues, so it's important to limit your consumption of salty food.

The Basics

Table salt is a form of sodium, an element which plays a vital role in keeping your blood circulating at the right pressure and volume and which also assists in the proper functioning of your muscles. Salt occurs naturally in low levels in many healthy foods; sodium in various forms is also added to to a wide range of processed food to enhance its flavor or prolong its shelf life.

Health Risks

Excessive salt intake has been linked to high blood pressure, which is in turn a contributor to heart disease and stroke. In addition, high sodium can make you more prone to kidney stones, osteoporosis and even stomach cancer. The University of Maryland Medical Center also warns of links to cirrhosis.

Food Sources

Common high-sodium foods include cured or processed meats such as sausage, salami, bacon and ham. But there are also less obvious sources, such as pickled produce, cheese, vegetable juice and many condiments. In addition, canned goods usually contain salt or other forms of sodium to keep them looking fresh.

Recommended Intake

With so much salty convenience food on the market, it can be all too easy to lose track of how much sodium you're consuming. The US Department of Agriculture recommends a daily intake for adults of 2,300 milligrams of sodium -- equal to 1 teaspoon of table salt – going down to 1,500 mg per day for individuals diagnosed with high blood pressure. To limit your intake, make recipes with garlic, pepper and herbs rather than salt, opt for fresh produce over processed food, and read food labels to see how much salt per serving an item contains – a healthy level being 100 mg per serving or less.

Article # 217. How to Lose Weight with a Thyroid Problem

How to Lose Weight with a Thyroid Problem

The basic formula for weight loss is simple--burn more calories than you take in. However, when thyroid problems affect your body's metabolism, traditional dieting may feel like an exercise in futility.
Hypothyroidism, or underproduction of thyroid hormone, affects approximately 10 percent of American women and is the primary culprit in thyroid-related weight gain. Hyperthyroidism, by contrast, sends the metabolism into overdrive and typically causes weight loss; however, appropriate treatment often results in hypothyroidism and notable weight gain.

Step 1

See your doctor. Thyroid dysfunction is easily diagnosed with a simple blood test. According to the National Institutes of Health, your thyroid-stimulating hormone (TSH) level should be between .5 and 3. While the TSH test is considered the gold standard for diagnosing thyroid dysfunction, your doctor should also check your free T3 and free T4 levels. T4 is the inactive form of thyroid hormone. Your body converts T4 to T3, which is the hormone that drives your metabolism. If your T3 levels are inadequate, you will likely have a difficult time losing weight.

Step 2

Take your medications as directed. If you are diagnosed with a thyroid hormone deficiency, taking one little pill daily can restore your metabolism's normal function. Thyroid hormone should be taken on an empty stomach, either one hour before or two hours after eating. It should not be taken with vitamins, calcium or certain other medications. Periodic blood tests will be needed to ensure your dosage level is optimal.

Step 3

Ask your doctor about other medications if your symptoms persist. Natural thyroid hormone and synthetic T3/T4 combinations are alternatives to the T4-only regimen that is commonly prescribed. The American Thyroid Association recommends a three- to six-month trial period of any new medication to determine whether symptoms improve.

Step 4

Take a multivitamin. Certain minerals affect conversion of T4 to T3 and the body's ability to use thyroid hormone effectively. Adequate iodine intake is important to thyroid health, though the typical American diet with iodized salt has more than enough. In fact, too much iodine can also be a concern. Richard Shames, M.D., a California-based thyroid specialist, advocates supplementation with selenium, zinc, Vitamin D, Vitamin E and essential fatty acids to enhance thyroid function.

Step 5

Avoid excessive soy intake. Soy can interfere with absorption of thyroid hormone.

Other Pointers:

Drink a lot of water if you are working on losing weight with thyroid disease. Drinking water is essential to everyone's well-being, but as with exercise, a person with thyroid disease needs to go above and beyond what is considered the norm. For example, where regular diets recommend drinking 8 glasses of water a day, if you have thyroid concerns, you may have to add an additional glass for each pound (.45 kg) you wish to lose.

