In an article with Medscape, Heidi Prather, DO, Founder and Medical Director of the HSS Lifestyle Medicine Program said, “When middle-aged women present with new joint pain, it is important to determine where they are in the menopausal transition” to guide appropriate education and management strategies. “Women may not offer the information without being asked, as they may be unaware of the links between hormone changes and soft tissue and joint pain.”

For some women, the chronic systemic inflammation associated with estrogen loss can be well managed with lifestyle and conventional medical interventions including hormone replacement therapy (HRT), Dr. Prather explained. “For others, things can seem out of control, and usual care is not as effective.”

Dr. Prather pointed to the need for studies assessing “modifiable and nonmodifiable factors to best arm women with the information they need to manage and improve their health” across the menopause transition and beyond.

Read the full article at medscape.com.

She highlighted lifestyle medicine as an effective framework for addressing these interconnected challenges, shared outcomes from the HSS Lifestyle Medicine Program – a standardized, interprofessional program designed to help people with musculoskeletal pain improve whole-person health, reduce pain, and enhance function through behavior change – and outlined what's next.

Watch the full webinar at Osteoarthritis Action Alliance YouTube Channel.

Knee osteoarthritis is the wearing out of cartilage at the ends of the bones that allow them to glide freely, explained Dr. Campbell-Potter.

“Multiple factors contribute to developing knee arthritis including mechanical load, biologic susceptibility [genetics] and prior joint injuries” she noted. “I tell my patients it’s like developing potholes on a road, and it can lead to pain and stiffness in the joint.”

“Compression knee sleeves are often sufficient for mild to moderate knee arthritis,” continued Dr. Campbell-Potter. “I typically recommend neoprene sleeves because they have a good balance of strength and flexibility.” 

Read the full article at womansworld.com.

Two research teams, at Duke University and at the University of Colorado, Boulder, have developed injections or infusions that regrow bone and cartilage, ARPA-H announced. And a third team, at Columbia University, may have discovered a way to regrow an entire knee.

“It’s hugely promising,” said Dr. Rodeo, who was not associated with the studies. “Right now, everything we have just modifies symptoms,” he added. Curing arthritis by regrowing cartilage and bone “would be a paradigm shift.”

Read the full article at nytimes.com. A subscription is required to access. 

The part of the thumb most likely to develop osteoarthritis is the joint at the base of the thumb, where it joins the wrist, which is called the basal joint or the carpometacarpal (CMC) joint. (A joint is a place where two or more bones meet, in this case metacarpal bone of the thumb and the trapezium bone of the wrist). Your doctor can diagnose this kind of arthritis by evaluating symptoms, which is often the first step.

When a patient says, “It hurts to open a jar or it hurts to turn a door [knob] or I feel like my hand is weak when I’m pinching things,” that’s “classic CMC arthritis,” said Dr. Barr. Other signs can include swelling at the base of the thumb, a bony bump over the joint and limited thumb movement, according to the American Academy of Orthopaedic Surgeons. 

Read the full article at aarp.org. 

HSS Presents Innovative Research Aimed at Faster Recovery After Knee Surgery at AAOS Annual Meeting

HSS investigators presented several significant studies, three of which focused on new ways to help patients recover faster after total knee arthroplasty (TKA), also known as knee replacement surgery. 

Preclinical Study Finds Earlier ACL Reconstruction is Associated with Lower Risk of Knee Osteoarthritis 

A preclinical study by HSS investigators led by sports medicine surgeon Scott Rodeo, MD, found that earlier ACL reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.

New Study Reveals Young, Active Patients Who Have Total Knee Replacements are Unlikely to Need Revision Surgery in their Lifetime

A 40-year study by HSS researchers led by hip and knee surgeon William J. Long, MD, FRCSC, has found that active young adults who underwent total knee replacement were unlikely to require knee replacement revision in their lifetime.

The medical device company Lipogems is currently conducting two Investigational Device Exemption (IDE) studies in the United States for the use of microfragmented adipose tissue (MFat) for the treatment of knee osteoarthritis (OA).  Tsun Sean Law, MD, director of clinical research at HSS Florida, discusses the two IDE trials, called ARISE and ARISE2, and other orthobiologics being explored as treatments for OA.

