It’s understandable that your son doesn’t want to lose his father and it is important that you both listen to him express his feelings and grief about this. But it also is important for your son to listen to his father explain why he does not wish to continue treatment and accept that this is his father’s choice to make. Also be sure your son understands that his father isn’t entirely forgoing treatment. He will instead be receiving a different type of care—an approach that prioritizes alleviating his symptoms and preserving his quality of life and dignity, instead of exposing him to potentially unpleasant drug side effects for what may be very little gain. (A recent study focusing on this very topic suggested that systemic treatment of people who are near the end of life due to cancer does not improve survival rates.) It also is important to emphasize to your son that this still can be a fulfilling and happy time you spend together, sharing old memories and making new ones that will help sustain you after your husband has died.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I keep reading that exercise benefits knee arthritis, but I find it hard to believe. I have osteoarthritis in one of my knees—I’ve seen this type of arthritis described as “wear-and-tear” arthritis, so how can forcing my knee to keep flexing back and forth possibly be beneficial?

Numerous studies have shown that exercise eases arthritis symptoms and may help people delay knee replacement surgery if they don’t feel ready to take that step. Regular exercise helps maintain range of motion in an arthritic joint, supply lubrication to the remaining cartilage, and strengthen the muscles and bones that support the joint. There also is a less direct benefit—physical activity may help you avoid the weight gain that subjects arthritic knees to even greater stress. Exercise also boosts your mood, which may help you better cope with your symptoms. If you find exercise difficult and/or uncomfortable, you may be exercising at a duration and intensity that is too much for your knee. Ask your doctor to refer you to a physical therapist who can work with you to establish a regimen that strenghtens the muscles around your knee while ensuring that you avoid overtaxing the joint.

David C. Thomas, MD, MS, MHPE

Medicine, Rehabilitation and Physical Medicine

My elderly father-in-law refuses to wear sunscreen outdoors. He says that since he is African American he doesn’t need to wear sun protection because darker-skinned people don’t get skin cancer. Is this true?

Compared with white people, Black people and other dark-skinned individuals do have a slightly lower risk of skin cancer. This is because their skin contains higher amounts of melanin, a pigment that gives skin its color and provides some protection against the sun’s harmful ultraviolet rays. However, low risk doesn’t mean no risk; moreover, skin cancer in people of color often is diagnosed at a more advanced stage that makes it harder to successfully treat. It is possible that this late diagnosis may be due to the fact that when melanoma occurs in people of color it often develops in less obvious areas of the body that may not have seen much sun exposure (such as the fingernails, soles of the feet, groin, between the fingers/toes, mouth, and genitals). If your father-in-law has been lax in using sun protection for many years, I recommend he regularly examine these areas for possible cancers (signs include darker spots and patches on the skin, a rough patch of skin, a sore that won’t heal, or a dark line underneath a fingernail or toenail). I also recommend he take appropriate steps to protect himself from the sun in the future, by applying sunscreen with a sun protection factor of at least 30 and staying in the shade when the sun is at its strongest (10 a.m. to 4 p.m.).

Michael Cameron, MD

Dermatology

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Replacing the shoulder is generally considered to be a more complex surgery than hip or knee replacement, and full rehabilitation takes time. “The decision about what to do or not do about shoulder pain can be difficult,” says Leesa Galatz, MD, professor of orthopedics at Mount Sinai. “It is a good idea to seek an evaluation from a shoulder specialist to learn what your options are.”

Complex and Vulnerable

The shoulder joint consists of a small, shallow socket with a large ball, almost like a golf ball on a tee. The rotator cuff consists of four small muscles that come from the shoulder blade and envelop the ball, keeping the ball centered on the socket. “The shallow, unconstrained shoulder socket allows you to rotate your arm to place your hand almost anywhere in space,” says Dr. Galatz. “However, this extensive range of motion subjects the shoulder to a great deal of wear and tear, particularly if your job involves physical labor.” Wear and tear may manifest as arthritis and/or rotator cuff tears that, if large, may result in weakness, loss of motion, and/or pain.

Types of Shoulder Replacement

You may be able to control arthritis symptoms with over-the-counter pain medications and non-drug strategies like acupuncture, heat and ice packs, yoga, and therapeutic massage. Rotator cuff tears often respond to physical therapy or may be repaired surgically. However, if these approaches don’t provide the relief you need, and pain is limiting your physical function, your doctor may suggest shoulder replacement.

• Total shoulder replacement replaces the arthritic joint surfaces—the ball at the top of the humerus (upper arm bone) and the glenoid cavity (shoulder socket)—with artificial ones. “The ball at the top of the humerus is replaced with a metal ball, and the socket is lined with a hard plastic socket,” says Dr. Galatz. “The artificial parts recreate normal shoulder anatomy, with the muscles and tendons that power the shoulder left intact.”

Total replacement requires that the rotator cuff be undamaged and working well, since it holds the head of the humerus tightly within the shoulder socket. “If there is a tear in the rotator cuff, this may result in too much movement of the humeral component of the replacement joint, which may migrate upward and loosen the socket component,” Dr. Galatz explains.

• Reverse shoulder replacement may be preferable if you have sustained rotator cuff damage. This approach switches the positions of the artificial joint components—the metal ball is placed onto the shoulder socket, and the cup is fitted into the top of the metal stem inserted into the humerus. “Reversing the artificial joint enables the deltoid muscle—the large, rounded muscle on the outside of your shoulder—to compensate for the damaged rotator cuff and shifts the load of raising the arm from the damaged rotator cuff to the deltoid,” says Dr. Galatz.

• Partial shoulder replacement generally is carried out if arthritis affects only the head of the humerus or the top of the humerus has sustained a fracture. The surgery replaces the humeral head with a metal ball and stem component, but the natural shoulder socket is left intact. “This approach is not common, since pain relief and the longevity of the artificial components is better with a total shoulder replacement,” Dr. Galatz notes.

Recovery and Rehabilitation

Shoulder replacement is increasingly performed as an outpatient procedure, although people with multiple medical problems that need close supervision after surgery may stay one to two nights in the hospital. “The shoulder and arm are immobilized for the first 24 hours, and you’ll be given pain medication to relieve discomfort, antibiotics to reduce the risk of infection, and blood thinners to decrease the risk of blood clots,” says Dr. Galatz. Call your surgeon immediately if the incision from your surgery swells, drains, or becomes red or painful, and/or if you develop a temperature over 101°F in the days following the procedure. Also immediately alert him or her if you experience swelling in your legs, chest pain, or shortness of breath.

Physical therapists will help you begin to gently move your arm the day after the surgery. After a total shoulder replacement, you will be advised to use a sling for 10 days to two weeks, and therapy will be focused on restoring your range of motion. Light strengthening can begin about a month after the procedure when you can raise your arm. After a reverse shoulder replacement, you’ll need to use a sling for about three weeks, and range-of-motion exercises will begin seven to 10 days after surgery. Keep in mind that your physical therapy regimen will be individualized and may vary depending on the condition of your shoulder before surgery.

Sustained Benefits

About 90 percent of shoulder replacements last longer than a decade, and the benefits reported by people who undergo the procedure are sustained. Most people typically regain at least two-thirds of normal shoulder motion after replacement of the joint, although this will to some extent depend on what you were able to do before the surgery and how badly the joint was damaged. Depending on how your recovery progresses, you likely will be able to drive again six to eight weeks after your surgery. “Any discrepancy in range of motion compared to what you had when your shoulder was healthy is typically made up for by being able to carry out normal daily activities without pain,” Dr. Galatz concludes.

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Osteoarthritis

The ends of the bones in a joint are covered with cartilage: a smooth, slippery tissue that lubricates and cushions joints, protecting the underlying bone from the friction of movement. In osteoarthritis, cartilage begins to wear away and becomes more likely to split and tear under stress. Without the bone-cushioning properties of healthy cartilage, the ends of the bones begin to rub and grind against each other, causing pain, swelling, stiffness, and a grating sensation. The soft connective tissues that attach muscles to bone deteriorate, becoming inflamed and painful. When osteoarthritis affects the spine, the vertebrae may develop bone spurs, bumps along the edges of the bones that officially are termed osteophytes. Bone spurs are not painful in themselves, but they can cause pain if they press on the spinal nerves.

Yousaf Ali, MD, professor of medicine at Mount Sinai and Chief of Mount Sinai West’s

Division of Rheumatology, says that osteoarthritis essentially represents mechanical deterioration of the joints. “Although it happens almost inevitably with age, there are some other conditions, such as overuse or trauma, that can exacerbate the condition,” he adds. Overuse might come in the form of high-intensity sports or many years of working in jobs that involved hard physical labor or repetitive motions. Trauma might be a sports injury incurred in your younger years, even if the injury healed with no issues at the time. Obesity often plays a role in osteoarthritis, since it places weight-bearing joints like the knees under greater stress. Smoking also raises the risk of osteoarthritis.

Treating Osteoarthritis

If your arthritis symptoms are mild, Dr. Ali recommends non-drug strategies to relieve the symptoms. “Physical therapy can help maintain range of motion in the affected joints as well as strengthen the muscles that support joints,” he says. He also suggests you try acupuncture (see Resources). Heat and ice packs also are worth trying, as are capsaicin-based creams, which contain the same active ingredient as hot peppers.

When it comes to over-the-counter painkillers, opt for acetaminophen (Tylenol®) instead of oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®), since oral NSAIDs are associated with gastrointestinal bleeding and other harmful side effects in older adults. With regard to acetaminophen, watch how much you take, since too much can harm the liver. Keep in mind that acetaminophen is a common ingredient in many over-the-counter medications (most notably cold and flu remedies), so check labels to avoid inadvertently overdosing on the drug. “I generally recommend my older patients take no more than 3,000 milligrams per day,” Dr. Ali says. He adds that if acetaminophen doesn’t provide sufficient relief, judicial use of COX-2 inhibitors (a type of NSAID) at a low dose can be helpful in people without gastrointestinal risk factors or chronic kidney disease.