Discuss beginning a daily exercise regimen that gets your body working and your muscles strengthened. In order to be effective with a low thyroid condition you will have to incorporate a fairly long and strenuous workout. A good workout will build your metabolism and help you lose weight. You can also make exercising fun by taking up Tai Chi, Kung Fu or kick boxing. Making exercise more about learning something new and less about losing weight will be more motivating.

Have a cup of green tea, and you will feel more energized and motivated to exercise. With a low thyroid you will feel sluggish and too tired to work out, but it is very important to energize yourself if you want to lose weight.

Add the recommended amount of fiber to your diet when you have a hypothyroid condition. Foods that contain fiber include fruits, vegetables, nuts and whole grains.

Opt for medication that can assist you in your plan to lose weight. You should check with your doctor about natural supplements that help improve a thyroid issue, such as bladderwrack (sea weed) and iodine.

Article # 182. Step Up Your Sedentary Lifestyle and Get Healthy

It’s a fact: far too many people today are living a sedentary lifestyle. What defines a “sedentary lifestyle” you ask? Well, you might be more familiar with the casual term of “couch potato.” People who live sedentary lives spend most of their time inactive, often sitting - usually in front of the TV, the computer, or a video console.

What’s wrong with a sedentary lifestyle?

A sedentary lifestyle leads to high blood pressure and excessive weight gain, among a number of other health conditions. In fact, this type of lifestyle is one of the leading factors known to cause obesity. It’s inevitable: with no exercise, a person has no way to burn the fat calories that are consumed on a daily basis. High blood pressure alone is a very dangerous condition; it can lead to strokes and heart attacks. 

The body needs exercise, not just to keep toned, but also to keep healthy. Without adequate exercise, you are more prone to most illnesses, from cancer to depression. Heart problems are often associated with a sedentary lifestyle, and even arthritis is thought to be related to lack of exercise. People with an elevated risk of type-2 diabetes should definitely get active; a sedentary life can significantly heighten the risk of developing this type of diabetes. Even your bones are affected by how much (or how little) you exercise. Osteoporosis, which causes the bones to become brittle and easily broken, can be brought on through an inactive lifestyle.

Who is affected by a sedentary lifestyle?

Unfortunately, this unhealthy tendency is not limited to adults. Children are also becoming increasingly sedentary. It’s not hard to see why some kids stay inactive all day. Traditional schools require long periods of sitting, and all the exciting new video games and computer “fun” out there can take up the remaining time. 

This kind of lifestyle can lead kids to have problems with weight and self-image. It can also contribute to metabolic syndrome, which includes problems with obesity, insulin and cholesterol. Teens that have spent their childhoods without exercising much can even develop high blood pressure at a very early age.

How can you change your sedentary lifestyle habits?

A sedentary lifestyle can be a hard habit to break. However, it is well worth it for the health benefits you will receive. Regular exercise strengthens your heart and helps your blood pressure stay at manageable levels. The simple act of Jogging, Gym or Swimming can help you banish stress and feel happier, all while helping you avoid such serious problems as diabetes and cancer. Some statistics indicate that exercise can cut your chances of getting bowel cancer by half. Experts usually recommend you spend between 45 minutes to one hour doing vigorous exercise, five days per week. 

If you want to get away from your sedentary lifestyle but are unsure where to start, think of some type of exercise you enjoyed as a child or teen. Jumping rope, walking or running, and stair-stepping are all great ways to burn some calories and give your health a boost. Children who are trapped in a sedentary life will benefit greatly if you can get them involved and active with other kids. Try learning a new sport together; baseball, tennis, and swimming can be excellent family activities that will get you all off the couch and into a healthier life! 

Article # 155. How to Heal a Dislocated Shoulder Fast

How to Heal a Dislocated Shoulder Fast

Shoulder

As the most movable joints in your body, your shoulders often do a great deal of work on the court, on the field, and even when you’re just reaching for something on the top shelf. Though it’s anchored by muscles, tendons and ligaments, the shoulder has a tendency to be unstable, subjecting it and you to many common problems.

