Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis in the aging adult and a leading cause of debility. Because of this correlation, it is often thought of as the “wear and tear” joint disorder of aging, but there are many different contributing factors to osteoarthritis!
OA usually manifests itself through pain in a joint, and the most commonly affected joints are the hands, knees, hips, and spine. Hand OA symptoms are more prevalent in women, especially if there is a family history. Other symptoms are limited movement, swelling, and joint deformity, and a frequently recognized change that occur in hands are nodes (bumps) that form on finger joints. These are called Heberden and Bouchard nodes and can be extremely distressing to the person experiencing them.
There are global estimates that nearly 10% of men and 20% of women over the age of 60 have painful OA. This pain leads to increasing difficulty completing daily tasks and general enjoyment of life. Things that a person used to do become more challenging. Going for a hike becomes impossible and going for a walk around the neighborhood becomes a chore and challenge. This leads to a more sedentary lifestyle which lends itself to higher risk of other diseases including heart disease, obesity, diabetes, and even cancer. Regardless of a sedentary lifestyle, OA can also lead to depression, insomnia, and deteriorating mental health!
Because OA is so common, and can even start to manifest well before age 60, there are many different treatment types aimed at reducing pain. First and foremost, a personalized exercise program should be initiated along with a weight-loss program if needed. Typically I recommend exercise classes like Tai Chi and yoga along with gentle walking to start, all the while getting set up with physical and occupational therapists for other exercise programs. Medications for OA should progress from topical therapies, which are generally the most effective, to systemic therapies. The most effective topical treatments are medications like menthol (IcyHot) and salicylate (Aspercreme) based therapies with progression to diclofenac (Voltaren) if those are not effective. These are great for joints that are “near to skin” like knees, hands and lower back, but are much less effective for deeper joints like hips. If these are not effective, then it is reasonable to try systemic therapies - medications taken by mouth. These are commonly found over the counter in the form of ibuprofen (Advil) and naproxen (Aleve), but I rarely recommend these for people over 70 years old due to the high risks that come with this type of medication (Non-Steroidal Anti-inflammatory Drug - NSAID) that only increase as a person’s age increases. Due to this limitation, there are alternatives like acetaminophen (Tylenol) which should be used under supervision of a physician, and also duloxetine (Cymbalta). If none of these are effective at controlling the pain and limiting the debility, I typically progress to joint injections with steroids and hyaluronic acid. Steroids may accelerate joint degradation, but for an older adult with limited life expectancy and who wants to avoid surgery, are an acceptable treatment after discussion of what Matters with a patient. Finally if none of these are effective, the final step is to replace the affected joint.
Overall, OA is an incredibly complex disease and can severely affect a person’s quality of life. It is important to discuss what Matters in a person’s life to remain focused on decreasing debility and maintaining Mobility. In the meantime, keep exercising - the best investment you make is in yourself!
Key Points:
Osteoarthritis (OA) is a severely limiting disease that is increasingly common as we age
OA can affect a person’s physical and mental health
OA can be treated through multiple modes, including exercise and medication
Focus on what Matters to maintain and improve your quality of life