While joint discomfort due to arthritis may put you off exercising, Dr. Ali recommends you try to keep active, since regular exercise may alleviate pain and stiffness and slow the progression of osteoarthritis. “Physical activity keeps muscles and bones strong, so it is key,” he emphasizes. Exercise also can help with any efforts you may be making to shed the excess weight that can speed up joint degeneration in arthritis. “If you find exercise painful, try swimming,” Dr. Ali suggests. Chest-deep water is buoyant and offers arthritic joints relief from the weight-bearing impacts that come with other forms of physical activity. “Using an elliptical machine or cycling also are non-weight-bearing forms of exercise,” Dr. Ali adds.

If you don’t gain sufficient relief from conservative treatment, you may want to look into joint replacement. “I recommend my patients consider joint replacement if they are experiencing chronic and/ or intolerable pain that limits their quality of life despite appropriate conservative management,” Dr. Ali says. “Hip and knee replacement can be life-altering.”

Rheumatoid Arthritis

Cartilage also degenerates in rheumatoid arthritis, but for a different reason. “Rheumatoid arthritis is an autoimmune disease, meaning that the body’s immune system is attacking itself,” Dr. Ali explains. This onslaught affects the synovium (joint lining), a layer of cells that lubricates and nourishes joints. “The synovium normally is thin, but in rheumatoid arthritis synovial cells proliferate and cause the synovium to thicken and erode the cartilage and bones of the affected joint, causing pain and swelling,” Dr. Ali says.

Rheumatoid arthritis typically affects the smaller joints in the hands and feet, but may progress to the elbows, shoulders, knees, hips, jaw, and neck. In most cases symptoms occur symmetrically, affecting the same joints on both sides of the body. Women are at greater risk for rheumatoid arthritis, and obesity and smoking also make you more vulnerable. There likely is a genetic component to the disease, which means there is no sure way to prevent it. However, there is some evidence that people with a family history of rheumatoid arthritis may be able to lower their risk for developing it by quitting smoking and maintaining a normal weight.

Treating Rheumatoid Arthritis

There is no cure for rheumatoid arthritis once it develops, but—as with osteoarthritis— painkillers, physical therapy, and other conservative approaches can ease discomfort levels. People with rheumatoid arthritis also benefit from disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Rheumatrex®, Trexall®), which slow the course of rheumatoid arthritis. Other drugs, called biologic DMARDs, may relieve severe rheumatoid arthritis that doesn’t respond to standard DMARDs— options include etanercept (Enbrel®) and adalimumab (Humira®). Dr. Ali stresses the importance of starting DMARD therapy early in the course of the disease. “The window of opportunity to arrest rheumatoid arthritis is in the first three months,” he notes. “Delaying this treatment may cause irreversible joint damage.”

DMARDs work by suppressing the immune system, which can lower your resistance to infections, so you’ll likely be advised to get the shingles vaccine prior to taking them. Be sure to discuss possible drug side effects with your doctor.

Rheumatoid arthritisis is associated with a greater risk for cardiovascular disease, heart failure, blood clots, and chronic obstructive pulmonary disease. Follow your doctor’s advice for lowering your risk factors for these conditions, as well as treating them. You also should quit smoking if you still engage in the habit, since it can affect your response to drug treatments. As with osteoarthritis, people with severe joint destruction due to rheumatoid arthritis may want to consider joint replacement.

Resources

Acufinder (www.acufinder.com) has an online tool to help you find a local acupuncturist.

The post Arthritis a Problem for Many Older Adults appeared first on University Health News.

Managing the Pain

The poll included 2,277 adults, ages 50 to 80. About half of those surveyed who were having arthritis symptoms said they experienced pain every day and that the discomfort was significant enough to somewhat limit their usual activities. More than one-third said the pain interfered with day-to-day life.

Most poll respondents who were experiencing joint pain said they had at least some confidence they could manage it on their own. And many were doing just that—66 percent reported taking over-the-counter pain relievers, such as aspirin, acetaminophen (Tylenol®), and the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil®) and naproxen (Aleve®). Stronger prescription medications also were being used, including non-opioid pain relievers, steroids (both oral and injected into painful joints), opioids, and disease-modifying anti-rheumatic drugs (DMARDs). “The latter commonly are used to treat rheumatoid arthritis, an autoimmune disease that causes similar symptoms to those of osteoarthritis,” Dr. Thomas says.

About 26 percent of poll respondents said they took supplements, such as glucosamine or chondroitin, 11 percent said they used cannabidiol (CBD, which is derived from marijuana) and 9 percent said they used marijuana.

Risky Treatments

There are risks associated with many of the treatments poll respondents reported using. “For example, NSAIDs are associated with gastrointestinal bleeding in older adults and also may raise the risk of high blood pressure and cardiovascular events,” Dr. Thomas notes. “While acetaminophen is considered safer, it is the active ingredient in numerous cold and cough remedies, so there is a risk of inadvertent overdose if people use these remedies while also taking the drug for joint pain. The risk of dependency that accompanies opioid use has been widely publicized, while oral steroids can affect bone strength if taken long term.” DMARDs are highly effective at easing rheumatoid arthritis symptoms and can help prevent disease progression, but also come with a range of side effects (these differ depending on the drug used).

The CBD and marijuana used by some poll respondents also are risky prospects. CBD is the active ingredient in medical marijuana, and does not have the mindaltering effects of tetrohydrocannabinol (THC), which is another component of marijuana. Even so, CBD may interact with other drugs in a way that alters their effectiveness—moreover, a 2020 study found that some CBD products contain THC. “THC is especially risky for older adults because it causes intoxication and may lower blood pressure, which raises the risk of falls,” Dr. Thomas cautions.

Keep Your Doctor in the Loop

The best way to avoid side effects from medications is to keep your doctor informed about any drugs, including supplements and other alternative remedies, you are taking to manage your joint pain. But if the poll results are anything to go by, many people don’t do this. About 60 percent of respondents who reported taking two or more substances for their joint pain said they hadn’t discussed the potential risks with their health-care provider, or they couldn’t recall if they had.

Safe Pain Relief

If you have arthritis, the American College of Rheumatology (ACR) guidelines for treating both types mentioned here aim to reduce the risk of drug side effects. People with osteoarthritis are advised to try tai chi and yoga, both of which can improve range of motion in stiff joints; braces, splints and taping to support painful joints; acupuncture, which may stimulate release of endorphins, the body’s natural painkillers; and the application of heat and cold. Topical pain relievers, like capsaicin ointment or Voltaren Gel (a topical NSAID) also are recommended, along with weight loss if you are overweight or obese. “Excess weight places arthritic joints under great stress and may hasten arthritis progression,” Dr. Thomas notes.

For medications, the osteoarthritis guideline focuses on short-term use of over-the-counter pain medications, in as low a dose as possible. But the ACR recommends against most supplements, and against opioids and other prescription drugs because of a lack of evidence or evidence of risk. If you have rheumatoid arthritis, DMARDS likely will remain the cornerstone of your treatment regimen but the non-drug strategies recommended by the ACR also may help.

Don’t Give Up on Finding Relief

Many older adults in the poll agreed with the statement that there is nothing that people with joint pain can do to ease their symptoms. But help is available. Talk to your doctor about how much pain you’re experiencing and how you’re managing it. Together, you likely can come up with a treatment plan that works for you. And don’t discount joint replacement if your pain is so severe it is interfering with your quality of life and ability to complete daily tasks of living. “While conservative therapies can be effective at helping you manage mild-to-moderate arthritis, more severe disease may be best treated with surgery to replace the affected joint,” Dr. Thomas confirms.

The post What Are You Doing to Ease Your Joint Pain? appeared first on University Health News.

Medications Can Ease Pain

Drugs used to help manage arthritis symptoms include acetaminophen (Tylenol®). This is a safer initial option than nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®), and naproxen (Aleve®), since NSAIDs are associated with potentially serious side effects (including gastrointestinal bleeding, raised blood pressure, heart failure, and kidney damage) in older adults. If acetaminophen does not provide sufficient pain relief, try NSAIDs—but if you find that you’re having to take the drugs regularly, discuss with your doctor the possible side effects. If you cannot tolerate NSAIDs, you may want to discuss with your doctor whether opioids are an option—however, keep in mind that these drugs carry a risk of addiction and dependence.

Rheumatoid arthritis (see What You Should Know) may warrant treatment with disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Otrexup®), which slows the course of the disease. Biologic drugs are an option for severe cases that don’t respond to NSAIDs or DMARDs—options include etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®). “Since these drugs work by suppressing the immune system, they can lower your resistance to infections,” Dr. Pruzansky cautions. With this in mind, you’ll likely be advised to get vaccinated against shingles prior to taking biologics (see our page 5 article).

Another option is cortisone, which is injected into the joint. “Cortisone can provide relief for several months or more but cannot be used too often, as it weakens the tissue,” says Dr. Pruzansky. “The good news is that cortisone basically stays where it is, meaning that it minimally enters the rest of the body and usually doesn’t cause other side effects.”

Other Approaches

Other options for easing the discomfort of arthritis in the hands include splints that immobilize the joint so that the bones don’t rub together. Typically worn overnight, splints enable you to rest affected joints, and can be particularly helpful if you have osteoarthritis at the base of your thumb (see What You Should Know). You also may be referred to an occupational therapist, who can prescribe exercises that will improve pain and flexibility while not aggravating your arthritis. “An occupational therapist also can analyze how you tend to use your hands, and give specific advice on ways to reduce stress and increase stamina in weakened joints,” Dr. Pruzansky adds.