Common shoulder injuries include cuff tendonitis, tears and adult shoulder arthritis. But whether these specific shoulder injuries or others are causing you nagging discomfort or debilitating pain, our fellowship-trained shoulder experts can help.

As with many other musculoskeletal injuries, we recommend treatment that may include:

• Therapy
• Exercise
• Physical medicine and rehabilitation (also known as physiatry)
• Surgery, if necessary

What could we do to help take your mind off your aching shoulder and make you happier and more productive? Maybe now’s the time to find out.

Shoulders can become dislocated by popping out of the cup-shaped socket, or glenoid, that is part of your shoulder blade. Shoulder injury can also happen with some accidents by falling in 2 wheelers and giving full balance on your shoulder. When your shoulder is dislocated, you are likely to feel pain and unsteadiness at the site of the injury. Prompt medical treatment helps improve your chances of regaining full shoulder function quickly.

Open and Closed Reduction

Going for a closed reduction done by a doctor will be part of getting your shoulder to heal quickly. The shoulder needs to be placed back into the socket from which it has been removed. The doctor physically manipulates the bones to perform a closed reduction. If you have a lot of swelling and pain, a sedative or painkillers may be provided. You may stay on painkillers or muscle relaxants for a prolonged period as your shoulder heals. In case closed reduction does not work, a doctor may need to perform an open reduction. This involves surgical manipulation of the shoulder bones.

Healing at Home

Once home, your doctor is likely to prescribe a regimen of rest, ice and heat therapy. Lifting needs to be limited and you should not perform repetitive actions with the shoulder. Reaching overhead should be avoided as well. Icing the shoulder for 15 to 20 minutes helps relieve inflammation and pain. Heat is permitted after three days of ice application. The Mayo Clinic advises a 20-minute maximum for heat applications.

Regaining Strength

Regaining the strength in your shoulder is another part of healing a dislocated shoulder. Movement may be limited at first if your doctor decides to place the shoulder in a splint or sling. Once swelling has gone down, the splint or sling is likely to be removed. According to the Mayo Clinic, part of healing involves a rehabilitative program that helps you restore movement and strength to the shoulder joint. The program will include light muscle-toning exercises and buildup to the use of weights.

Article # 153. Rheumatoid arthritis

People have long feared rheumatoid arthritis (commonly called RA) as one of the most disabling types of arthritis. The good news is that the outlook has greatly improved for many people with newly diagnosed (detected) RA.

Of course, RA remains a serious disease, and one that can vary widely in symptoms (what you feel) and outcomes. Even so, treatment advances have made it possible to stop or at least slow the progression (worsening) of joint damage. Rheumatologists now have many new treatments that target the inflammation that RA causes. They also understand better when and how to use treatments to get the best effects.

Fast facts

·         RA is an autoimmune disease. A faulty immune system (the body’s defense system) triggers it.

·         RA is the most common type of autoimmune arthritis.

·         At least 1.3 million U.S. adults have RA.

·         Treatments have improved greatly and help many of those affected.

·         Rheumatologists are doctors who have the expertise to correctly diagnose this disease and to offer patients the most advanced treatments.

What is rheumatoid arthritis?

RA is a chronic (long-term) disease that causes pain, stiffness, swelling and limited motion and function of many joints. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs.

The stiffness seen in active RA is most often worst in the morning. It may last one to two hours (or even the whole day). Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way. For instance, osteoarthritis most often does not cause prolonged morning stiffness.

Other signs and symptoms that can occur in RA include:

·         Loss of energy

·         Low fevers

·         Loss of appetite

·         Dry eyes and mouth from a related health problem, Sjogren's syndrome

·         Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands

The normal joint structure appears on the left. On the right is the joint with rheumatoid arthritis. RA causes synovitis, pain and swelling of the synovium (the tissue that lines the joint). This can make cartilage (the tissue that cushions between joints) and bone erode, or wear away.

What causes rheumatoid arthritis?