Read the full article at medscape.com. 

“Our goal should always be to prevent the first fracture by identifying those at risk. The Own the Bone program from the American Orthopaedic Association has called on orthopedic surgeons to “capture the fracture” (ie, recognize fragility fractures and recommend treatment for osteoporosis) to optimize bone health prior to elective orthopedic surgery,” explained Dr. Serota. 

"The current paper adds to our growing body of evidence that consideration of underlying bone health is just as important to arthroplasty surgeons as to orthopedic trauma and spine surgeons," said Dr. Serota. 

Read the full article at healio.com. 

Read the full article at nature.com. 

Exercise and weight loss, where appropriate, can ease the pain of knee osteoarthritis and prevent it from worsening, said Dr. Charnoff. Low-impact exercises, such as walking, cycling, rowing and deep-water running, are also important to strengthen muscles around the knee.

Read the full article at washingtonpost.com. 

By reducing one-third of the normal weight-bearing load on the medial (inner) side of the knee, the system relieves stress on the joint. The device is designed to postpone arthroplasty in some patients, acting as a bridge between conservative treatment and knee replacement, especially for younger, active people. 

Anil  S. Ranawat, MD, sports medicine surgeon at HSS said that the device “fills a treatment gap for early arthritis in these patients.” 

The nonrandomized clinical trial leading to FDA approval compared the system with high tibial osteotomy (HTO) — an operation that adds or removes bone to shift weight from the damaged side of the knee joint. The benefits of HTO last eight to 10 years, and the surgery is not considered a permanent stand-in for knee replacement. Dr. Ranawat, one of the study authors, noted that the shock absorber can be temporary or permanent.

Read the full article at arthritis.org. 

The connection between osteoarthritis and allergic diseases could be the low-grade inflammation, said Theodore R. Fields, MD, FACP, rheumatologist at HSS, who was not involved in the study, but commented on the findings.

"If treatment of atopic disease helps prevent or lessen osteoarthritis, there are a lot of options and will be more," said Dr. Fields.

"For patients with eczema or asthma, this data can make them aware that they might be more likely to get osteoarthritis," he continued.

If you have an allergic disease and develop aches and pains in your joints, see your doctor, advised Dr. Fields.

"We have many strategies to improve the symptoms of osteoarthritis but don't yet have a disease-modifying treatment," said Dr. Fields. 

"There can be some hope in this study for patients with eczema or asthma that their treatment for atopic disease might prevent or diminish their potential to develop osteoarthritis," he added.

Read the full article at healthday.com. 

Patients with moderate to severe osteoarthritis (OA) or osteonecrosis (ON) eligible for total joint arthroplasty (TJA) who have failed one or more nonoperative therapies should proceed directly to surgery, according to the new guideline. 

"One of the reasons for creating this guideline was that many patients have been subjected to delays for surgery after completing nonoperative therapy, despite persistent moderate to severe pain, loss of function, and moderate to severe radiographic OA or ON," said co-authors Susan M. Goodman, MD,  rheumatologist at HSS, and Charles Hannon, MD, orthopedic surgeon at Washington University. "This guideline supports surgery being performed in an expeditious fashion after the decision has been made to proceed with surgery by both the physician and patient through a shared decision-making process," they said.

Read the full article at medscape.com. 

"The results of this study are consistent with the experiences of many lifelong runners and observations of sports medicine professionals that osteoarthritis is not an inevitable consequence of distance running," said Brett G. Toresdahl, MD, sports medicine physician at HSS, who was not involved with the study.

Dr. Toresdahl emphasized that more research is necessary to understand whether running contributes to the risk of developing osteoarthritis. The participants in the study were current marathoners, he noted, so it is likely they have healthy joints that can tolerate running longer distances. “If there is a subset of people who have joints that are negatively affected by running, they wouldn't likely be registering for a marathon.”

Read the full article at medscape.com. 

