Daily News: Disease

Osteoarthritis not just for the aging

Pocono Record (Stroudsburg, PA)

09-05-13

Sept. 05--Osteoarthritis, the most common form of arthritis, affects 27 million Americans.

Your grandparents' generation accepted OA as an inevitable condition of aging, but new research is changing how doctors look at the disease.

One in 20 working-age adults (18 to 64 years old) face work limitations attributed to arthritis.

Eight million people will have suffered from arthritis between 2005 and 2015, according to the Centers for Disease Control and Prevention.

Even though the numbers for OA continue to increase, and the disease can leave people disabled, "osteoarthritis is still marginalized," said Kelly Donahue, communications director for the Arthritis Foundation in Cleveland, Ohio.

Arthritis is so unpredictable, said Dr. Roger Componovo of Mountain Valley Orthopedics, East Stroudsburg. "I have had two patients, both with arthritis. Within 30 days, one patient's joints will become so bad it becomes bone-on-bone, while the other patient's disease shows no further progression."

Other than sports injuries or congenital deformities, there doesn't seem to be any one factor that dictates who gets and who doesn't get arthritis, he said.

Contributing OA factors

Genetic link: Researchers suspect a genetic link, because OA is such a common disease.

Data results from family and twin studies show the disease can be inherited, but after scanning every gene in the body to look for changes that might increase the risk, researchers have been unable to find a straightforward path.

Osteoarthritis probably involves more than one gene with susceptibility to environmental and genetic factors, said Dr. Joanne Jordan, an arthritis researcher at the University of North Carolina, Chapel Hill.

"The complexity of studying OA genetics make it difficult, but with improving technologies, researchers have been able to pinpoint small genetic variations (alleles) that may increase the risk of OA," she said. "The goal is to identify people that have the variations and detect the disease at an early stage."

Then the joints could be treated before the patient reaches end-stage disease, when total joint replacement is the only option.

Post traumatic: Playing sports in school, even if it was 20 years ago, increases the chances of being in the 12 percent of people with hip, knee or ankle OA. Data gathered by researchers at the University of Iowa Hospital, Iowa City, determined that 10 to 20 years after traumatic injury to the knee, close to 50 percent of patients had developed OA.

Obesity: Overweight or obese people have a greater chance of developing the disease simply because of biomechanical factors. The more weight on the body's joints, the more stress the joints endure. Excess weight certainly contributes to OA, particularly in the knees, but is also related to hip and hand, although not as strongly, Jordan said.

"This makes it less likely the weight is only working through excess mechanical loading on the joints, since we do not walk on our hands," she said.

Studies recently showed the hormone leptin plays a major part in regulating how much fat is stored and how the body metabolizes fat.

When leptin is present in body fat, there is a narrowing of joint space in the hip -- a sign of arthritis -- but body fat itself without leptin did not lead to OA, according to the American Arthritis Foundation.

Aging: Certainly aging is one of the greatest risk factors for OA, but aging does not directly cause the disease, Donahue said, "because then everyone would have it at a certain age."

Although 50 percent of people older than 65 do have the disease, the cause is a combination of factors -- obesity, genetics and injuries to the joints, she said.

"Unfortunately the cells that make up cartilage (chondrocytes) do not repair and regenerate themselves like other cells in the body," she said.

Be proactive against OA

Be physically active. Physical activity and weight management are important and can help manage the pain and stiffness from many forms of arthritis.

Protect your joints. Whether you are working out, working in the yard or just looking for a way to be kind to your hard-working joints, it is important to minimize the trauma they experience.

Eating a variety of fresh, frozen or dried fruit is important every day, but go easy on fruit juice, which can be high in sugar. Recommended servings of fruit vary with age, gender and level of activity, from 1 1/2 to 2 cups per day for adults. The recommended amount can be reached with a large banana, an orange and a 1/4 cup of dried peaches or other dried fruit, for example.

Vegetables, especially dark green and orange vegetables, and dried beans and peas are essential to a healthy diet. As with fruit, recommended amounts of vegetables depend on your age, gender and level of activity, but for adults, figure 2 to 3 cups of vegetables per day, with most coming from dark green vegetables such as spinach, greens and broccoli. Also: orange vegetables such as sweet potatoes, squash and carrots and dried beans and peas such as black beans, black-eyed peas or garbanzo beans.

Your daily meals should also include whole grains -- foods made with the entire grain kernel, including whole-wheat flour, bulgur, oatmeal, whole cornmeal and brown rice. Eat 3 ounces of whole grains each day from foods such as brown or wild rice, buckwheat, oatmeal, popcorn, and whole-wheat bread, pasta, crackers and tortillas.

Calcium-rich dairy products are important in a healthy diet. Choose low- or no-fat milk, cheese and yogurt. Adults need about 3 cups of dairy per day.

The final food group, protein, includes meat, poultry, fish, dried beans and peas, nuts and seeds. While dried beans and peas also are part of the vegetable group, they can be an important and low-fat source of protein as well. The challenge is to choose lean or low-fat sources, such as chicken, seafood and beans or peas. Broiling, grilling or baking poultry and fish can help lessen the amount of added oil and fat in your diet.

arthritistoday.org

Symptoms of OA

* Joint soreness after periods of overuse or inactivity.

* Stiffness after periods of rest that goes away quickly when activity resumes.

* Morning stiffness that usually lasts no more than 30 minutes.

* Pain caused by the weakening of muscles surrounding the joint due to inactivity.

* Joint pain is usually less in the morning and worse in the evening after a day's activity.

* Deterioration of coordination, posture and walking due to pain and stiffness.

* Osteoarthritis most commonly occurs in the weight-bearing joints of the hips, knees and lower back. It also affects the neck, small finger joints, the base of the thumb and the big toe.

arthritis.org

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