Living with
Arthritis

Bone rubbing on bone is not a good thing! That’s why there is cartilage in the body to prevent this direct bone on
bone contact. Cartilage can become inflamed or break down for a variety of reasons. This leads to  inflammation
of the joints, a condition  called arthritis.
There are many different types of arthritis such as osteoarthritis (degenerative joint disease or “DJD”), crystal
deposit arthritis (pseudogout, gout), autoimmune arthritis (Rheumatoid arthritis, lupus, scleroderma, inflammatory
bowel syndrome, psoriasis, lupus, Scleroderma) and infectious arthritis (Lyme disease, Staph infections, …). In all
cases the cartilage in the joint(s) thins out or becomes inflamed causing pain when it comes in contact with the
surrounding bone. All forms of arthritis cause pain and can eventually lead to joint deformity. Other common
features include:
•        Morning stiffness.
•        Limited motion of the joint.
•        Cold and humidity worsen pain.
•        Tenderness and occasional swelling.
•        Deformity of the joints.
•        Cracking or "creaking" of the joints, usually painless.
•        Disease goes through a relapsing and remitting course but almost never disappears completely.
•        Worsening with age, weight gain, repeated trauma to the involved joint.

Factors specific to arthritis types include:
DJD: Vitamin D deficiency, menopause, repeated minor/sports injuries, running, sleeping on one shoulder.
Crystal deposit arthritis: diet, some medications.
Autoimmune Arthritis:  exacerbations of underlying disease.
Diagnosing the type of arthritis one has can be as simple as examination in the office or may involve sophisticated
immunological testing. Regardless of what type of arthritis one has the principles of therapy are the same.
Conservative therapy
•        Exercise aimed at maintaining joint mobility. Squeezing a ball (hands), stretch bands/gripping both ends of a
towel behind the head (shoulders), flexing and extending knees and hips against mild resistance (lower extremity
joints) strengthen the muscles and cartilages of affected joints.
•        Morning heat therapy: warm packs, hot bath or towel.
•        Avoiding re-injury: arthritic joints are weakened and prone to injury. Although exercise is an essential part of
the therapy it should be picked carefully. For example, jogging is not a good choice for those with hip or knee
arthritis, knitting not a good choice for those with hands arthritis and so on.
•        Avoid immobility of the affected joint for prolonged periods. Stretch out the joint unless in an acute
exacerbation period.
•        Ultrasound, tiger balm (and similar ointments), massage or electrical means for generating heat (TENS) and
maintaining flexibility.
•        Assistive devices such as canes and crutches may help limit weight bearing thus reducing the degree of re-
injury to weight bearing joints.
•         Braces, splints may be helpful by limiting mobility during periods of severe exacerbation. They should not be
used chronically.
•        Reduce stress on weight bearing joints using orthotics, wedged insoles and cushioned shoes redistribute
weight and can.
•        Diet is clearly a factor in the group of crystal deposition arthritis such as gout. Strict dietary avoidance of
foods like meats, gravy and broccoli that contain high levels of purines is the mainstay of therapy (ask us for a
complete list of foods to avoid). In all types of arthritis having natural anti-inflammatory in the diet can help reduce
symptoms. Best sources of natural anti-inflammatories are found in ginger and turmeric.
Medications
•        Anti-inflammatory medications such as motrin can reduce inflammation in and around a joint that sometimes
plays a part in exacerbations.
•        Tylenol and other pain relieving medications can be additive to the above class of medicines and is usually
better tolerated.
•        Capsaicin is a topical medication useful for pain relief.
•        Glucosamine/chondroitin is a good combination for pain relief and may reverse some of the cartilage loss in
those suffering from DJD. Usual dosage is 1500 mg Glucosamine and 12 mg Chondroitin per day. It must be
avoided in those with shellfish allergy.
•        Joint drainage and corticosteroid injections into the joint can be helpful as a temporizing measure in patients
with fluid collection and severe pain during an exacerbation.
•        Hyaluronan injections may help replace the thinning cartilage in patients with DJD.  
•        Opiates and other pain medications can be used in patients with arthritis who do not respond to milder
medications.
•        Specific treatments for crystal and auto-immune arthritis are available. Dietary discretion is usually sufficient
for most cases of gout and chronic medical therapy is usually not required. For autoimmune arthritis, subspecialty
consultation and close medical follow up is often required.
•        Surgery for replacement or repair of the cartilage or replacement of the joint is a last resort and is reserved
for cases that do not respond to any of the therapies outlined above. MRI or other investigations beyond blood
tests and plain X-rays are usually reserved only for patients who are considering surgery or if there is uncertainty
regarding the diagnosis.