Simple self-help strategies include ice and heat packs, while many arthritis sufferers also report relief from complementary approaches, such as acupuncture and massage. But Dr. Pruzansky recommends that you tread carefully when it comes to dietary and/or herbal supplements that claim to help ease arthritis pain. “These are not regulated by the Food and Drug Administration, and may interact with conventional drugs,” he says. “If you are considering using supplements, be sure to discuss their safety and efficacy with your doctor or pharmacist.”

What About Surgery?

Surgical options for arthritis in the hands include ligament and tendon repair to tighten loose joints and restore motion. Removing the swollen, inflamed tissue within the joint is called synovectomy. Other surgical options include a partial or complete wrist fusion, in which the bones are joined together using wires, screws, and/or metal plates. “Pain is alleviated by eliminating motion and the rubbing of bones on each other,” Dr. Pruzansky explains. However, you won’t be able to bend your wrist after the surgery. Another procedure is proximal row carpectomy, in which the row of arthritic wrist bones closest to the forearm is removed. “This generally reduces pain and preserves partial motion,” says Dr. Pruzansky.

An approach that preserves more motion is wrist replacement, which replaces the damaged parts of bones with metal and plastic components. The procedure can improve range of motion to about 50 percent of normal, according to the American Academy of Orthopaedic Surgeons. It’s reserved for people who don’t need their wrists for heavy daily use, and the artificial joint typically lasts 10 to 15 years with careful use.

Other surgical developments include knuckle replacement, but its success depends on patients having healthy bone and soft tissue to stabilize the replacement part, and avoidance of heavy daily use. Dr. Pruzansky emphasizes that surgery is a last resort for people whose hand arthritis and pain is severe and unresponsive to medications. “Pain and infection are risks of surgery,” he cautions.

The post Coping with Arthritis in Your Hands appeared first on University Health News.

“Theoretically, cutting back on those pro-inflammatory foods might ease inflammation and arthritis symptoms, although we don’t have conclusive evidence. But more rheumatologists are becoming interested in nutrition as a secondary therapy for arthritis,” says Gabrielle Gambino, a registered dietitian nutritionist with Weill Cornell Medicine.

Gambino recommends ditching pro-inflammatory foods and focusing on whole (unprocessed) foods that promote health, sometimes called “anti-inflammatory foods.” To ease arthritis inflammation, consider adding the following to your diet.

Fiber. Foods rich in fiber support the growth of good bacteria in the gut, which is especially important when you have arthritis. “People with arthritis are prone to lower levels of gut microbiota diversity,” Gambino notes. “This can lead pro-inflammatory gut microbes to dominate, which can, in turn, trigger a cascade of positive inflammatory effects throughout the body.” Make sure your diet includes lots of legumes (beans, lentils), whole grains (whole wheat, quinoa, brown rice, oats), seeds, and nuts.

Omega-3 fatty acids. Omega-3 fatty acids are crucial for cell health and for supporting many body systems, including the immune system (which sometimes mistakenly attacks the lining of the joints—a condition called rheumatoid arthritis). We get omega-3 fatty acids from foods such as fish (salmon, tuna, sardines), vegetable-based oils, flaxseed, and nuts. “Eat about four ounces of fish twice per week,” Gambino suggests.

Polyphenols. Polyphenols are a large class of plant compounds that may be beneficial for health. “One subtype of polyphenols in particular, called flavonoids, may help decrease cell damage and protect cell membranes, which can decrease the amount of inflammation in our bodies and support our immune system,” Gambino says. Foods rich in flavonoids include apples, berries, black and green tea, broccoli, citrus fruits, grapes, kale, legumes, onions, peppers, and red wine (for its resveratrol).

Vitamin D. Gambino says people with arthritis tend to have low levels of vitamin D. “This could be due to the decreased physical activity caused by pain, possibly leading to lower levels of UV rays from the sun,” Gambino says. “Vitamin D, when in supplement form, has been shown to possibly help with symptom relief. And in theory, adding vitamin D-rich foods—such as fortified cereals, orange juice, and dairy—may help as well.” Speak with your doctor before starting any supplements.

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A: Fear and anxiety about a new disease can be overwhelming, and public health actions, such as social distancing, can make people feel isolated and lonely, and can increase stress and anxiety. Stress during an infectious disease outbreak can cause some of the following:

• Fear and worry about your health and the health of your family.
• Anxiety about your financial situation or your source of income.
• Changes in sleep or eating patterns.
• Difficulty sleeping or concentrating.
• Worsening of chronic health problems.

Different Types of Depression. There are several different types of depression, including situational and clinical depression. Situational depression is typically temporary and can be brought on by an event such as loss of a loved one. Clinical depression is complex and can arise for numerous reasons, including genetic vulnerability, severe life stressors, and medical conditions that affect the way your brain regulates your moods.

You may be depressed if, for more than two weeks, you’ve experienced several of the following symptoms:

• Feelings of hopelessness and/or pessimism.
• Feelings of guilt, worthlessness and/or helplessness.
• Irritability and restlessness.
• Loss of interest in activities or hobbies once pleasurable.
• Fatigue and decreased energy.
• Difficulty concentrating, remembering details and making decisions.

Find a Therapist. Talking to a mental health professional can help. To schedule a face‑to-face or telemedicine appointment, contact your insurance provider or follow this link https://bit.ly/34fmRyD to the Anxiety and Depression Association of America’s Find a Therapist web page.

Q: I have osteoarthritis in my hip, so swimming is my exercise of choice, but my gym pool is closed until further notice because of COVID-19.  What kind of exercises can I do that will be easy on my joints?

A: Good for you for recognizing the importance of keeping moving. If you don’t exercise, your muscles will get weaker, your arthritis symptoms will worsen, and you will lose vital strength and mobility. Walking, yoga and tai chi are three activity options that won’t stress your joints, don’t require a pool, and can be done at home or close to home.

Walking. You may worry that walking will cause your arthritic hip to deteriorate faster, but research suggests you can walk for at least 10,000 steps each day without doing additional damage to your arthritic hip joint. If you want some ”virtual” company or need support or direction, follow this link https://bit.ly/30ieJfG to learn about the Arthritis Foundation’s Walk With Ease program.

Yoga. People with arthritis who practice yoga regularly can reduce joint pain, improve joint flexibility and function, and lower stress and tension. Iyengar yoga is often recommended to people who have arthritis because it can be adapted for limited mobility. Assistive props, such as ropes and foam blocks, can be used during challenging poses. For example, if you have a hard time bending over and touching your toes, you can place a foam block on the floor and reach for that instead. Floor stretches are another great way to gain the benefits of yoga without inflicting undue stress on your joints. Follow this link
https://bit.ly/36jUty4 to learn how to do a dynamic reclined hip stretch sequence that can help you gently release tension around your hip joint and hamstrings.

Tai chi. With its gentle, fluid movements, tai chi is gaining popularity as a way to fight off arthritis pain and increase flexibility and strength without straining joints. Recent studies have found that the slow, graceful exercise, which originated centuries ago as a martial art, can improve balance, reduce stress and offer pain relief. For more info, follow this link https://bit.ly/3ikGudL to watch—or participate in—a tutorial on tai chi stretches for arthritis.

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The line between mainstream “Western” medicine and complementary/alternative medicine has become increasingly blurred—and now there is another form of health care, referred to as “integrative.” To make sure everyone is on the same page when talking or reading about the various kinds of treatment available to people who have arthritis, try the “Health Care Choices: What’s the Difference?” matching test on the next page.

The information in this chapter highlights some of the most popular complementary and alternative methods of treatment. Be warned that while there is evidence that some work, some don’t!

Acupuncture

This form of traditional Chinese medicine is based on the theory that health and well-being depend on a harmonious balance between “yin” and “yang,” which are the two extremes of “qi,” or life force. Qi is believed to flow through pathways in the body called meridians, which can be accessed via more than 300 acupuncture points. Inserting fine needles into these points is believed to rebalance yin and yang. There also is a scientific explanation behind the therapy: Stimulation of the points with fine needles may cause your body to release more of its own natural painkillers.

Acupuncture is endorsed as a treatment for arthritis pain by the American College of Physicians. According to the American Academy of Orthopaedic Surgeons, when acupuncture is combined with traditional pain-relief methods, it may be helpful for low back pain, fibromyalgia, and osteoarthritis (OA). A review of 44 trials concluded that acupuncture can enhance standard care by reducing the severity of pain associated with a variety of conditions and diseases. However, acupuncture is not recommended for people who are taking certain drugs—for example, blood thinners like warfarin (Coumadin)—or those who are extremely anxious. It also is inappropriate for conditions such as head injuries, herniated discs, or unstable joints.

If you decide to try acupuncture, consult a practitioner certified by the American Academy of Medical Acupuncture (see the Resources section at the back of this report).

Antioxidants

Antioxidants are substances that prevent or delay cell damage and inflammation due to free radicals (harmful molecules that occur naturally in the body). Popular antioxidants include vitamins C and D, resveratrol, and compounds in tea.

According to the National Center for Complementary and Integrative Health (NCCIH), diets that are high in fruits and vegetables (which are good sources of antioxidants) have been found to be healthy. However, research has not shown antioxidant supplements to be beneficial at preventing diseases.

• Vitamin C is essential for the formation and health of collagen and other connective tissue. The recommended daily amount for vitamin C is 90 milligrams (mg) for men, and 75 mg for women. Taking vitamin C supplements may have a counterproductive effect in OA, and there also is conflicting evidence as to whether it has a protective effect for gout.
• Vitamin D. Vitamin D is essential for the metabolism of calcium. It is manufactured in the skin with exposure to sunlight and also can be consumed via fortified cereals, milk and fruit juice, fish, and eggs, or taken as a supplement. The Institute of Medicine recommends that people get 600 International Units (IUs) of vitamin D per day, but many experts recommend 800 to 1,000 IUs. While there is some evidence vitamin D may help in osteoporosis and fibromyalgia, there is conflicting evidence of any benefit in arthritis.
• Resveratrol. This antioxidant is present in berries, grapes, and wine, and it may decrease inflammatory markers. In a 2018 study, people with RA who were given resveratrol along with conventional drugs experienced improvements in clinical markers of RA disease activity compared to those treated with drugs alone.
• Green tea. In one study, people with RA who were treated with green tea for six months alone or in combination with the biologic drug infliximab (Remicade) or an exercise program showed significant improvement in disease activity. Benefits also may be seen with black tea.

