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Healthy weight and activity can protect joints, says Consumer Reports

Thursday, January 17, 2013 - 12:01 am

Americans are wearing out their joints, Consumer Reports notes. Knee replacement is now among the most common major surgeries, up 162 percent in the last two decades, according to an analysis of Medicare data published in the Journal of the American Medical Association.

The increase is partly due to the population growth of aging baby boomers. It also reflects rising rates of obesity and the fact that a more active group of people is unwilling to live with the pain and disability of osteoarthritis.

Surgery to replace joints is a good option if your condition has become disabling, but it's possible to delay or prevent the need for surgery. Consumer Reports offers this roundup of evidence-based approaches that can help protect joints and minimize the painful symptoms of arthritis.

•Achieve a healthy weight. Being overweight increases the stress on joints and might even hasten the breakdown of cartilage. Obesity can have systemic effects that are not well understood. Research suggests that it even increases the risk of developing arthritis in joints that don't bear weight.

Fortunately, even modest weight loss – as little as 5 percent of body weight – has been shown to reduce the risk of arthritis later. Research suggests that losing weight reduces pain in people who already have the disease.

•Stay active. Because osteoarthritis can arise from the overuse of joints or sports injuries, some people who have the condition worry that exercise will make it worse. In fact, the opposite may be true. Limited evidence suggests that routine physical activity is linked to healthier cartilage in the knees, according to a 2011 review of 28 studies. People have a higher likelihood of ending up disabled from arthritis if they're sedentary.

•Treat injuries promptly. Left untreated, injuries such as a small tear in the knee cartilage or a shoulder tendon can set in motion a wear-and-tear process that leads to joint deterioration. See a doctor for any injury that causes severe pain or swelling, or minor pain that doesn't resolve after a week or so. Take steps to minimize the risk of injury in the first place. For example, don't wear running shoes, which are designed to keep your weight from shifting sideways, to play tennis.

•Consider nondrug options. Finding effective ways to alleviate pain, swelling and stiffness is critical to staying active. Many people find that one or more of these nondrug measures can reduce the need for pain medication: acupuncture; heat and cold, including moist heating pads for stiff joints and ice packs for acute pain and swelling; massage; and mechanical aids such as a cane, crutch or walker.

•Simplify drug treatment. Newer, heavily advertised name-brand drugs such as duloxetine (Cymbalta) – which is approved for treating chronic musculoskeletal osteoarthritis pain – often don't work better than basic pain relievers, but they cost more and can carry a greater risk of side effects.

Instead, start with a tried-and-true pain reliever, such as over-the-counter acetaminophen (Tylenol and generic). Consumer Reports also suggests talking with your doctor about the topical version of the NSAID diclofenac (Pennsaid and Voltaren Gel). Finally, shots of anti-inflammatory steroids are an effective short-term remedy for moderate to severe pain and swelling in the knees and hips.

•Use supplements wisely. Despite mixed evidence and a lack of support from major health groups about the role of the supplements glucosamine and chondroitin in treating osteoarthritis, some people think they help. But if you don't experience relief within three months, there's no point in continuing to take them.

•Skip unproven treatments. In particular, the most recent data suggests that injections of hyaluronic acid (Synvisc) directly into a joint, known as viscosupplementation, isn't worth the risk. In an Aug. 2012 review of 89 clinical trials involving more than 12,000 patients, the authors concluded that viscosupplementation did little or nothing overall to relieve pain or increase function in people with knee osteoarthritis.