The results of a new study that compared both high and low dose exercise in 189 people with knee osteoarthritis showed improvements on a standard scale measuring knee osteoarthrosis pain and function at three, six and 12 months. 

Calling the new study results "music to any physical therapist's ears," Fitzgerald pointed out that participants showed meaningful improvements in knee symptoms and that adherence to their program was excellent across both groups.

This is at least partially due to the fact that exercise was prescribed on a minimal/no pain basis, Fitzgerald said. "Regardless of the exercise dosage, when we are capable of prescribing exercise within pain-free limits, there is more hope that patients will respond well to the treatment," he explained.

"If you are prescribing exercises for these patients with their best interest in mind, the program should be specific to the likes and goals of the patient keeping in mind loading principles to manage pain," Fitzgerald added.

Read the full article at dailyjournalonline.com.

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic,  a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote. 

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

According to Dr. Prather, a number of lifestyle and other nondrug treatments can help ease symptoms — and prevent OA from progressing. “Sleep is crucial to pain perception,” noted Dr. Prather. Insufficient sleep time can reduce the levels of neurotransmitters — feel-good brain chemicals that can help blunt pain, she explained.

Additionally, a Mediterranean-style diet, which is rich in produce, whole grains, seafood, beans and nuts. A high-sugar diet may negatively affect the gut microbiome, according to a study published in the journal PLOS One in 2021. And “your gut makes most of your body’s serotonin, a brain chemical that boosts mood and makes it easier for you to tolerate pain,” said Dr. Prather.

Read the full article at Washingtonpost.com.

According to Dr. Blazer, “Rheumatoid arthritis is a primarily inflammatory condition, so what I hear from my patients with rheumatoid arthritis is when they wake up in the morning, their joints feel very stiff, sometimes swollen. It improves with movement or putting the hands particularly under hot water, and this stiffness lasts for over 30 minutes, sometimes up to an hour or two or longer.”

Osteoarthritis (OA) is caused by degenerative wear and tear on the joints. Over time, the cartilage or meniscus becomes damaged, leading to joint injury and pain.

Dr. Blazer explained, “OA does more classically happen in older adults, but we're seeing it happen younger and younger for a couple reasons. Osteoarthritis is one of these conditions that goes along with overall difficulty with metabolism. So, the more that we see things like obesity, diabetes, hypertension, metabolic syndrome, we're also seeing OA.”

“Just as those conditions are happening in people younger and younger, OA is happening in younger and younger people,” she added.

Dr. Blazer underscored that if people suspect their pain could be rheumatoid arthritis, they should be seen by their physician as quickly as possible.

Watch the full segment at Cbsnews.com.

Dr. Prather explained that many of the medications that are used for pain relief aren’t recommended for regular use by older adults, but a number of lifestyle and other nondrug treatments can help ease symptoms and prevent OA from progressing.

According to Dr. Prather, “Sleep is crucial to pain perception.” Insufficient snooze time can reduce the levels of neurotransmitters – feel-good brain chemicals that can help blunt pain.

Dr. Prather noted that a healthy diet is also important, such as a Mediterranean-style diet, which is rich in produce, whole grains, seafood, beans, and nuts. She noted, “your gut makes most of your body’s serotonin, a brain chemical that boosts mood and makes it easier for you to tolerate pain.”

Read the full article at Consumerreports.org.

HSS limb lengthening surgeon Austin T. Fragomen, MD, who was not involved in the study, shared his perspective on the clinical implications.

 Dr. Fragomen said, “I read this article by Nobuo Adachi, MD, PhD, and colleagues on knee joint distraction arthroplasty paired with stem cell therapy with great interest as our limb lengthening and complex reconstruction service at Hospital for Special Surgery has one of the largest experiences with ankle distraction arthroplasty. Joint distraction is a non-prosthetic arthroplasty, biologic solution for knee osteoarthritis that harnesses the body’s own ability to regenerate tissue.”

He underscored, “Joint distraction will find a more mainstream role in the management of osteoarthritic joints as articular cartilage restoration techniques evolve. The two methods will likely have a synergy greater than current bone marrow applications.”