Aromatherapy/Essential Oils

Aromatherapy is the use of essential oils from plants to improve the mind, body, and spirit, according to the National Cancer Institute, which has conducted or sponsored most of the current research on aromatherapy.

Aromatherapy may be used with other complementary treatments, such as massage and acupuncture. Among the oils used are those from Roman chamomile, geranium, lavender, tea tree, lemon, and cedarwood. They are thought to stimulate scent receptors, which send messages through the nervous system to the part of the brain that controls emotions.

Aromatherapy is used in three ways:

• Indirect inhalation. Breathing in the oil via a room diffuser, which spreads the oil through the air, or by placing drops of oil nearby.
• Direct inhalation. Breathing in the oil through an inhaler.
• Massage. Massaging diluted oil into the skin through lotions or bath salts.

The U.S. Food and Drug Administration (FDA) considers essential oils cosmetic, so manufacturers are not required to prove their product’s effectiveness, purity, or potency. Any advertising claim that an essential oil can treat a health condition is illegal.

Studies of aromatherapy massage and inhalation have had mixed results. There have been reports of improved mood, anxiety, sleep, nausea, and pain levels, but nothing specifically about arthritis. The Mayo Clinic found that patients who tried aromatherapy after surgery had better pain management and higher overall satisfaction with their care. Another study suggested that lavender oil may help reduce pain for people with OA of the knee. A review of several small studies published in Pain Research and Treatment indicated that aromatherapy can successfully treat pain when combined with conventional treatment.

Side effects are rare when essential oils are used according to directions, but they are possible and include allergic reactions, skin irritation, and sensitivity to sunlight. You should never apply undiluted essential oils to your skin; they are potent and should be added to a neutral carrier oil or lotion before use. Never ingest essential oils.

Biofeedback

Biofeedback measures body functions that are related to emotional stress and chronic pain. Awareness of the physical changes that take place when you are under stress or feel pain can help you manage those variables.

Electrodes placed on the body measure functions such as breathing rate, heart rate, blood pressure, skin temperature, and muscle tension. A monitor displays the results for you and the person administering the process. He or she will show you which body function levels indicate abnormalities, and will then teach you how to lower those indicators using techniques such as controlled breathing, imagery, and exercises. The goal is for you to gain control over these body functions and, in the process, self-treat a variety of physical problems, including your arthritis pain.

Cognitive Behavioral Therapy

Cognitive behavioral therapy—a type of “talk therapy”—is one of the most common psychological interventions for people with arthritis pain. If you decide to try it, you will attend a pre-determined number of in-person or online sessions with a mental health counselor. He or she will attempt to help you identify and correct ingrained patterns of negative thoughts and behaviors. The process is most effective in people who can quickly identify a specific concern and learn how to cope with it, even if the level of pain they are experiencing remains unchanged.

Cognitive behavioral therapy is considered a mainstream pain-management treatment by some people and a complementary technique by others. It’s traditional because it has been recommended by physicians for more than a decade. It’s complementary (or integrative) because it almost always is used in combination with one or more additional mainstream strategies.

Copper Bracelets

Copper bracelet manufacturers claim that tiny amounts of copper move from the bracelets through the surface of the skin and neutralize molecules that can damage cells in and around joints. The bracelets have strong support among those who believe that they relieve pain. However, there is no evidence that they have any meaningful therapeutic effect beyond that of a placebo (an inert substance or “fake” treatment).

Dimethyl Sulfoxide (DMSO)

DMSO is a colorless, sulfur-containing organic byproduct of wood pulp processing that has analgesic and anti-inflammatory properties. It can be taken orally or applied to the skin and is used in wound healing, burns, and arthritis. However, evidence of its effectiveness is mixed.

When taken orally, DMSO may cause side effects including headaches, dizziness, vomiting, diarrhea, constipation, drowsiness, nausea, and anorexia. Topically it may lead to skin irritation.

Do not use DMSO if you have diabetes, asthma, or liver, kidney, or heart conditions. Industrial-grade DMSO should not be used under any circumstances.

Fish Oil

Fish oil from fatty fish (such as herring, salmon, tuna, halibut, sardines, and cod) contains the omega-3 fatty acids eicosapaentanoic acid (EPA) and docosahexaenoic acid (DHA), both of which have been shown to block inflammatory chemicals.

The NCCIH has concluded that there is some evidence omega-3s from fish oil and seafood may be modestly helpful in relieving RA symptoms. A 2017 meta-analysis of 42 trials found considerable variation in the results, but 22 trials suggested that fish oil eased pain in RA. (Only five trials looked at OA, and the improvements were not significant.)

Health experts recommend that people eat two to three servings of fish per week, but you should avoid some types (including tilefish, swordfish, shark, and king mackerel) due to their high mercury content. Since it is difficult to get enough omega-3 fatty acids in only three portions of fish, you may want to consider taking fish oil supplements. It is recommended that people with RA take fish oil capsules with at least 30 percent EPA/DHA.

The U.S. National Academy of Sciences has established a minimum daily requirement for omega-3 fatty acids: 1.1 grams (g) per day for adult women, and 1.6 g per day for adult men. Don’t exceed these dosages, since too much fish oil may cause nausea and diarrhea and also may increase the risk of bleeding in people who take blood thinners such as warfarin (Coumadin).

Glucosamine and Chondroitin

Research on glucosamine and chondroitin is perennially inconsistent. The two supplements may be beneficial for certain populations, but the evidence is not at all conclusive. A 2018 study published in Advances in Rheumatology found that a fixed-dose formulation (two drugs in a single capsule or tablet) of glucosamine and chondroitin was effective in treating OA. However, according to a 2018 NCCIH report, chondroitin was not helpful for pain caused by OA of the knee or hip, and it was unclear whether glucosamine helps with knee OA, or if either substance lessens OA pain in other joints. In 2017, Arthritis & Rheumatology published data indicating that 164 knee OA patients who took a combination of glucosamine and chondroitin daily for six months did no better when it came to pain or daily function than those who took a placebo.

If you and your doctor decide that it’s worth you giving glucosamine and chondroitin a try, the most commonly recommended dosages are 1,500 mg of glucosamine and 800 to 1,200 mg of chondroitin daily. Thirty to 90 days of use are needed to get an accurate assessment of their effectiveness.

Heat, Cold Applications

Cold therapy—also known as cryotherapy—can relax tense muscles, numb nerves, and reduce inflammation, swelling, pain, and stiffness. It is particularly useful in acute inflammatory episodes and after exercise. Cold therapy for arthritic joints includes cool packs, ice massage, and over-the-counter ointments or sprays. You also can use a bag of frozen peas or corn, but don’t apply it directly to your skin—wrap it in a towel.

If a joint is not actively inflamed, heat therapy may provide temporary relief from arthritis symptoms by enhancing blood flow, relaxing tense muscles, and improving flexibility. Heat also may be useful for warming your muscles before an exercise session. Heat therapy includes heat packs, a hot water bottle, warmed towels, a bath, or a shower.

Herbals

There is a lack of convincing evidence regarding the effectiveness of herbals, but while scientific research may fail to prove that herbal remedies work for the general population, they may be effective for an individual.

Herbal remedies promoted for the treatment of arthritis include turmeric, ginger, Chinese thunder god vine, willow bark extract, feverfew, cat’s claw, and stinging nettle. These and other herbal remedies contain a complex mix of biologically active ingredients that impact processes in the body and have side effects, interactions, and contraindications, just like pharmaceutical drugs. Check with your pharmacist or doctor for possible interactions with conventional medications before starting any herbal remedy.

A review of evidence carried out by the NCCIH focused on the following popular supplements:

Turmeric (Curcuma Longa). Turmeric contains a group of biologically active chemicals known as curcuminoids. Curcuminoids are believed to have anti-inflammatory effects, and preliminary studies have found that they may work as well as the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (Advil, Motrin) when it comes to controlling knee pain from OA. However, the NCCIH concludes that there are no really strong study data supporting claims that turmeric helps to reduce inflammation. The herb may cause gastrointestinal issues if it is taken in large doses and also may interact with the blood thinner warfarin.

Devil’s Claw. Devil’s claw sometimes is used for arthritis, gout, general muscle pain, tendinitis, and other musculoskeletal conditions. The NCCIH concludes that there is limited evidence that devil’s claw may provide modest improvements for low back pain and OA of the spine, hip, and knee. Devil’s claw may lower blood pressure as well as interact with blood thinners, statins, and diabetes drugs, among others.

Thunder God Vine. Thunder god vine is a perennial vine native to China, Japan, and Korea, and is not widely available in the United States. The NCCIH says the vine may reduce some RA symptoms. However, it comes with a range of gastrointestinal side effects and can be toxic if it is not properly prepared.

Gamma Linolenic Acid. An omega-6 fatty acid, gamma linolenic acid (GLA) is found in seed oils, including evening primrose, borage, and black currant. In the body, GLA may be converted into inflammation-reducing substances. Preliminary evidence suggests that GLA is beneficial for RA. More rigorous studies suggest it may relieve joint pain, stiffness, and tenderness. GLA should not be used if you take blood thinners.

Avocado-Soybean Unsaponifiables. Avocado-soybean unsaponifiables (ASU) is a natural vegetable extract made from one-third avocado oil and two-thirds soybean oil. Preliminary evidence suggests that ASU may have a modest beneficial effect on OA symptoms.

