Answers from Dr. Greene

QUESTION: Will a change of diet improve my osteoarthritis?

DR. ALAN GREENE: Obesity is known to increase the odds of developing osteoarthritis, and to increase the progression of osteoarthritis in someone who already has it. Losing excess weight has been associated with reducing the pain and disability of osteoarthritis, especially if the person loses excess body fat.

Research has not yet proven that eating larger amounts of certain foods will prevent osteoarthritis or reverse its effects. Yet it is prudent to control obesity by limiting calories, opting for healthy eating habits, and cutting down on the intake of fatty foods. Some changes in body chemicals related to painful inflammation can be initiated by replacing red meats with fish and by using certain vegetable oils. Some people believe that 'acid foods' cause arthritis. This is not the case. In addition, alcohol does not affect osteoarthritis, although alcoholism can damage bone and be a secondary cause of osteoarthritis.

QUESTION: I have broken my knee twice playing football. Will I develop osteoarthritis in that joint?

DR. ALAN GREENE: It is possible. Joint trauma is known to be a factor in the development of osteoarthritis. Furthermore, if a bone is broken near a joint, there is a greater likelihood of developing osteoarthritis in the joint itself.

QUESTION: My stomach is easily upset. Will arthritis medicine upset my stomach or give me an ulcer?

DR. ALAN GREENE: Make sure that your health care provider knows about your stomach problems so that they can prescribe a pain reliever that does not irritate the stomach or cause bleeding from or ulcers in the stomach, which these medications can sometimes do. Suitable choices may be an aspirin-free pain reliever, such as acetaminophen, or an NSAID (non-steroid anti-inflammatory drug) that causes fewer GI symptoms (such as salsalate). As an alternative, the health care provider may prescribe another medication to lessen the side effects of NSAIDs. In some cases, it may be beneficial to switch to a COX-2 inhibitor that significantly lessens the chance of stomach problems, although this medication also has important side effects.

QUESTION: Will moving to a different climate improve my osteoarthritis?

DR. ALAN GREENE: It is well known that arthritis sufferers often feel more joint pain in damp locations, just before it rains, or sometimes during humid periods. However, osteoarthritis occurs in all climates. The effect of the weather on symptoms really is temporary and does not actually affect the disease. This means that climate does not improve or worsen arthritis, although it may affect the symptoms.

QUESTION: I have osteoarthritis in my hip joint. Will I need surgery to correct it?

DR. ALAN GREENE: Very likely, no. Most people with osteoarthritis never need to have surgery. Surgery only becomes an option if the person suffers from (1) severe pain that is not relieved by available treatment methods, (2) a dramatically impaired ability to perform daily activities, or (3) marked joint instability. Simpler treatments must be tried before surgery is considered.

QUESTION: Both my mother and father had osteoarthritis. Am I likely to get it too?

DR. ALAN GREENE: Heredity appears to play a role in osteoarthritis, although the exact causes remain unknown. In a few people scientists have found an abnormal gene that causes the early breakdown of joint cartilage. This eventually may lead to the development of osteoarthritis. However, it doesn't at all follow that you'll develop osteoarthritis in a joint just because a parent has it.

QUESTION: What is the difference between osteoarthritis (OA) and rheumatoid arthritis (RA)?

DR. ALAN GREENE: The principle features of the two conditions are not the same, and their treatment is very different. In osteoarthritis, the cartilage in the joint becomes damaged and, ultimately, the joint degenerates. The joint is not primarily inflamed, although inflammation may occur as a late result.

On the other hand, in rheumatoid arthritis, there is initial inflammation of the lining of the joint. This produces a soft, tender swelling in contrast to the bony enlargement of osteoarthritis. Cartilage damage occurs later as a result of this inflammation. The pain of osteoarthritis is often least troublesome in the morning but may gradually worsen during the day. With rheumatoid arthritis, the pain and stiffness usually is worst upon waking, but gradually improves during the day.

Rheumatoid arthritis is not just a disease of the joints. Abnormalities occur in the blood vessels, circulating cells, and proteins, as well as connective tissue. Not surprisingly, rheumatoid arthritis is associated with more generalized disturbances -- such as anemia (low red blood cell count) -- which are proportional to the activity of the arthritis. Usually more than one joint is involved in rheumatoid arthritis, with the hands almost always affected.

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