 Read the full article at Healio.com.

Dr. Chan explained, “To improve outcomes in OA, we need to do a better job of defining it and understanding mechanisms behind it. Though we do not typically think of ‘phenotypes’ when we think of OA, we also instinctively know that the ‘wear-and-tear’ conception of OA is not the whole picture either, as illustrated by those pesky Heberden nodes.”

She continued, “In the past decade, more advanced imaging and lab methods, statistical tools, and machine learning have contributed to more sophisticated phenotyping attempts. This work has become so relevant and critical that in 2020, a panel of 25 osteoarthritis researchers published a framework for doing this work. Defining phenotypes and endotypes will lead to a better understanding of the natural history of the various types of OA and allow for better treatment paradigms rather than the limited and rather blunt instruments of pain management and joint replacement surgery that we currently use.”

Read the full article at Medscape.com.

According to Dr. Carlson, osteoarthritis (OA), the most common type of arthritis, is a condition caused by the natural wearing away of the cartilage that covers the bone. In healthy joints, the cartilage coverings at the ends of the bones match up and glide smoothly against one another.

Cartilage cannot not be built back, but motion can be preserved by keeping the soft tissue in the joint as supple as possible.

Dr. Carlson advised incorporating moves to help maintain hand function, such as a shoulder stretch. She noted the impact of tense shoulders, “Stiffness in your shoulders can lead to all sorts of problems in your extremities.”

Other recommended moves include elbow flexion and extension, prayer and reverse prayer, finger spread, finger touch, thumb stretch and a knuckle bend.

However, some exercises, like squeezing a stress ball, can irritate joints by causing rough cartilage to rub together, noted Dr. Carlson.

Read the full article at AARP.org.

Dr. Rodeo explained, “This area has tremendous potential — a lot of promise — but currently needs further development. We need further basic and clinical research. I think we need to recognize that, frankly, there has been a lot of indiscriminate use of unproven therapies — that gets back to the aggressive marketing — but it’s an area that really has great potential, and it’s on us to collect the relevant clinical and laboratory data to really bring this to fruition for our patients.”

Watch the full interview at Healio.com/news/orthopedics.

The study was led by Titilayo Ologhobo, MPH, Director, Outcomes and Data Analytics at HSS, and found after attending biweekly 60-minute low-intensity Zoom fitness classes at six-week increments, participants improved physically and became more socially active.

Ologhobo explained, “We made sure our classes were structured to increase interactions with others. We promoted a dialogue before the class began so people could talk and catch up with each other. They said it helped promote social connections.”

Read the full article at Everydayhealth.com. Additional coverage: Prevention.com, Healio.com.

According to Dr. Mehta, “Over the years, with better disease control and biologics, these cases have gone down. We wanted to know if this was the case nationally in patients < 21 years of age. Also, we wanted to know if more procedures are done in these patients.”

The study found the number of THAs performed in this age group from the Kids’ Inpatient Database increased from 347 in 2000 to 551 in 2016, with the most frequent diagnoses being osteonecrosis, osteoarthritis, and inflammatory arthritis.

“Overall, the number of THAs are increasing even though the patients with inflammatory arthritis have a lower number of surgeries. Likely this is because joint damage even in young patients is recognized and instead of these patients being permanently disabled, we are able to observe and treat them with a THA,” she concluded.

Read the full article at Ryortho.com. 

Additional coverage: 

• Healthday.com
• Healio.com
• Ryortho.com

Dr. Lingor recommended regular exercise, stating “Low impact activity allows for better joint lubrication. It also strengthens muscles to help take unnecessary stress off the joints, decreases inflammation responsible for the progression of arthritis, and helps you maintain a healthy weight.”

However, Dr. Lingor advised not to start a workout regimen that is too intense. “Pushing yourself too hard, too fast can also be a detriment to your joints,” he added.

He explained that when arthritis is in one joint, nearby muscles and joints have to work a little harder to pick up the slack. “This compensation can contribute to pain or injury from extra stress in that new area,” he noted.

