Expert Q & A:
Doctor, My Knee Hurts
Achy joints are like gray hair — most of us will get them. Rheumatologist Mohamed Aboyoussef lays out tips and cautions.
AL: Why do our joints give us problems as we get older?
Dr. Aboyoussef: Most of us will get osteoarthritis. It’s caused by breakdown of cartilage, the cushion that fills our joints, and it’s the most common joint disorder.
People usually start coming in to see me after the age of 50. Conditions that increase the likelihood of getting osteoarthritis include advancing age, excess body weight, family history, and history of trauma to the joint.
Repeated traumas to the joint can be of particular importance. That’s why sometimes certain types of professional athletes will have osteoarthritis at an earlier age. Bicyclists, for example, can have early osteoarthritis of the hip. Soccer and basketball players can have early osteoarthritis of the hips and knees.
AL: What joints are most at risk?
Dr. Aboyoussef: The knees, hips and lower back, because these are weight-bearing joints. Osteoarthritis doesn’t really affect shoulders as much, unless someone walks on their hands all the time. Osteoarthritis can lead to pain and occasionally to locking of a joint.
Hands are commonly affected as well, and sometimes patients find lumps or nodes over the knuckles.
AL: What are your best tips for keeping joints healthy?
Dr. Aboyoussef: One, watch your weight.
Two, regular exercise is good. It’s important to choose a type of exercise that you enjoy. Living in Hawaii, we have the luxury of the beautiful weather and the ocean. Walking by the beach or swimming are great exercises for joints. There are also public parks and pools that offer aquatic exercises for patients with arthritis that can help a lot.
Swimming is very easy on the joints. However, people need to know that for bone health, you need weight-bearing exercise as well, so alternating swimming with jogging every other day can be a good start regardless of your age.
Tai chi is also very helpful. As long as the patient enjoys it, I don’t restrict exercise — but always discuss your symptoms and exercise plan with a physician first.
AL: What local foods increase inflammation?
Dr. Aboyoussef: There are no specific foods that will worsen osteoarthritis. Gout, on the other hand, is inflammation of the joints, and patients with gout can be affected by foods that are rich in purine, such as shellfish, meat products and alcohol.
AL: How can you reduce inflammation?
Dr. Aboyoussef: First, it is useful to remember that natural agents may have some of the same components as pharmaceutical agents.
Ginger has good anti-inflammatory features. Chinese thunder god vine helps some patients, but if it’s used for a long time, it can affect the immune system and the bones.
We don’t have real data on other products that certain manufacturers claim will help, like willow bark extract, cat’s claw, or stinging nettle.
You don’t want to overdo herbal remedies, because some can affect the kidneys or liver, such as herbal kava.
Whatever you’re using, it’s important to let your doctor know about all herbal supplements you’re taking. You need to present the names and ingredients.
AL: Do supplements for arthritis work?
Dr. Aboyoussef: The three major ones would be SAM-e, glucosamine-chondroitin and fish oil. SAM-e occurs naturally in our body and has been used in Europe for some time as a prescription drug for depression, and it’s used for arthritis and inflammation.
If a patient wants to try SAM-e, they can try it for three months. If it does nothing but drain the wallet, stop taking it.
The same applies for glucosamine-chondroitin. The data show that these can help some patients with osteoarthritis, but not everybody.
Fish oil in appropriate doses can help certain patients with arthritis, but always make sure you are getting a good product. Some fish oil supplements contain high levels of mercury, which can be toxic. Currently, we have FDA-approved prescriptions for fish oil, but not other supplements.
AL: What about alternative therapies?
Dr. Aboyoussef: Some studies show that acupuncture may be helpful in reducing pain, mainly for osteoarthritis of the knee. When acupuncture needles were applied in appropriate places recommended by Chinese medicine, it was effective. Of course, it’s not as effective as medications, injections or surgical interventions, but it can lead to a 20 percent to 30 percent improvement in pain levels—the same rate seen with a placebo. So whether it’s a placebo effect, nobody knows.
Patients also need to know there are lots of safe options a physician can offer. Not all medications are bad. Options include pills, injectable medications, physical therapy, and when other things fail, certain surgeries can be considered.
I always tell my patients that everything in moderation is OK. It is good to listen to the joints. Don’t overdo it. This applies for supplements, diet and exercises.
Patients should discuss options with their physician. Doctors can talk about risk versus benefit and offer what’s best for the patient with the least side effects.
