DEAR DR. ROACH:
I really appreciated your recent column on arthritis -- specifically, osteoarthritis. I'm a big exerciser; however, I have always heard that this arthritis is caused or aggravated by wear and tear. I was surprised to hear the opposite!
I have modified or given up several exercises that seem to cause me more joint pain, specifically full body weight on my wrists. Can I incorporate these exercises back into my routine? I found that certain activities like shuffling cards, buttoning, etc. made my thumbs hurt, so I adapted. Should I push through the pain assuming I'm not causing further damage to the joints?
— L. D.
ANSWER: Most exercise does not damage the joints, but high-impact or high-frequency activities can certainly make arthritis pain worse.
For osteoarthritis of the knees and hips, I recommend walking as the best exercise, start slowly and build up according to what a person can tolerate. Movement is most important, not resistance, so swimming (or just walking in a pool) is a great option for people who experience too much pain when walking.
For smaller joints in the hands and wrists, I would recommend activities that don't hurt as much. Joint stretches and movements like push-ups are a good place to start. You might consider a "stress ball" or hand therapy ball, which provides some resistance and builds hand strength.
Adapting your activities to your limitations is a good idea, but you also want to work on improving those limitations. A physical or occupational therapist is your best partner in designing a program.
Remember that over-the-counter topical anti-inflammatory drugs such as diclofenac are very effective on small joints and are very safe.
DEAR DR. ROACH:
Could you discuss the difference between rheumatoid arthritis and ankylosing spondylitis?
— S. Y.
ANSWER: Both rheumatoid arthritis and ankylosing spondylitis are uncommon (each affects about 1% of the population), inflammatory, multisystem diseases. RA affects the synovium (lining of the joint) and tends to affect the hands first, but can affect almost any joint. The main area of AS activity occurs where bones connect to ligaments, cartilage and tendons.
Both diseases have an autoimmune component. Without treatment, RA leads to joint deformities, while AS causes new bone formation, leading to pain and reduced joint mobility. The back and neck are most commonly affected in AS, but the hips and other joints can also be affected.
RA is treated early and aggressively with disease-modifying agents such as methotrexate and hydroxychloroquine or biologics.
Physical therapy is helpful in RA, but is the mainstay of therapy in AS. Medications are often needed for AS, usually starting with anti-inflammatory drugs and progressing to stronger agents as needed. About 30% will need biologics, while 94% of people with RA need a disease-modifying drug.
A rheumatologist is an expert in both conditions, and a person with both conditions should be referred to a specialist once a diagnosis is made.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.