According to Dr. Lingor, working on flexibility can also help with compensation. “You may not be aware of your own imbalances in strength and flexibility. This asymmetry may put extra stress on one side of the body resulting in injury. Doing exercise like yoga, Pilates, or tai chi can help make you more aware of and correct these imbalances.”

Dr. Sutton said to think of joints like a plant sapling (a young tree). She explained, “Saplings need strings around them to help them grow straight and strong — just as joints need muscles and ligaments around them for support and stability.”

Read the full article at CreakyJoints.org.

Dr. Rodeo said, “There is great interest in the potential of novel treatment of musculoskeletal conditions. This particular study of the use of an injectable orthobiologic, platelet-rich-plasma, of a common knee ligament injury may lend insight into treatments to either prevent or minimize the later development of osteoarthritis of the knee.”

Read the full article at Beckersspine.com.

Additional coverage: Beckersspine.com

Dr. Wang noted, “Nonoperative treatment options are similar for all patients, whether they are recreational or advanced athletes. I think about it as a pyramid. The base, which we build off of, consists of PT [physical therapy] to strengthen the surrounding muscles and take load off the joint, activity modification to lessen impact activities using pain/swelling as a guide, and weight loss, if appropriate. The next step up the pyramid is over-the-counter medications, as needed, for pain (for example, acetaminophen or NSAIDs). The following step is injections (cortisone or lubricating gel injections).”

He continued, “In certain situations where the arthritis and pain are in one specific part of the knee, I also consider adding an unloader brace with activity. With recreational athletes, we generally start at the base of the pyramid and work up, if symptoms are not controlled with the previous level of treatment. Advanced athletes may not be able to modify their activities as easily or allow the time for PT to take effect, so we may need to start further up the pyramid with more invasive options.”

Dr. Wang concluded, “Ultimately, every patient works their way through the pyramid differently and we adjust our approach for each individual taking into account their symptoms and activities.”

Read the full article at Healio.com/news/orthopedics. This article also appeared in the April 2021 print issue. 

“It was fascinating to find that we could have Drs. S. Robert Rozbruch (chief of Limb Lengthening and Complex Reconstruction Service at HSS) and Austin Fragomen (limb lengthening surgeon at HSS) correct a wide variety of deformity in the tibia, as well as limb length discrepancy prior to total ankle replacement in patients with severe ankle arthritis,” said Dr. Ellis.

Dr. Ellis added, “Successful results in total ankle replacement can be achieved only when correct alignment is obtained at the time of surgery. Sometimes, however, when there are deformities of the tibia or femur (either from congenital problems or previous trauma), much more complex correction of the deformity is required above the level of the ankle before a total ankle replacement can even be considered.”

When asked why this is a new topic in the literature, Dr. Ellis noted, “This has not been studied before because this work can generally only occur at a center with expertise in both tibial osteotomy alignment and total ankle replacement. The study required collaboration between the two services. Also, these cases are not very common, making such a large number of cases not readily accessible.”

Read the full article at Orthospinenews.com.

It's not surprising that a combination of interventions were more effective in reducing pain and increasing function, particularly because splinting has been previously proven an effective intervention for thumb-base osteoarthritis, said HSS occupational therapist Alexandra MacKenzie OTR/L, CHT, who was not involved in the study. A combination of strategies provides a multifaceted approach targeting multiple aspects of thumb-base osteoarthritis, whereas education alone only targets one aspect, added MacKenzie. "The take-home message is that a combination of interventions, individualized to each patient, can be beneficial to improving patient outcomes, and that such interventions can have long-term benefits," she noted. 

This article originally appeared on Reuters Health. 

Dr. Altchek explained elbow injuries are categorized into three problem areas: tendon injuries, bony problems and ligament injuries. Tennis elbow is an injury to the extensor group tendon, originating at the outer part of the elbow extending through the forearm. Discomfort arises when extending the wrist against resistance and resolves in two to 12 months. Treatment involves ice, nonsteroidal anti-inflammatories (NSAIDs) and avoiding aggravating activities.