RA is an autoimmune disease. This means that certain cells of the immune system do not work properly and start attacking healthy tissues — the joints in RA. The cause of RA is not known. Yet, new research is giving us a better idea of what makes the immune system attack the body and create inflammation. In RA, the focus of the inflammation is in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals. These chemicals can damage cartilage (the tissue that cushions between joints) and bone.

Other things likely play a role in RA as well. For instance, genes that affect the immune system may make some people more prone to getting RA.

Who gets rheumatoid arthritis?

RA is the most common form of autoimmune arthritis, The disease most often begins between the fourth and sixth decades of life. However, RA can start at any age.

How is rheumatoid arthritis diagnosed?

RA can be hard to detect because it may begin with subtle symptoms, such as achy joints or a little stiffness in the morning. Also, many diseases behave like RA early on. For this reason, if you or your primary care physician thinks you have RA, you should see a rheumatologist. A rheumatologist is a physician with the skill and knowledge to reach a correct diagnosis of RA and to make the most suitable treatment plan.

Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA. Telltale signs include:

·         Anemia (a low red blood cell count)

·         Rheumatoid factor (an antibody, or blood protein, found in about 80% of patients with RA in time, but in as few as 30% at the start of arthritis)

·         Antibodies to cyclic citrullinated peptides (pieces of proteins), or anti-CCP for short (found in 60–70% of patients with RA)

·         Elevated erythrocyte sedimentation rate (a blood test that, in most patients with RA, confirms the amount of inflammation in the joints)

X-rays can help in detecting RA, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.

There is no single test that confirms an RA diagnosis for most patients with this disease. (This is above all true for patients who have had symptoms fewer than six months.) Rather, a doctor makes the diagnosis by looking at the symptoms and results from the physical exam, lab tests and X-rays.

How is rheumatoid arthritis treated?

Therapy for RA has improved greatly in the past 30 years. Current treatments give most patients good or excellent relief of symptoms and let them keep functioning at, or near, normal levels. With the right medications, many patients can achieve “remission” — that is, have no signs of active disease.

There is no cure for RA. The goal of treatment is to lessen your symptoms and poor function. Doctors do this by starting proper medical therapy as soon as possible, before your joints have lasting damage. No single treatment works for all patients. Many people with RA must change their treatment at least once during their lifetime.

Good control of RA requires early diagnosis and, at times, aggressive treatment. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. These drugs not only relieve symptoms but also slow progression of the disease. Often, doctors prescribe DMARDs along with nonsteroidal anti-inflammatory drugs or NSAIDs and/or low-dose corticosteroids, to lower swelling, pain and fever. DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA. Ask your rheumatologist about the need for DMARD therapy and the risks and benefits of these drugs.

What is the broader health impact of rheumatoid arthritis?

Research shows that people with RA, mainly those whose disease is not well controlled, have a higher risk for heart disease and stroke. Talk with your doctor about these risks and ways to lower them.

Living with rheumatoid arthritis

It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.

When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will improve your overall health and reduce pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.

Finding that you have a chronic illness is a life-changing event. It can cause worry and sometimes feelings of isolation or depression. Thanks to greatly improved treatments, these feelings tend to decrease with time as energy improves, and pain and stiffness decrease. Discuss these normal feelings with your health care providers. They can provide helpful information and resources.

Rheumatoid arthritis affects the wrist and the small joints of the hand, including the knuckles and the middle joints of the fingers.

Points to remember

·         Newer treatments are effective. RA drugs have greatly improved outcomes for patients. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage.

·         Seek an expert in arthritis: a rheumatologist. Expertise is vital to make an early diagnosis of RA and to rule out diseases that mimic RA, thus avoiding unneeded tests and treatments. A doctor who is an expert in RA also can design a customized treatment plan that is best suited for you. Therefore, the rheumatologist, working with the primary care physician and other health care providers, should supervise the treatment of the patient with RA.

·         Start treatment early. Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. They also are less likely to have the type of joint damage that leads to joint replacement.

The rheumatologist's role in the treatment of rheumatoid arthritis

RA is a complex disease, but many advances in treatment have occurred recently. Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. Thus, they are best qualified to make a proper diagnosis of RA. They can also advise patients about the best treatment options.

