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Middle age aches could be osteoarthritis

Joanna Cable demonstrates one of the exercises at MultiCare Rockwood Clinic Integrated Sports Medicine in Spokane on Wednesday. She is very active with tennis and biking and is dealing with early arthritis. (Kathy Plonka / The Spokesman-Review)
Joanna Cable demonstrates one of the exercises at MultiCare Rockwood Clinic Integrated Sports Medicine in Spokane on Wednesday. She is very active with tennis and biking and is dealing with early arthritis. (Kathy Plonka / The Spokesman-Review)

You first notice swelling in a finger or a stiff knee when you get up in the morning.

In those moments, you brush it off as the normal aches and pains of aging. But it might be arthritis.

The joint disease osteoarthritis is thought to be on the rise, partly because of active baby boomers and also higher U.S. obesity rates. It occurs from the wearing down of protective joint cartilage, leaving bones rubbing together.

People at younger ages might have this type of arthritis, but not know it. A recent study published in Arthritis & Rheumatology suggests such cases among U.S. residents ages 18-64 have been underestimated.

“The pain got pretty bad about a year ago,” said Joanna Cable, 52, a South Hill resident who sought health care because of early arthritis in her lower back, hips and knees.

Cable considers herself very active, including skiing, yoga, gardening, cycling, and pursuing her family’s passion of playing tennis. In November, she had surgery on both hips.

She has done a monitored regiment that includes physical therapy, stretching and better nutrition.

“I have zero pain now,” she said. “I’m basically moving all the time.”

It’s good to notice such patterns and ask a doctor about any early remedies, said Cable’s physician, Dr. Christopher Dewing, orthopedic surgeon at MultiCare Rockwood Clinic Integrated Sports Medicine. A program of exercise, physical therapy and weight loss often can ease symptoms, he said.

“We have an aging population that remains very active into their later years; with that comes some wear and tear, aches and pains of arthritis, which is a normal aging process in the body,” Dewing said.

“But I think they are many people who probably ignore some of the early signs – just chalk it up to aging or sort of the aches and pains from life. Oftentimes, those areas of the body that have early arthritis can really respond to some specific treatment.”

He listed possible signs to bring up to a physician:

Specific joints such as a knuckle, shoulder or knee feel stiffer or more achy, especially while resting at night or after a night’s sleep.

Occasionally, there’s some swelling of the joint area or it looks slightly puffy.

Someone other than you notices you’re limping, and asks you about it.

“Sometimes, people don’t even realize they’re limping,” Dewing said. “It occurs over a prolonged period of time. The onset is very gradual and subtle, so people are slowly modifying what they’re doing, including the way they walk or the way they’re moving their shoulder or neck.”

Many people pursued athletics through high school and college, and beyond. Others continue with triathlons, Spartan races, skiing, tennis and other recreation. It’s good to be active, Dewing said, but there’s some toll over time.

“Cumulative minor injuries do add up to an increased risk for arthritis,” he said. “I think that’s contributed to maybe more people in their middle ages having some symptomatic arthritis, which in previous times we may not have seen.”

More sedentary people might have issues controlling weight, predisposing them to arthritic problems, Dewing said.

For anyone, it’s best if weight is kept at recommended levels for height and body mass, he said. And people need to keep moving, even if it’s low-impact activities.

“Motion is life,” Dewing said. “Keeping your joints in motion through stretching, walking and participating in regular fitness activities is a great way to combat some of the stiffness and loss of motion that can come with early arthritis.”

As it advances, osteoarthritis can affect quality of life or become a disability. More people are getting joint replacement surgeries. But Dewing said he and other doctors often work with patients on other steps first to lessen symptoms before resorting to invasive procedures.

Dewing agrees even a small weight loss can go far toward controlling pain and arthritis symptoms. The American population generally has a higher rate of obesity or borderline cases than in other cultures.

“Your body weight can really have a big influence on how much force you put across your joints especially in your back, hips, knees, ankles and all that,” he said.

“It’s hard to face when your doctor sits down with you and says, ‘Hey, the best thing for you would be to lose 20 pounds.’ I have that conversation frequently with my patients; it’s not an easy conversation but I usually tell them, ‘I could stand to lose 20 pounds too, and I’m working on it.’ ”

“The truth is as we age, the closer we are to our ideal body mass index, or weight in general, probably the slower the progression of arthritis will be, and the more subtle the symptoms.”

Another important factor is nutrition, Dewing said, based on research in the past decade.

“A low-sugar diet has been shown to be extremely beneficial for arthritic symptoms, because high sugar intake has been associated with bursts of inflammation in the body.”

Dewing said Spokane has many resources, such as running shoe experts at regional stores, nutritionists and physical therapists. As an example, he said many people enjoy running as exercise, then suddenly realize a knee or ankle aches from early arthritis.

“Another thing that can be extremely beneficial is doing gait analysis with a talented physical therapist who can really study the way you’re running,” he said.

Experts can help people strengthen hip areas or specific muscle groups in legs for a more even stride and balanced style of running, he said. Runners also can vary their routine, applying interval training.

Aqua-running can be done in a pool or with an underwater treadmill, he said. Some clinics including Rockwood’s offer an anti-gravity option, called an AlterG treadmill, Dewing said.

People also can benefit from cross-training with swimming, low-impact water workouts, stretching and muscle-strengthening options. Programs like yoga or Pilates can help joint mobility and motion.

Genetics is mainly a factor in the inflammatory types of arthritis such as rheumatoid arthritis, usually felt in multiple joints with specific characteristics, Dewing said. “That type of arthritis does require good medical management with immunological modifying-type drugs.”

Dewing said osteoarthritis is more common. “That’s the type of arthritis that can happen after injuries, trauma or just part of the aging process.”

Some patients in their 30s and 40s experience that type of arthritis, he said.

“They’ve already had significant injuries or trauma that led to early onset arthritis. If there is joint replacement surgery in that group, these are plastic or metal components that have life spans of their own. The younger you are, the more likely you’ll have to have it again.”

Managing joint disease covers a wide range of ages, Dewing added.

“In Spokane, I regularly see athletes in their 70s, and sometimes even in their 80s, who are still engaged in very athletic lifestyle,” he said. “They’re skiing in winter, boating and surfing in summer. They’re hiking and really engaged with being outdoors and active.

“My goal is as an orthopedic surgeon to keep them as pain free, and as mobile and fit as I can, with the use of all sorts of modalities: Therapy, nutrition, and when appropriate, surgery or injections.”

Joint replacement surgery – typically a very successful surgery – can be the best option if arthritis causes a person to be disabled, and other remedies don’t help, he said.

“That’s a huge, important part of aging. How can we find ways to really enjoy being outdoors and playing the sports we’ve loved all our lives without paying a huge price afterward and limping around or lying in bed at night with pain? I really care a lot about that.”

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