Elbows can develop “bone spurs” as a result of degeneration from osteoarthritis. In younger individuals, it can result from the repetitive overload of throwing or racquet sports. Most spurs occur in the back of the elbow, and limit ability to extend the elbow fully. Spurs can be easily removed with minor arthroscopic surgery.

According to Dr. Altchek, the most common elbow ligament injury is the ulnar collateral ligament (UCL) on the inside of the elbow. Causes include trauma, or aggressive throwing, as seen in baseball pitchers. In athletes, this usually requires Tommy John surgery. Injuries also occur at the outside of the elbow, generally because of trauma or degeneration from tennis elbow. This injury can create significant disability and requires surgery.

This article appeared in the print edition on February 21, 2021.

Dr. Vigdorchik wrote, “We are entering a new era in orthopedic surgery as we are at the tipping point for using technology in joint replacement: We have surpassed 10% of surgeons using some form of robotics and computer assistance in hip and knee replacement. The next 5 to 10 years in joint replacement will be about data, data acquisition and data science. There will soon be a day when a patient will walk into your office, you will make an analysis and create a patient-specific risk profile, find a target for the surgery, achieve that target with high accuracy and precision using robotics/technology, and then monitor that patient’s outcome, which will then feed back to the original algorithm. This is the core philosophy behind robotics and artificial intelligence in joint replacement.”

He concluded, “However, along with this shift come new challenges. With respect to artificial intelligence, there is no question that machine learning and deep learning can digitize datasets and run analyses that no human can ever dream of doing. But there are reports of significant racial biases of the underlying algorithms, skewed against minorities. We must overcome these biases for everyone to trust the information and use it effectively; work is currently underway in these regards.”

Read the full article at Healio.com/news/orthopedics.

Dr. Gausden explained how over the counter and prescription anti-inflammatories are commonly used to treat OA pain. “When someone has a sudden flare, I suggest two weeks of NSAIDs [Nonsteroidal anti-inflammatory drugs] daily, as long as you can tolerate it,” she noted. “Corticosteroid injections are commonly used to treat symptomatic knee pain from OA and can be used if pain is not adequately treated by over-the-counter medications,” continued Dr. Gausden. “Unfortunately, the pain relief is usually best with the first injection, with shots becoming less effective over time,” she added. “A good response would be several months of relief.”

When it comes to surgery, patients will often know when it’s time. “When pain or lack of mobility is affecting you every day—if you’re cancelling plans or modifying your life because of OA—I advise my patients to start thinking about surgery,” advised Dr. Gausden. “Ultimately, the decision is best made by you.”

Read the full article at Healthcentral.com.

"I would suggest seeing a physical therapist, a physiatrist, or your primary care physician if you are experiencing knee pain at night," advised Rogers, as there are different conditions that can cause that pain, and only a trained expert can make that call. "Osteoarthritis is the musculoskeletal condition I see most often in my clinical practice that can present with worsening pain at night," noted Rogers. "However, any knee condition that is associated with increased inflammation can present with increased pain at night. Some examples could be patella femoral pain syndrome, patella tendonitis, quadriceps tendonitis, and medial or lateral meniscus tears,” he continued.

Another reason that knee pain can feel more uncomfortable at night is due to increased activity levels during the day that are outside the person's exercise or functional capacity. "This can be seen when someone is accustomed to running one mile per day for exercise but then one day that person decides to run three or four miles without proper training or gradually building up to this distance,” explained Rogers.

Additionally, there are some things you can do at home to help relieve your knee pain. "When dealing with knee pain at night, I recommend applying an ice pack to the knee before bed for 15-20 minutes to help soothe the pain," said Rogers. "A lot of times ice before bed will be sufficient to help reduce the knee pain at night." Alternating between a heating pad and an ice pack could also be helpful if ice alone isn't doing the trick. "One can use a heating pad on the knee for 15-20 minutes about an hour before bed and then use an ice pack on the knee for 15-20 minutes right before bed. Sometimes the alternating combination of heat and ice before bed can be helpful to soothe knee pain at night,” he added. Gentle stretching of the quadriceps, hamstrings, and calves may also help in reducing knee pain at night, concluded Rogers.

