Osteoarthritis

Osteoarthritis is a mechanical wear and tear disease of the joints, where the normal cartilage of the joint breaks down and no longer provides a cushion between the bones of the joint. It most affects middle aged to older individuals. While some people do not even know they have osteoarthritis, in others it leads leads to functional disability and pain.

Commonly involved joints include the back, hips, knees and fingers.

We do not have medications which can reverse the osteoarthritis process. Symptom control remains the key objective.

Exercise, muscle strengthening, diet and weight control are all important to control osteoarthritis. Braces for the knee or hand, and walking aids can also be useful. In some instances, these simple steps is all that is required to reduce pain and maintain joint function.

Acetaminophen (Tylenol) is the first choice for pain relief. When used properly, it is an effective and safe option for most patients with osteoarthritis. Follow the directions provided closely and discuss its optimum use with your doctor.

Anti-inflammatories, or NSAIDs, can also be used for pain relief and can be safely used with acetaminophen. However, NSAIDs are not a good option for patients with heartburn, a stomach ulcer, a heart condition or kidney problems.

Glucosamine is a natural product which has been studied to relieve pain and slow the progression in osteoarthritis. While its effects remain unclear when studied, some patients find it effective. It can take 2-3 months to work.

Joint injections, either with corticosteroids or hyaluronic acid, are also effective and safe options.

If none of these options are effective, often in combination, and you have uncontrolled pain or you are unable to go about your day to day activities as you would like, you may need to discuss further pain control options, or joint replacement surgery, with your doctor.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis, or RA, is an autoimmune disease where your immune system causes inflammation in your joints.
Why does RA happen?

No one really knows. There is as of yet an unidentified trigger which causes your immune system not to recognize the cells in your joint as belonging to you. Because of this, they attack these cells, causing the clinical symptoms.
Is there something I could have done to prevent RA?

Because we do not fully understand why RA happens, we do not know if anything could prevent it. We do know there is a genetic predisposition for some patients for RA, meaning it may be inherited. We also know smoking increases your risk of developing RA, particularly if you have the right genetic makeup. It’s never too late to stop smoking though; even quitting now may decrease the severity of RA and make it easier to treat effectively.
Who gets RA?

Anyone can get RA. On average, every 1 in 100 people have RA. It is not related to age, as patients from 6 months of age to over 80 years old can develop RA for the first time. The peak age to develop RA is in the fifth decade. More women than men develop RA.
What are the symptoms in RA?

RA starts slowly in most people, developing over weeks. However, it can develop suddenly too. Most people notice joints becoming increasingly stiff, worse in the morning and better with activity. There can also be joint pain, decreased range of motion in the joints, inability to do some activities (Eg turning door knobs, difficulty with keys, etc.), swelling around joints and fatigue.
Which joints are commonly involved?

While almost any joint can be affected by RA, the most common ones are the small joints in the hands and feet. Wrists, elbows, shoulders, neck, hips, knees and ankle can also all be involved. It is unusual however to have lower back involvement because of RA.
What is the difference between RA and osteoarthritis?

While RA is an autoimmune disease, osteoarthritis, or OA is often described as a disease of “wear and tear.” In other words, for most people with osteoarthritis, the cartilage in the joints can wear out because of mechanical damage from years of use. OA is very common; 10% of people will develop OA in their lifetime and that number increases with age. Common joints in OA are weight bearing joints and the spine.
How do you diagnose Rheumatoid Arthritis?

RA is a clinical diagnosis made by your rheumatologist based on your medical history and the findings on your physical examination.
Is there a blood test which can confirm the diagnosis?

There are a number of blood tests which can be and are performed by your rheumatologist to help make the diagnosis of RA. They may look for signs of inflammation, or antibodies which can be associated with RA. However, these tests do not diagnose RA. Many patients are diagnosed with RA with completely normal blood tests. RA is diagnosed based on your medical history and physical exam findings.
How about x-rays?

There are typical findings on x-rays in patients with rheumatoid arthritis. However, we hope never to see them! The goal of treatment is not only to prevent pain, stiffness, swelling and loss of function, but also to prevent bone changes. If RA is diagnosed early enough and treated properly, the chance of bone changes is reduced. Hopefully, your x-rays are still normal when diagnosed with RA.
Can RA affect more than just joints?

Unfortunately, RA is not always just limited to joints. Some patients can have involvement of other parts of the body, including skin, eyes, heart, lungs, nerves, blood and blood vessels. Often, these findings are in patients with more severe joint involvement, but it reinforces the need to treat RA.
Is there a cure for RA?

No, there is currently no cure for rheumatoid arthritis. However, there are a growing number of medications which have been shown to be very effective in treating RA, reducing patient symptoms and slowing bone changes. Click here for a general overview for RA treatment. Please see the medications page for more specific information on particular drugs.
DMARDs sound dangerous. What can happen if I don’t want to use them?

DMARDs, or Disease Modifying Anti-Rheumatic Drugs, are the class of choice to treat RA. While many of them do have the risk of side effects, which can particularly sound scary for patients who have never required medications before, their benefit outweighs the risk. Your rheumatologist has training and experience with these medications, and would only prescribe a DMARD if it was appropriate, if it was thought to be helpful in treatment, and that benefit outweighed any risk. Keep in mind, it is likely more dangerous to let RA continue without treatment.
Are there any natural treatments that have been proven to be helpful?

There are many different products patients use in the hope it would help treat their RA. Unfortunately, there has been little research in this area to recommend anything specific. However, if you do want to try a natural treatment, please be sure to discuss it with your rheumatologist to ensure its safety with your other medications. There is some evidence that Omega-3 supplementation may help reduce joint swelling, although not in place of other treatment. Maintaining joint mobility and strength with regular exercise is not only safe, but encouraged and beneficial. Smoking cessation may make it easier to treat RA and therefore lead to a quicker recovery, besides its other harmful effects. RA Education is important. Please feel free to read more about RA at your leisure. If you have questions for your rheumatologist, remember to bring them with you to your next appointment. Some centres offer comprehensive educational programs.
What is the prognosis for rheumatoid arthritis?

Older data suggests patient with RA may die younger than those without RA as well as develop disabilities. However, with appropriate DMARD therapy and newer medications now available, the prognosis for RA is becoming brighter.