1. This program is for Osteoarthritis. There are many types of arthritis, and the following treatments do not apply to all of them.
2. This program is designed to reinforce and clarify some of the information given to you during your visit in the office.
3. If you have a history of heart or lung disease do not start an exercise program without first consulting with the physician that cares for these problems.
4. We generally try to progress from the top of the list and work down. If you have already tried the things at the top of the list then you may be starting further down the list.
5. These treatments are written with the hip and knee particularly in mind. They may apply to other joints to some degree, but probably not as well.

This is probably self-evident. But you may not be aware that due to the mechanics of the hip and knee, every pound that your hip or knee has to carry translates into as much as four to seven pounds of pressure on the cartilage of the joint. The more weight on the cartilage the faster it wears out. To make a comparison, this is just like the tires on a car, which wear faster with a heavy load. Losing weight is not only good for your joint but, at least as importantly, good for your overall health.

Unfortunately, don't look to me for any easy answers to this problem. As a general rule, fad diets don't work, and any long lasting weight reduction will take a permanent change in activities and diet. Once again consult your primary care physician before starting an aggressive exercise program.

Exercises

This might sound kind of crazy, and you might be saying "my knees hurt so bad that I can't exercise", but exercising can actually help the cartilage in the joints. Also we know that exercise is important for your general health, the strength of the bones, and for losing weight. The question then becomes not so much whether or not to exercise, but what kind of exercise is best. Generally exercises for people with osteoarthritis should be low impact and repetitive.

Water:
Without a doubt the best exercise for patients with arthritis of the hip and knee. This is like an instant weight loss program and your joints love it. There are several pools in the area with arthritis classes. They are all heated, and don't think that you are the only one that hasn't put on a bathing suit in years. Consult your local Arthritis Foundation for locations and programs near you.

Bicycle riding:
Bicycle riding is often very therapeutic for arthritis. Most of the weight during bicycle riding is put on the seat so the knees and hips get moving pretty fast with little pressure on them.

We generally recommend stationary bicycle riding until you have little or no pain. Riding on the street is not as safe as stationary riding (particularly if you are thinking about your hurt knee), and does not always allow the exercise to be stopped if pain develops.
The seat should be set at a height such that you can just touch the pedal with your heel at the down stroke with your knee fully extended. Make the resistance light enough so that you can pedal at 60 to 90 revolutions per minute for 20 to 30 minutes without pain.

Walking:
Walking is an excellent exercise that is recommended, if you don't hurt. If your knees or hips hurt when walking, then you should try water exercises or bicycle riding that take the pressure of weight bearing off of your legs.

When walking, start with a short distance (maybe as little as 100 yds) and build up. Use cushioned shoes, of course.

Organized Physical Therapy:
A short course of therapist directed physical therapy can be very helpful, but an extended cource is not usually recommended because of the cost. Exercises for arthritis will need to be continued for a long time and possibly for the rest of your life. A physical therapist can help you develop a plan.

Bracing

Often an elastic wrap around the knee can provide a little support and add warmth to the knee. Some people say that this helps. If you don't mind the inconvenience or the cost it is probably worth a try. Probably an elastic brace or wrap bought over the counter is as good as a prescription model.

There are also some more expensive, prescription braces that may help in special cases. These are generally worth the cost and inconvenience only if you have osteoarthritis that involves just one area of the knee and a dramatically bowed leg. Further, these braces are usually less effective in people that are overweight.

Anti-inflammatory medications:
There are many of these medicines. Many of the ones that have been around for a long time are just as good as the new ones. These medications help most people, at least for a while. Unfortunately the complications with these medications are potentially significant, making the treatment of the disease worse than the disease itself. These complications include, in particular, bleeding, ulcers, liver damage and kidney damage. There have been some advances in the prevention of complications with these medications, but they should all be taken under the direction of a physician if taken for more than a month or so. As with any medicine, check with your physician to make sure that whatever medicine you want to take, even one bought over the counter, does not interfere with another medicine.

Let me say again that these medications do not cure the disease, but they can sometimes be taken and remain effective for years. Generally the risk of complications and side effects increases the longer that you take them.

I usually recommend starting with the cheapest and trying others from there. They can get pretty expensive ($2 / day).

Aspirin: still a good drug but tends to cause ulcers and bleeding

Ibuprofen (Advil, Motrin): probably the best place to start. Cheap, over the counter, about as effective as any of the others, but like all of the anti-inflammatory drugs it can cause the complications described above.

Lodine, Relafen, Feldene, Ansaid, Voltaren, Naprosyn, Anaprox, Dolobid (and some others I probably left out): Each of these may work in some people and not in others. They all have the same potential complications of anti-inflammatory medications.

Cox – 2 inhibitors (Celebrex):

This medication is designed to spare the stomach from the side effects caused from the other medicines. It seem to work about as well at relieving pain as do the anti-inflammatory drugs. Other side effects can still occur (including stomach bleeding). Expensive.

Health foods and Herbs:
The only currently used medicines that I know of that possibly improve the health of the cartilage, rather than just relieving pain, are classified as health food supplements. These are Glucosamine and Chondroitin sulfate. To my knowledge there is no solid evidence that Glucosamine and Chondroitin sulfate actually make new cartilage grow, but they do seem to help most people to some degree. The mechanism for this is uncertain. Although the scientific data that supports these supplements is not as strong as we would like to see, I generally recommend them. They are usually taken together and cost about a dollar a day. I usually recommend that you give it a try for at least a month before giving up on it. They are available at most pharmacies, drug stores, or health food stores. I know of no studies that clearly show one brand to be superior to the other, and the content of the medication is not monitored by the government since they are classified as food supplements and not medications.
There are many other health foods and herbs that may help some people with arthritis feel better. I would refer you to a book named "The Arthritis Foundation's Guide to Alternative Therapies" for more information.

There are basically two types of injections and both involve shots into the joint, cortisone and viscosupplementation (Hyalgan and Synvisc).

Cortisone has gotten a bad name over the last 10 years or so because for a long time it was overused. It is still an excellent drug in the right situations. The cartilage basically becomes less healthy and wears out faster if cortisone is injected into the joint more than 3-4 times a year. If the cartilage has already worn down to bone and the joint is destroyed, cortisone probably won't cause additional damage to the joint. In general, the more severe the arthritis the less likely that a cortisone shot is likely to work. The length of time that a shot will help is difficult to predict and depends on the severity of the arthritis. Some injections may help for years; others may not help at all.