Read the full article at Popsugar.com.

While there isn’t a universal cause of OA, there are certain things that increase a person’s risk, explained Dr. Wu. “Age is the strongest predictor,” she said. “Simply put, the chance of developing OA goes up as you get older.”

Other factors that increase the risk for OA: trauma to a joint, genetics, and gender. OA tends to run in families, though experts don’t know of a specific gene that’s responsible, noted Dr. Wu. And women are more likely than men to both develop OA and end up with more severe cases, she added.

OA symptoms may not always correlate with what you see on an x-ray. Because of this, a physician will recommend treatment based on more than just your x-ray and stage. “Clinical history is more important than x-ray, because a lot of people have damage on an x-ray but are asymptomatic,” cited Dr. Wu. The goal of OA treatment is to allow you to function normally without pain, so the way you feel and how much OA is impacting your daily life is more important than what the x-ray shows.

Read the full article at Healthcentral.com.

The first symptom you’ll likely notice is joint pain, explained Dr. Chan. It’s a dull, achy, or sharp pain that comes and goes at first and gets more constant over time, she continued.

OA pain acts up when you move the affected joint, and it may be triggered by a specific activity—like knee pain when you climb stairs or pain in the base of your thumb when you twist open a jar or turn a doorknob, said Dr. Chan. Extended activity (e.g., long walks or prolonged standing) can also lead to pain. It may get worse as you use the joint throughout the day. Conversely, pain from inflammatory arthritis (like rheumatoid) tends to feel better with movement, not worse, she counseled.

OA patients often report feeling stiff and creaky for five or 10 minutes after they’ve been inactive for a while—like when you wake up in the morning or get up after eating dinner or watching a movie, noted Dr. Chan.

One of a few reasons indicating it might be time to see a doctor is if the individual’s joint pain is interfering with an activity they would otherwise enjoy – which is often a telltale sign of OA, cited Dr. Chan.

Read the full article at Healthcentral.com.

Some pain when you move is normal with OA, but that shouldn’t stop you from exercising, explained Lamothe. Lamothe counseled to follow her three-point rule: Before physical activity, rate the pain from zero to 10. If the pain goes up by more than three points—say, from a three to a seven—you’ve done too much. Stop and rest. If the pain comes back down, you can continue. For post-exercise pain, try icing the joint for 10 to 15 minutes.

Quality of performing the moves is key. Lamothe advised to complete the moves slowly and intentionally to focus on proper form. She recommended beginning with two sets of 8-10 repetitions for each exercise, three or four days per week (with a day of rest in between). As you get stronger, you can add a set and/or do 12 to 15 reps, she added.

Strength training exercises Lamothe recommended and offered guidance on how to perform them include but are not limited to hip extensions, heel slides, glute bridges, and others.

Read the full article at Healthcentral.com.

Dr. Wu explained OA and rheumatoid arthritis (RA) both involve joint pain and damage, however they’re very different diseases. Both lead to inflammation, but the chronic inflammation that occurs with RA is much worse, said Dr. Wu. Treatment is different and having one type of arthritis doesn’t preclude you from having another. Additionally, RA typically feels better when you move, whereas OA typically feels worse, she noted.

Weight-bearing joints like the knees and hips are under a lot of pressure during everyday activities like walking, climbing stairs, or simply standing up. With excess weight, the pressure intensifies and can speed up joint damage. The risk of knee OA, in particular, is strongly correlated with weight, cited Dr. Wu “People who are obese are 6.8 times more likely than people at a healthy weight to develop knee OA.” For those who are overweight, weight loss can help slow down OA progression, reduce pain, and improve joint function.

The form of exercise can also help improve joint function and reduce OA symptoms, “Exercise helps build muscle mass to support the joints and also contributes to a healthy weight,” said Dr. Wu. The key is keeping exercise low-impact so that you don’t contribute to wear and tear on weight-bearing joint.