Article # 152. Osteoarthiritis

Osteoarthritis

Osteoarthritis is a joint disease that most often affects middle-age to elderly people. It is commonly referred to as OA or as "wear and tear" of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone. Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Symptoms include:

·         Joint pain and stiffness

·         Knobby swelling at the joint

·         Cracking or grinding noise with joint movement

·         Decreased function of the joint

In osteoarthritis, the cartilage between the bones in the joint breaks down (left image). Slowly, affected bones get bigger, as in the hand at right.

Who gets osteoarthritis?

OA affects people of all races and both sexes. Most often, it occurs in
patients age 40 and above. However, it can occur sooner if you have
other risk factors (things that raise the risk of getting OA).

Risk factors include:

·         Older age

·         Having family members with OA

·         Obesity

·         Joint injury or repetitive use (overuse) of joints

·         Joint deformity such as unequal leg length, bowlegs or knocked knees

How is osteoarthritis diagnosed?

Most often doctors detect OA based on the typical symptoms (described earlier) and on results of the physical exam. In some cases, X-rays or other imaging tests may be useful to tell the extent of disease or to help rule out other joint problems.

How is osteoarthritis treated?

There is no proven treatment yet that can reverse joint damage from OA. The goal of treatment is to reduce pain and improve function of the affected joints. Most often, this is possible with a mixture of physical measures and drug therapy and, sometimes, surgery.

Circles indicate joints that osteoarthritis most often affects.

Physical measures – Weight loss and exercise are useful in OA. Excess weight puts stress on your knee joints and hips and low back. For every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing knee OA by up to 50%. Exercise can improve your muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA.

Also helpful are support ("assistive") devices, such as braces or a walking cane, that help you do daily activities. Heat or cold therapy can help relieve OA symptoms for a short time. Certain alternative treatments such as spa (hot tub), massage, acupuncture and chiropractic manipulation can help relieve pain for a short time. They can be costly, though, and require repeated treatments. Also, the long-term benefits of these alternative (sometimes called complementary or integrative) medicine treatments are unproven but are under study.

Drug Therapy – Forms of drug therapy include topical, oral (by mouth) and injections (shots). You apply topical drugs directly on the skin over the affected joints. These medicines include capsaicin cream, lidocaine and diclofenac gel. Oral pain relievers such as acetaminophen are common first treatments. So are nonsteroidal anti-inflammatory drugs (often called NSAIDs), which decrease swelling and pain.

Surgery – Surgical treatment becomes an option for severe cases. This includes when the joint has serious damage, or when medical treatment fails to relieve pain and you have major loss of function. Surgery may involve arthroscopy, repair of the joint done through small incisions (cuts). If the joint damage cannot be repaired, you may need a joint replacement.

Supplements – Many over-the-counter nutrition supplements have been used for treatment of OA. Most lack good research data to support their effectiveness and safety. Among the most widely used are glucosamine/chondroitin sulfate, calcium and vitamin D, and omega-3 fatty acids. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially true when you are combining these supplements with prescribed drugs.

 

Living with osteoarthritis

There is no cure for OA, but you can manage how it affects your lifestyle. Some tips include:

·         Properly position and support your neck and back while sitting or sleeping.

·         Adjust furniture, such as raising a chair or toilet seat.

·         Avoid repeated motions of the joint, especially frequent bending.

·         Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA.

·         Exercise each day.

·         Use arthritis support devices that will help you do daily activities.

You might want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assistive devices.

Points to remember

·         OA is the most common form of arthritis and can occur together with other types of arthritis.

·         The goal of treatment in OA is to reduce pain and improve function.

·         Exercise is an important part of OA treatment because it can decrease joint pain and improve function.

·         At present, there is no treatment that can reverse the damage of OA in the joints. Researchers are trying to find ways to slow or reverse this joint damage.

The rheumatologist's role in the treatment of osteoarthritis

Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. You may also need to see other health care providers, for instance, physical or occupational therapists and orthopaedic doctors.