SAMe. S-Adenosyl-L-methionine, or SAMe, is categorized as a dietary supplement in the United States, but it is considered a drug in much of Europe. Results of research on SAMe for OA are mixed. In general, studies that compared SAMe with NSAIDs showed that each provided a similar degree of pain relief and improved joint function, with fewer side effects in people taking SAMe. However, other studies have shown no such benefits from SAMe.

Magnet Therapy

Magnet manufacturers claim their products are effective in treating fibromyalgia, back pain, headaches, neck pain, knee pain, and foot pain, but the science to prove these claims does not exist.

Magnet use in specific populations (people with polio, degenerative knee pain, or diabetes, and women with low back pain) has shown the treatment to be therapeutic. Other studies have shown no benefit, however, and it may be that positive findings are a result of the placebo effect (a phenomenon in which people respond positively to a placebo due to a psychological benefit).

No research specifies how strong the magnets should be, how long they should be applied, whether they could be harmful, or exactly how they work.

Massage Therapy

According to the American Massage Therapy Association, therapeutic massage promotes health and well-being by way of soft tissue manipulation and movement of the body. Massage can reduce pain, boost circulation, reduce muscle tension, and improve a joint’s range of motion. However, it can’t cure or reverse the course of any disease.

Research suggests that massage therapy may result in significantly less pain, anxiety, and depression among fibromyalgia patients. It also may reduce pain, improve function, and increase flexibility in patients with knee OA (see “Massage May Provide Short-Term Improvement in Knee Osteoarthritis”).

Other trials have suggested that massage might be helpful in treating low back pain. However, it also appears that these effects are short term and that people need to keep getting massages for the benefits to continue.

Medical Marijuana

Medical marijuana is administered in various forms: as an oil, transdermal patch, pill, vaporized liquid, nasal spray, dried leaves and buds, and the plant itself.

The primary active component of marijuana is a compound called delta-9-tetrahydrocannabinol (THC). THC is responsible for marijuana’s psychoactive effects; it stimulates the release of a “feel-good” brain chemical called dopamine. It also may decrease pain and inflammation. Cannabidiol (CBD), which is another component of marijuana, is non-psychoactive and also may have pain-relieving and inflammation-reducing effects.

Medical marijuana is being studied as a treatment for several health conditions, including arthritis pain. A 2018 study in the journal Pain found that people with chronic pain who used marijuana reported health benefits including improved pain management and sleep. A study published in the European Journal of Internal Medicine found that marijuana therapy was safe and effective, particularly for neuropathic (nerve) pain. A 2019 study published in Cannabis and Cannabinoid Research used simulated data to conclude that marijuana appears to be a cost-effective option for treating several medical conditions, including neuropathic pain.

The FDA is aware of considerable interest in using marijuana to treat a number of medical conditions, including some forms of arthritis. However, as of July 2019, the FDA had not approved marijuana as a safe and effective drug for treating pain. Bottom line: Multiple studies suggest that medical marijuana has benefits when it comes to relieving neuropathic pain, but there is very little evidence supporting its use specifically for arthritis or arthritis pain.

Mindfulness Meditation

Mindfulness meditation is increasingly used for arthritis pain. Mindfulness means paying attention to the moment at hand without judging or interpreting it. Acquiring this skill may help you purposefully avoid dwelling on the negative aspects of your life, including your arthritis pain. Training yourself to choose how you respond to the pain can help give you back the sense of control you may have lost when it comes to your health.

In a study funded by the NCCIH, adults with chronic low back pain received mindfulness-based stress reduction (MBSR) training, cognitive behavioral therapy, or “usual care” (painkillers and stretching exercises). At the end of one year, 60 percent of participants who attended MSBR sessions and 58 percent of those who received cognitive behavioral therapy reported a “meaningful” improvement in their back pain and function, compared with 44 percent of people who received usual care.

Reiki

As with acupuncture, reiki—which originated in Japan in the 1800s—is based on the idea that an unseen “life force energy” flows through us, giving us life and healing what ails us. But if that life force is blocked, the resulting imbalance may impact physical and emotional health. A reiki practitioner attempts to correct this underlying imbalance and restore the flow of energy by simply placing his or her hands on or over the recipient.

A reiki session lasts about one hour, and proponents report that it leaves them feeling relaxed. While there isn’t much solid evidence for its effectiveness, some research suggests that reiki may be helpful for increasing a person’s sense of well-being while reducing stress levels. The take-home message is that it probably won’t hurt but is not likely to help.

Spinal Manipulation

Between 8 and 14 percent of Americans use spinal manipulation for low back pain caused by arthritis and other conditions. A 2017 review suggests that the therapy can provide modest pain relief, and the American College of Physicians includes the practice in its recommendations for non-drug pain relief.

Chiropractors, osteopaths, naturopaths, and some medical doctors practice spinal manipulation. It involves applying controlled force to specific joints in the spine, with the aim of restoring spinal alignment, improving function, and relieving pain.

Spinal manipulation is relatively safe when performed by a licensed practitioner, but you may experience side effects, such as mild tiredness and temporary soreness. Consult your doctor before undergoing spinal manipulation if you suffer from severe pain, nerve involvement, a herniated spinal disc, osteoporosis, or significant bony abnormalities.

Tai Chi

Tai chi combines relaxation, meditation, and deep breathing with slow, gentle, continuous, and structured exercises called forms. “Standing, graceful postures,” “achieving harmony between body and mind,” and “meditation in motion” are some of the phrases used to describe tai chi movements.

The NCCIH offers a cautiously optimistic summary of tai chi research. Tai chi may improve balance and stability in older people, reduce pain from knee OA, and help people cope with fibromyalgia and back pain. Tai chi is especially effective in older adults because it can be practiced at different intensity levels.

Indirectly, exercise of any kind seems to reduce pain, so tai chi qualifies in that respect. However, anyone who has acute chest pain with minimal exertion, severe shortness of breath, dizziness or fainting spells, or uncontrolled blood pressure should seek the advice of a physician before starting tai chi, as should people who have osteoporosis, acute back pain, or active infections.

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) lies somewhere between traditional and alternative medicine.

A TENS device is a small, portable, battery-powered unit with adhesive electrodes that are placed on the skin over the painful area. The unit transmits a mild electrical current through the skin that lasts a fraction of a second, followed by a pause, and then the next wave of current. It can be adjusted to deliver intermittent waves.

Exactly how TENS therapy works is a mystery. It may stimulate the production of substances in the body that diminish pain, or it may simply serve as a distraction from pain.

TENS units are used in clinical settings by physical therapists, but patients can purchase them for home use. There are also over-the-counter TENS devices available without a prescription. Keep in mind that the American Academy of Neurology warns that TENS is ineffective at treating lower back pain that has persisted for three months or longer.

Yoga

Yoga uses movement, meditation, relaxation, and gentle breathing, all of which contribute to a sense of self-awareness. For some people, yoga is more of a spiritual experience that enhances their mood. For others, it’s an alternative exercise that promotes flexibility, strength, and endurance.

An important component of yoga is breathing technique. Specific breathing exercises are thought to serve as mood elevators, as well as tools to calm the central nervous system. At Arizona State University, yoga-type slow breathing techniques reduced pain intensity in women with fibromyalgia.

Under certain conditions, yoga has been shown to relieve pain caused by OA of the hands. Researchers writing in the Journal of Family Practice and Archives of Internal Medicine have highlighted its benefits for back pain, while a study funded by the NCCIH found that it may help relieve low back pain and neck pain. Studies reviewed in the Journal of Evidence-Based Complementary and Alternative Medicine showed that yoga reduced pain and morning stiffness, improved physical function, and was associated with lower levels of depression in people with OA.

The post 10. Complementary and Alternative Treatments for Arthritis appeared first on University Health News.

There also is a connection between diet and OA, but the evidence is not as strong. Food does not cause or cure arthritis, but some foods can trigger symptoms if you suffer from gout, while others may be associated with a greater chance of remission in rheumatoid arthritis (RA).

Four Types of Exercise

The National Library of Medicine recommends flexibility, strengthening, aerobic, and balance exercises for middle-aged and older adults. See the exercise section at the back of this report for examples.

Flexibility

Flexibility exercises consist of stretching movements that improve your range of motion and reduce joint stiffness due to arthritis. Flexibility exercises should be individualized depending on your level of fitness, existing range of motion, overall health status, lifestyle, age, and degree of pain.

Always warm up before stretching. Warming up loosens your muscles and increases blood flow to them, which reduces the risk of injury. Marching on the spot or going for a quick walk before stretching is a good way to warm up.

• Frequency: Daily, but don’t worry if you miss a session or two. Generally, morning is best, since morning stretches will help loosen your muscles and joints for the day ahead.
• Intensity: Stretch until you feel tension or resistance, but not to the point of pain. Hold each stretch for 15 to 30 seconds (or do three 10-second stretches instead).
• Repetitions: Two to three per stretch.
• Stretches per session: At least one for your upper body, one for your lower body, and one for your core (trunk).
• Sample exercises: Overhead reaches for your arms and shoulders, sitting or standing twists for your trunk and upper body.

Strength

Strength training (also known as resistance training) may be the most helpful type of exercise for older adults to perform, although research suggests that many avoid it. Strengthening exercises use the resistance of your own body weight, free weights, exercise bands, or other devices. This more strenuous form of exercise can help prevent muscle atrophy (which is common with age and arthritis) and strengthen muscles. The result: improved muscle tone, joint stability, and function, as well as stronger bones and perhaps less inflammation.

• Frequency: Two to three non-consecutive days per week.
• Intensity: A weight you can lift eight to 12 times with good technique; over time, gradually increase the resistance (amount of weight) or number of repetitions.
•   Repetitions: One at the beginning; two to three later.
• Lifts per session: At least one to two for your upper body, and one to two for your lower body and/or core.
• Sample exercises: Shoulder shrugs, bicep curls, partial wall squats, push-ups, heel raises.