X-rays are important for diagnosing OA and seeing the severity of cartilage and joint damage, but they don’t reveal much about a person’s symptoms. “There’s not a real direct correlation between how lousy X-rays look and how bad you feel,” said Dr. Wu. “Some people have bone-on-bone and minimal pain, while others have minor X-ray changes and a lot of pain.” Because OA treatment is all about managing symptoms, the way you feel is sometimes more important than what a scan can show, she noted.

Read the full article at Healthcentral.com.

Dr. Burger and colleagues accessed data from the Dutch Arthroplasty Register to compare survivorship of 537 lateral unicompartmental knee arthroplasties (UKAs) and 19,295 medial UKAs with regard to implant and patient characteristics. “The effect of patient characteristics on revision rate was comparable between lateral and medial UKA. However, higher revision rates were observed for mobile bearings compared to fixed bearings on the lateral side; while medially, no difference was observed between mobile and fixed bearings,” said Dr. Burger. “Five-year revision rate was 12.9 for lateral and 9.3 for medial UKA,” he added.

“Progression of osteoarthritis was the main reason for revision on both sides, accompanied by tibial loosening for medial UKA,” noted Dr. Burger. “Our findings reflect the differences in anatomy and kinematics between the two compartments and suggest that other surgical principals need to be considered in lateral compared to medial UKA.”

Read the full article at Healio.com/news/orthopedics.

Dr. Goodman noted any effects that ginger may have seem to be on relieving symptoms, not on the actual course of arthritis disease itself. “The effect of ginger on arthritis appears limited to mild pain relief — no studies have demonstrated an important effect on disease modification,” she explained. “This is especially important for people with rheumatoid arthritis, as there are excellent disease-modifying medications available, while osteoarthritis patients do not have good disease modifying medicines.”

Dr. Goodman advised to seek caution when taking ginger as a supplement for arthritis. “I don’t recommend ginger supplements, as there are many better studied, more effective treatments.” People on blood-thinning medications should talk to their doctor before taking ginger. “While ginger may help with mild nausea, and may help relieve mild pain, it may also increase the tendency to bleed, so this may be a concern for some people who are at risk for bleeding due to an underlying condition or medications,” said Dr. Goodman. “Ginger in teas or through cooking are less likely to provide levels that are high enough to cause adverse effects.” She added, “A diet rich in fatty fish, utilizing ginger and turmeric in seasonings may help some patients gain better control of their pain and stiffness due to arthritis.”

Read the full article at Creakyjoints.org.

“Osteoarthritis (OA) often affects the lower back (lumbar spine) and neck (cervical spine) and develops through wear and tear, though it has a strong genetic component, too,” said Dr. Kirschner. “OA pain is typically more noticeable when you bend backward or twist your back or when you’re standing for a while.”

Dr. Kirschner explained other possible causes for back pain such as scoliosis, degenerative disc disease, and lumbar spinal stenosis. “The physical changes of scoliosis often start in childhood or adolescence, but the condition might not start causing back pain until middle or older age. Scoliosis usually causes back pain from muscle imbalance or because it leads to other conditions (like spine arthritis or disc disease), but it in and of itself doesn’t cause pain." Degenerative disc disease is a condition where pain is caused from an unhealthy disc. Normally, discs don’t have much feeling, however after a disc injury, new nerves grow into the area that can transmit pain signals, he noted. Lumbar spinal stenosis compresses the nerves that branch out from the spinal cord, causing symptoms such as tingling, numbness, or weakness. You may have sharp shooting pains that radiate down the leg. Or, pain can be dull, burning, tearing or feel like a muscle pull, said Dr. Kirschner.

Radiofrequency ablation is another option for treating OA in the back aside from medication. “The treatment can provide longer-term pain relief for some patients; pain can be eased for one to two years,” said Dr. Kirschner. “However, it may not work in all patients and recent osteoarthritis treatment guidelines say there is only limited evidence for its effectiveness. It has limited effectiveness in knee OA, but guidelines don’t comment on spine OA,” he added. Surgery such as a spinal fusion, which fuses two or more vertebrae together in your spine permanently, are typically done for severe spinal arthritis causing deformity or for scoliosis, cited Dr. Kirschner.

Read the full article at Creakyjoints.org.