Aerobic

The goal of aerobic (endurance) exercise is to make your heart beat faster than it normally does—within a safe range—for extended periods of time. It improves heart health, lung capacity, muscle health, metabolism, mental health, sleep, and general health.

• Frequency: At least five days a week, for 30 to 50 minutes per day.
• Intensity: Aerobic exercise should be challenging enough to elevate your heart rate into its target zone.
• Repetitions: If you would rather not exercise for an extended period of time, it’s fine to break up your aerobic exercise into smaller time segments.
• Sample exercises: Walking, swimming, water aerobics, cycling, aerobic dance, elliptical trainers.

Balance

These exercises improve posture, coordination, and mobility, and can help prevent falls. All are beneficial to people with arthritis. If you are concerned about falling while doing balance exercises, rest your hand on a wall or sturdy chair until you feel steady.

• Frequency: Daily, several times a day— even a few minutes at a time will help your balance.
• Intensity: Intensity is not a requirement, but you can make the exercises challenging by aiming to hold your position for slightly longer each time.
• Repetitions: Your call.
• Sample exercises: Tai chi, yoga, stork stand, single leg stand, sit-to-stand, heel-to-toe walking.

Getting Started

If you have pre-existing medical problems, have recently undergone surgery (including joint surgery or replacement), or have significant arthritis, ask your doctor or physical therapist for advice regarding appropriate exercises and which ones to avoid.

At the local gym or YMCA, look for special classes for people with arthritis and/or back pain. They will be gentler and may include varying levels of activity. As a general rule, if an exercise hurts, stop. You are either executing the exercise incorrectly or doing an exercise that is not suitable for you.

• Water exercise is a relatively safe way to get started. Types of water exercise include swimming, water walking, and aerobic aquatic programs. These are low-impact options that minimize the risk of injury; in addition, warm water is very soothing for painful joints.
• Social exercise. If you’re struggling with motivation, try a social form of exercise—the Arthritis Foundation recommends sports such as bocce ball, golf, and shuffleboard.
• Walking is a great form of exercise that may help people with OA retain function (see “Weekly Walking Helps Prevent Osteoarthritis Disability”). Outdoor walking has the added advantage of providing fresh air and a natural dose of vitamin D—plus, it also can be a social activity if you walk with a friend or in a group.

Be wary of uneven surfaces and slippery or steep slopes, and consider using a walking stick or poles to improve your stability. Gentle walking is considered mild aerobic exercise and it may not raise your heart rate significantly. Walking faster, on an incline, or while wearing wrist or ankle weights will increase the intensity of the exercise.

Physical Therapy

Physical therapists are experts in musculoskeletal system function, so consulting one may be very beneficial. During the assessment, the therapist will determine your level of function and range of motion. If you are a good candidate for physical therapy, you may be prescribed a course of individual or group therapy and/or exercises you can do at home.

A physical therapist will teach you:

• Exercises to strengthen muscles and improve range of motion and function of your joints.
• Strategies for reducing your pain and swelling.
• How to exercise safely without injuring your joints and/or making your arthritis worse.
• How to safely move from one position to another or perform certain tasks.
• Ways to adapt your activity to protect your joints.
• Correct posture that keeps your joints in a good position and helps prevent further damage.
• How to use assistive devices such as walking aids, splints, and shoe inserts that can help align and support the structures of the foot.
• How to prepare for joint surgery and recover your joint function following surgery.
• The effective use of hot and cold therapies to ease pain and swelling.

Occupational Therapy

An occupational therapist can show you strategies that compensate for the limited function and joint weakness that can result from arthritis.

Your therapist will teach you techniques that increase your endurance and also may show you how to use adaptive equipment. For example, splints can be useful for arthritis in the hands—they help stabilize or support weak or unstable joints, and reduce the strain on joints by immobilizing them.

Other assistive devices used in arthritis can conserve your energy and help you maintain your mobility and independence. Examples include equipment designed to assist with walking, driving, eating, and maneuvering into and out of a chair, shower, bath, or car.

An occupational therapist can help you:

• Learn how to protect your joints, with techniques such as exercises or activity adaptations to reduce strain on your joints.
• Modify your home and work environment as needed.
• Utilize assistive devices that help you manage everyday life.
• Choose a chair and/or mattress that helps to alleviate back pain.
• Regain function after surgery.
• Conserve your energy using rest periods and adaptations.

The Role of Nutrition

There is limited research on direct links between diet and arthritis. However, there are some specific concerns about the effect of certain foods on OA, RA, gout, and fibromyalgia.

Osteoarthritis

A poor diet impacts OA risk and symptoms mainly by promoting weight gain—the more you weigh, the more pressure is put on your joints. Unfortunately, people with arthritis often find it difficult to maintain a normal weight because they are not able to stay as active as they would like. However, you don’t have to shed many pounds to benefit—
losing as little as 5 percent of your body weight can improve joint pain and function. Slow, steady weight loss of one to two pounds a week is more sustainable than rapid weight loss achieved through “crash” diets.

Some studies implicate a high intake of fiber with less pain in knee OA, although the link may be influenced by the fact that fiber increases the feeling of fullness after a meal. People who consume more fiber may feel less need to eat large meals or snack between meals, and this limits their weight gain. Other research suggests that a low-carbohydrate diet may benefit knee OA (see “Low-Carbohydrate Diet Helps Knee Osteoarthritis”).

Other research associates a high intake of saturated fat (found in red and processed meat, and full-fat dairy products) with decreased joint space (an indicator of how much cartilage remains in a joint) and weaker cartilage.

Rheumatoid Arthritis

A 2017 study found that a high daily intake of monounsaturated fatty acids (found in nuts, vegetable oils, peanut butter, and avocados) doubled the chance of remission in RA and was associated with a significant decline in the participants’ erythrocyte sedimentation rates (a key marker of inflammation).

Harvard researchers reviewed data on more than 1,000 women and concluded that a healthier diet was associated with a reduced risk of RA in those age 55 and younger. Another study looked at diet quality, disease activity, and ability to function in people with RA. Only 7.1 percent of the participants ate a diet that was categorized as “good,” while 58.3 percent ate a diet that was “fair,” and 34.5 percent ate a diet that was “poor.” The results showed an inverse relationship between diet quality and two problems: morning stiffness and levels of C-reactive protein (an inflammatory marker).

Gout

There is substantial evidence of an association between gout and purine-rich foods. Those foods include red meat, seafood, liver, alcohol, and soft drinks.

Fibromyalgia

Research does not establish a clear link between diet and fibromyalgia, but it suggests that certain foods may trigger episodes. The triggers are not the same for everyone. The list of foods includes refined carbohydrates (for example, white bread, pasta and rice; cakes; pastries), fried foods, red meat, processed foods, caffeine, and alcohol.

Focus on the Benefits of a Better Diet

A more healthful diet may help alleviate your arthritis symptoms, but if you think you might struggle with extensive modifications to your eating habits, begin with small changes. Start by adding a plate of green salad to your dinner, and schedule “meat-free Mondays,” when your main protein source is legumes or fish. If you aren’t a fan of fish, you might be swayed by research suggesting that eating fish two or more times per week is associated with lower disease activity in people with RA.

Also think about what might be stopping you from eating better. For example, cost and convenience prevent many people from switching to a healthier diet—often it is cheaper and easier to buy and prepare processed foods instead of fresh foods. Weigh these conveniences, however, against the costs of arthritis. The CDC estimates that the annual direct medical costs of arthritis are at least $140 billion—plus there are the considerable human costs of pain, disability, reduced quality of life, and lost leisure opportunities.

It also is vital to listen to your body. If a particular food makes your joint pain worse or makes you feel exhausted, it probably is not good for you.

To reduce your risk of chronic disease, and to feel more healthy and energetic:

• Increase your intake of fresh vegetables and fruits, healthy proteins (chicken, fish, seeds, and nuts), whole grains, and healthy fats (nuts, fish oil, olive oil). Consider taking a fish oil supplement, but check with your doctor first.
• Decrease your intake of processed foods, refined sugar, dairy, and red meat. Avoid foods containing high-fructose corn syrup and trans fats.
• Avoid foods that may worsen arthritis. Some people are sensitive to the nightshade family of foods, which includes potatoes, eggplant, tomatoes, and green peppers. Sensitive individuals may notice that they experience a flare-up or feel unwell after eating these foods. If you have inflammatory arthritis, it may be worth eliminating these foods from your diet before slowly reintroducing them to see if they aggravate your symptoms.

Hydrate for Healthier Cells

Good hydration reduces inflammation and keeps cells healthy. Dehydration may cause cartilage to dry out and become fragile, especially if you’re overweight. Gout flare-ups are often linked to dehydration.

The National Academies of Sciences, Engineering, and Medicine recommend a daily fluid intake of about 15.5 cups (3.7 liters) for men and about 11.5 cups (2.7 liters) for women. This may seem like a lot, but it includes fluids from water, other beverages, and food. About 20 percent of daily fluid intake usually comes from food; the rest comes from drinks.

Be Cautious About Alcohol

Some research suggests that alcohol in moderation has an anti-inflammatory effect and may reduce the risk of developing RA. The sweet spot for prevention is 5 to 10 grams of alcohol (that’s one small glass of wine or beer each day). This advice is not for everyone, however—some people with RA find that drinking certain alcoholic beverages triggers a flare-up.

Alcohol and pain-relieving medications do not mix well. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), are associated with an increased risk of ulcers and gastrointestinal bleeding—a risk that significantly increases when NSAIDs are combined with alcohol.

Drink while taking acetaminophen (Tylenol), methotrexate (Rheumatrex, Trexall), and/or leflunomide (Arava), and you’ll increase your risk of liver damage. Excessive alcohol intake also increases the chance of falls and fractures.

People with gout need to be cautious when drinking alcohol. Beer in particular increases the risk of uric acid buildup, gout flare-ups, and permanent joint damage due to gout.

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Fibromyalgia

Fibromyalgia affects up to 10 million Americans, according to the National Fibromyalgia Association. The condition causes tender spots in specific areas of the body that can be especially painful to pressure or touch. Exactly what causes fibromyalgia is unknown, but some studies show that genetic factors may predispose certain individuals to the condition. New evidence also suggests that fibromyalgia is related to how the body processes pain. Over time, the condition may cause the brain to become oversensitive to pain that most people would consider relatively minor. However, the pain that people with fibromyalgia experience is not imaginary—it’s real.

Fibromyalgia Risk Factors

Fibromyalgia usually develops between ages 35 and 60 and is more common in women than in men. People with RA, lupus, and spinal arthritis are more likely to develop fibromyalgia than people without these conditions. Fibromyalgia also has been associated with physically or emotionally stressful events, such as car accidents and illness.

Fibromyalgia Symptoms

Fibromyalgia is characterized by widespread muscle pain and multiple tender points on the neck, shoulders, back, hips, and extremities. The tender spots vary day to day in severity—one day they can be more severe in the shoulders; another day more severe in the lower back and legs. Joint stiffness also may occur, especially in the morning, and numbness or tingling may affect the extremities.

Many people with fibromyalgia find that the pain interferes with their sleep. More than 75 percent of people with fibromyalgia also report chronic fatigue as a major symptom, according to the Johns Hopkins Arthritis Center.

In addition to pain and fatigue, other symptoms of fibromyalgia include headaches, dizziness, memory problems (referred to as “fibro fog”), painful menstruation, and depression.

Diagnosing Fibromyalgia

Since the symptoms of fibromyalgia are vague and occur with other health conditions, it can be difficult to diagnose the condition (see “Fibromyalgia May be Misdiagnosed in Many Patients”). However, researchers recently reported success in detecting fibromyalgia through a blood test (see “Experimental Blood Test Detects Fibromyalgia”).

At one point, doctors relied on the presence of tender points to guide their diagnosis, but the American College of Rheumatology now recommends consideration of three criteria:

• Pain and symptoms over the previous week, based on the total number of painful areas out of 19 parts of the body, plus the level of severity of fatigue, waking feeling unrefreshed, memory problems (such as misplacing objects), and the number of other general physical symptoms.
• Symptom duration. Symptoms must have lasted for at least three months at a similar level.
• No alternatives. There should be no other health problem that might be causing the symptoms.

Fibromyalgia Treatment

People with fibromyalgia typically see several doctors before getting a diagnosis. Once the condition has been identified, a team approach (doctor, pharmacist, physical therapist, and other specialists) seems to work best. Treatment typically involves pain-relieving medications, but exercise and complementary therapies also have benefits.

Nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn), are not particularly good at easing fibromyalgia pain when taken alone. Drugs that target neuropathic pain are more effective, and the U.S. Food and Drug Administration (FDA) has approved three—the antidepressants duloxetine (Cymbalta) and milnacipran (Savella), and the anticonvulsive drug pregabalin (Lyrica)—for treating fibromyalgia. These medications relieve fibromyalgia symptoms by inhibiting the activity of nerve cells involved in the transmission of pain, and research suggests that they improve physical function and overall quality of life in people with fibromyalgia.

Metformin (Glucophage), a drug normally used to treat type 2 diabetes, also has shown some success in reducing fibromyalgia pain (see “Diabetes Drug May Ease Fibromyalgia Pain”).

While your symptoms may put you off physical activity, exercise may help. It is advisable to stick to low-impact options, since these are less likely to aggravate muscle discomfort than high-impact exercise. One you may want to try is the ancient Chinese martial art, tai chi. In a small 2018 study, people with fibromyalgia who engaged in twice-weekly tai chi sessions across a period of 24 weeks reported less pain than those who took part in aerobics sessions.

As well as being low impact, tai chi is a “mind-body” exercise that focuses on deep breathing and relaxation. Its meditative component means that it may help alleviate the stress and anxiety that accompany fibromyalgia. Other low-impact exercise options include walking, cycling, swimming, and yoga.

Complementary and alternative therapies, such as massage, chiropractic, acupuncture, and dietary supplements, also produce varying degrees of success at relieving fibromyalgia symptoms (see Chapter 10 for more on these). Getting adequate, quality sleep can improve the symptoms of pain and fatigue.

Lupus

Lupus (systemic lupus erythematosus) is an autoimmune disease. It can cause inflammation in any organ or system but most commonly affects the skin, hair, mouth, joints, kidneys, blood, brain, heart, and lungs.

Lupus Risk Factors

Multiple factors are implicated in lupus, among them hormonal imbalances, mental health problems, ethnicity, genetics, viruses, and environmental toxins.

• Hormones. About 90 percent of people with lupus are women.
• Environmental toxins. Cigarette smoke and mercury exposure have been linked to lupus.
• Race. People who have African, Asian, and/or Native American heritage are at increased risk for developing lupus.
• Genes. About 10 percent of people who suffer from lupus have a parent or sibling with the condition.
• Viruses. Varicella zoster, which causes shingles, and cytomegalovirus (a type of herpes virus) increase lupus risk.
• Depression. Research points to possible links between lupus and depression.

Lupus Symptoms

Initial lupus symptoms include feeling generally unwell, with fever, weight loss, and fatigue. A butterfly-shaped rash on the face also is typical. Thickened red circular skin lesions may occur elsewhere on the skin and are aggravated by sunlight.

Other symptoms include stiff, painful joints, easy bruising, and mouth sores. More serious symptoms include anemia, kidney damage and failure, blood clots, inflammation in the heart and/or lungs, confusion, and depression.

Diagnosing Lupus

There is no definitive test for lupus, but an experienced rheumatologist may be able to diagnose the condition based on your symptoms and exclusion of other rheumatic diseases. Your doctor also may carry out these diagnostic tests:

• Blood tests. Antinuclear antibody and autoantibody tests may be positive. A complete blood count may reveal low levels of red and white blood cells. Your kidney and liver function also will be checked.
• Urinalysis. This may reveal kidney involvement.
• Imaging tests. A chest x-ray can reveal whether fluid is building up in your lungs due to lupus.
• Other procedures. Arthrocentesis, lumbar puncture (which uses a needle to remove a sample of the fluid that surrounds the spinal cord and brain), and a kidney biopsy may be necessary.

Treating Lupus

Treatment for lupus varies according to the pattern of disease. Protocols may include the use of NSAIDs or antimalarials like hydroxychloroquine (Plaquenil), which reduces the risk of flare-ups. Keeping your doctor informed about how your symptoms are manifesting will help you both ensure that your treatment regimen is keeping pace with your needs (see “Reporting Lupus Symptoms in Real Time”).

If lupus is resistant to treatment, your doctor may prescribe corticosteroids, such as prednisone (Deltasone, Sterapred); disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex, Trexall); or biologics, such as rituximab (Rituxan) or abatacept (Orencia). A recent study suggests that the biologic drug ustekinumab (Stelara), which is approved to treat psoriasis, psoriatic arthritis, and Crohn’s disease, may ease lupus flare-ups (see “Ustekinumab Shows Promise for Lupus”).

Psoriatic Arthritis

About 5 percent of people with the skin condition psoriasis develop psoriatic arthritis. In 60 to 80 percent of psoriasis sufferers, arthritis develops after the skin condition, but occasionally arthritis appears first, or they occur simultaneously. Psoriatic arthritis can affect any joint in the body and may affect multiple joints.

Psoriatic Arthritis Risk Factors

The main risk factor for psoriatic arthritis is psoriasis, an autoimmune condition that causes skin cells to build up and form scaly, sore patches. People with psoriasis who develop the condition on their fingernails are more susceptible to psoriatic arthritis.

Other risk factors for psoriatic arthritis include:

• Genetics. About 40 percent of people with psoriatic arthritis have a first-degree relative with the condition. Multiple genetic variations associated with psoriatic arthritis have been identified, most notable of which are human leukocyte antigen (HLA) and interleukin genes.
• Infections. In some cases, a viral or bacterial infection precedes the development of psoriatic arthritis. Individuals with human immunodeficiency virus (HIV) are at greater risk.

Psoriatic Arthritis Symptoms

Psoriatic arthritis symptom severity is variable, and progression may involve flare-ups and periods of remission. Prominent symptoms include joint pain, stiffness, and swelling of two to four joints in any part of the body, including the fingertips and spine. Inflammation occurs at tendon or ligament insertions into bone, most commonly in the Achilles tendon and plantar fascia (fibrous tissue along the sole of the foot that connects your heels to your toes).

Other psoriatic arthritis symptoms include dactylitis, which causes the fingers to become swollen (this develops in up to 35 percent of people with psoriatic arthritis). Red, scaly lesions also are common and may itch and ooze pus. Eye lesions occur in 30 percent of people with psoriatic arthritis, and pink eye (also known as conjunctivitis) is another potential symptom.

Diagnosing Psoriatic Arthritis

There is no definitive test for psoriatic arthritis, but your doctor can use the following testing methods:

• Blood tests. These will check your erythrocyte sedimentation rate (ESR) to determine the presence of inflammation. Levels of C-reactive protein (CRP) and immunoglobulin-A may be abnormally high.
• Imaging tests. X-rays may detect a specific pattern of joint change, while magnetic resonance imaging (MRI) can detect sacroiliac joint involvement.
• Arthrocentesis. In psoriatic arthritis, joint fluid usually contains an elevated number of white blood cells.

Psoriatic Arthritis Treatment

Medical treatment regimens for psoriatic arthritis are similar to those used for RA, and include the use of NSAIDs and DMARDs.

Some research suggests that a low-calorie and/or low-gluten diet may be beneficial. Other treatment options, such as physical therapy, may alleviate symptoms. A European study determined that being overweight is associated with psoriatic arthritis severity, which suggests that lifestyle approaches may be appropriate in managing the condition (see “Weight Associated with Greater Psoriatic Arthritis Severity”).

Surgical treatment is occasionally required when joint damage is severe.

Reactive Arthritis

Reactive arthritis (ReA) is an autoimmune disease triggered by generalized infection. It usually resolves in three to 12 months, but recurrence is seen in 15 to 50 percent of cases. It is sometimes triggered by stress or a new infection. Up to 30 percent of people with ReA develop chronic, destructive arthritis.

Reactive Arthritis Risk Factors

ReA most commonly develops from gastrointestinal infections, such as Salmonella enterica, Shigella, and Campylobacter, and sexually transmitted infections, such as Chlamydia trachomatis.

Other risk factors include:

• Gender. Although it isn’t clear why, men are more likely than women to develop ReA after having a sexually transmitted infection.
• Genetics. While there is a specific genetic marker associated with ReA, most people who have the marker don’t develop the disease.

Reactive Arthritis Symptoms

ReA symptoms usually develop within a month of exposure to the bacteria. The most prominent symptoms—known as the “triad of ReA”—are inflammation of the urethra (the tube through which urine exits the body) that makes urination painful, asymmetrical joint pain (most commonly in the legs, fingers, and sacroiliac joints), and conjunctivitis. Other symptoms include fatigue, fever, a skin rash, and swollen fingers.

Diagnosing Reactive Arthritis

It is important to accurately identify ReA, since some medications are not suitable for people with the condition. Blood tests, imaging, and arthrocentesis may aid in the diagnosis.

• Blood tests. Your blood will be checked for signs of a previous infection that might have triggered ReA and for antibodies that might indicate inflammation or a genetic marker linked to ReA.
• X-rays may reveal signs of ReA or point to another type of arthritis.
• Arthrocentesis. A sample of synovial fluid will be examined for markers that might indicate another condition—for example, uric acid or calcium pyrophosphate (CPP) crystals may signal gout or pseudogout (see Chapter 5 for more on these).

Reactive Arthritis Treatment

ReA management is medical. It involves a combination of NSAIDs, corticosteroids (oral, topical, and injectable), and antibiotics that target the confirmed or suspected primary infection.

Septic Arthritis

Septic arthritis—also called infectious arthritis—is an infection within the joint cavity. Septic arthritis commonly occurs as arthritis in one joint (monoarthritis), and it involves the knee joint in 50 percent of cases.

The joint cavity is a sealed, sterile space, but in septic arthritis, bacteria from nearby soft tissue spread to the joint via the bloodstream. Once introduced to the joint, the infectious agent causes a cascade of inflammation and hyperplasia (overgrowth) of the synovial membrane. Inflammatory proteins are released, destroying the cartilage and, eventually, the bone. Excess synovial fluid also is released, and this results in significant swelling. Eventually, the blood supply to the bone may be impaired, leading to aseptic necrosis (bone death due to lack of blood).

Significant destruction of the joint may occur in as little as three days, and septic arthritis also raises the risk of death. For this reason, septic arthritis is considered a medical emergency.

Septic Arthritis Risk Factors

In most cases, the infection underlying septic arthritis is caused by a single bacterial pathogen. Staphylococcus aureus (a skin bacteria) is implicated in nearly half of cases. Other causes of septic arthritis include skin and genitourinary tract infections, Lyme disease, fungi, and tuberculosis. Additional risk factors include:

• Age. About 45 percent of cases occur in people age 65 and older.
• Joint injections, surgeries, or procedures. These involve entering or opening the joint space and run the risk of introducing bacteria (often from the skin) into the joint. The incidence of septic arthritis following joint replacement is between 2 and 10 percent. Infection of a prosthetic joint may occur in the weeks or months following surgery, and the joint remains at elevated risk of infection.
• Damaged joints due to trauma and/or medical conditions like gout, lupus, and RA (the incidence of septic arthritis is seven times higher in people with RA).
• Immunosuppression. Septic arthritis is more common in people with HIV and in those receiving immunosuppressive therapy for cancer or autoimmune diseases, including RA.
• Recreational drug users. Drug users who inject with non-sterile needles may introduce bacteria into their bloodstream that then spread to the joint.

Septic Arthritis Symptoms

Septic arthritis usually presents with a single swollen, painful joint that feels hot to the touch. Common sites include the knees, wrists, ankles, and hips. The joint usually will be stiff, with a reduced range of motion. In up to 19 percent of patients, more than one joint is affected.

Other symptoms include low-grade fever, which occurs in 20 percent of cases, bursitis (inflammation of the fluid-filled sacs that cushion joints), and swellings behind the knee (called Baker’s cysts). If septic arthritis occurs after joint replacement, a sinus tract (a channel between the joint and the skin) may develop and leak infected fluid.

Diagnosing Septic Arthritis

Several conditions mimic septic arthritis, including RA, gout, pseudogout, Lyme disease, and ReA. Your doctor will likely rule out these conditions with the following tests:

•  Blood tests. In septic arthritis, your white blood cells and ESR may be high.
• Imaging. X-rays can help your doctor monitor the progression of joint damage in septic arthritis.
• Arthrocentesis. Synovial fluid will be examined for bacteria and white blood cells that may indicate an infection, and for uric acid or CPP crystals that may indicate gout or pseudogout. A new technique may provide faster results than standard synovial fluid screening (see “mPCR Technique May Rapidly Diagnose Septic Arthritis”). If there are no crystals and infection screening is negative, a biopsy of the synovial membrane may be needed.

Septic Arthritis Treatment

A hospital stay of several days is usually required with septic arthritis. Treatment involves a three-pronged approach: drainage of the infected synovial fluid, treatment of the underlying infection, and immobilization of the joint. These strategies will be followed by physical therapy to rehabilitate the joint.

Drainage of the synovial fluid will likely involve needle aspiration two to three times per day for the first few days. Surgical or arthroscopic drainage and debridement (cleaning away debris in the joint) may be needed if the infection is resistant to antibiotic therapy, if there is soft tissue involvement, or if the infection is in a difficult-to-reach joint, such as the hip, shoulder, or sacroiliac joint.

Prompt treatment of the underlying infection is essential. Laboratory testing will guide treatment, but antibiotics will be prescribed on a best-guess basis until your lab results are received. If a bacterial infection is confirmed, antibiotics will be administered via an IV or central line for at least two weeks.

Joint immobilization with splints is required for at least five days. If there is a good response to treatment, gentle mobilization by a physical therapist may begin, followed by intensive physical therapy for several weeks.

If septic arthritis is linked to a prosthetic joint, the implant may need to be removed. A new joint will be inserted either immediately (which has a success rate of 39 to 91 percent) or later, when the infection has been completely controlled (this option has a greater success rate: 73 to 100 percent).

Ankylosing Spondylitis

The Arthritis Foundation defines spondyloarthritis as a general term for inflammatory diseases that involve the joints and the sites where ligaments and tendons attach to the bone. The most common of these diseases is ankylosing spondylitis, a chronic inflammatory condition that affects the vertebrae in the upper and lower spine and the sacroiliac joints. Over time, ankylosing spondylitis can cause the vertebrae to fuse, resulting in a hunched posture.

Ankylosing Spondylitis Risk Factors

Most people with ankylosing spondylitis share a common genetic marker called HLA-B27. This gene increases in incidence with distance from the equator. While 8 percent of the general population carry it, only 1 percent of HLA-B27-
positive individuals develop ankylosing spondylitis. The risk increases to 15 to 20 percent if a first-degree relative with ankylosing spondylitis carries the gene. Other risk factors include:

• Age. Onset is most common between the late teens and early 40s, but due to its slow onset, ankylosing spondylitis may go undiagnosed for some time.
• Gender. Men are more likely than women to develop ankylosing spondylitis, and the condition also tends to be more severe in men.
• Infection. There is evidence that the bacteria Klebsiella pneumoniae may trigger ankylosing spondylitis in people with the HLA-B27 gene.

Ankylosing Spondylitis Symptoms

Key features of ankylosing spondylitis include low back pain of slow, insidious onset, lasting more than three months. The pain is worse on waking or after a period of inactivity but is relieved by exercise. The spine will feel stiff, and some degree of kyphosis (“hunchback”) may develop. Other symptoms include inflammation in the hands and feet, fatigue, fragile vertebrae that are more likely to fracture, and extra-articular inflammation in the eyes, heart, aorta (the main artery that supplies oxygenated blood from the heart to the body), kidneys, lungs, nervous system, and gastrointestinal tract.

Diagnosing Ankylosing Spondylitis

Your doctor will perform a physical examination to check the flexibility of your spine. He or she also may order blood tests and imaging.

• Blood tests will check for inflammatory markers, including elevated ESR and CRP, as well as the HLA-B27 gene (keep in mind that having the gene does not necessarily indicate that you have ankylosing spondylitis).
• Imaging. X-rays may show inflammatory changes and erosion in the sacroiliac joints and spine. MRI and computed tomography scans may reveal early disease.

Ankylosing Spondylitis Treatment

Drug treatment for ankylosing spondylitis includes NSAIDs, corticosteroids, DMARDs, and biologics. The latter especially may help you live better with ankylosing spondylitis (see “Biologic Drug Eases Pain, Improves Quality of Life in People with Ankylosing Spondylitis”).

Physical therapy and range-of-motion exercises can improve strength and flexibility in your spine, while exercises that target the abdominal muscles can help with maintaining good posture. Some people have reported symptom relief from spinal manipulation.

Lifestyle changes, such as stopping smoking and staying physically active, may slow the progression of ankylosing spondylitis, ease its symptoms, and reduce your risk of complications from the condition. Surgery may be needed to fuse spinal vertebrae, stabilize fractures, and/or replace hip joints.

Your doctor may suggest genetic counseling to discuss the risk of passing on ankylosing spondylitis to any children you may have.

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