osteoarthritis management program · 2018. 1. 29. · osteoarthritis management program page 2•...

OsteoarthritisManagement Program

Osteoarthritis Management Program •

Osteoarthritis is one of the most common forms of arthritis, affectingover 21 million adults in the United States. Osteoarthritis affects thejoints and can significantly impact work, family and social life, andactivities of daily living.

Is there anything you can do?

Yes! You can manage osteoarthritis and itsimpact!

The Osteoarthritis Management Program will give you information and tools,such as a pain diary, to help you manage osteoarthritis more effectively. This resourceguide will help you get started. The guide is organized into units to help you find theinformation you need quickly. Other resources are listed in the units to help you findeven more information when you are ready.

Here is an overview of the guide:

Unit 1: Understanding OsteoarthritisLearn the basics about osteoarthritis, its symptoms and diagnosis.

Unit 2: Treating OsteoarthritisLearn about self-care measures, and medical and surgical treatments.

Unit 3: Pain ManagementLearn about managing osteoarthritis pain and identify the key elements of a pain diary.

Unit 4: Medicines for OsteoarthritisLearn about medicines commonly used in treating osteoarthritis and how you can use your medicines more safely.

Unit 5: Exercise and NutritionLearn about exercise and nutrition for osteoarthritis.

Unit 6: Your Healthcare TeamLearn about your role on your healthcare team, identify other team members and learn tips for getting the most fromyour medical appointments.

Welcome to the Osteoarthritis Management Program!


Understanding OsteoarthritisOsteoarthritis is the most common form of arthritis. It is sometimescalled degenerative joint disease or osteoarthrosis. Sometimesosteoarthritis is referred to by the abbreviation OA.

Osteoarthritis most often affects the joints at the ends of the fingers andthumbs and the joints in the neck, lower back, knees and hips. OA canaffect other joints if they have sustained injury. OA does not affect otherparts of the body.

What are joints?Joints provide flexibility and stability for the body. They also providesupport and protection.

A tough membrane sac called the joint capsule holds the bones andother parts together in the joint. The joint capsule is lined with a thinmembrane called the synovium (sin-O-vee-um). The synovium producesa fluid called synovial fluid, which lubricates the joint and providesnutrients and oxygen to the cartilage.

Cartilage is a hard, slippery coating on the end of each bone. Cartilageis composed of substances that absorb pressure that occurs betweenbones during movement.

What happens in osteoarthritis?In the early stages of osteoarthritis, the surface of the cartilagebecomes inflamed and swollen. In some people, the synovium may alsobe affected. The inflammation causes the cartilage to lose some of itscomponents, resulting in a worn, pitted appearance.

As OA progresses and more cartilage is lost, the ends of the bones areleft unprotected. The bones begin to rub together and cause pain andswelling. The joint is less able to move and may even lose its normalshape. Small growths called bone spurs develop at the ends of thebones and cause more damage and pain.

It is not known exactly what causes OA. Some scientists thinkcomponents of cartilage lose their ability to make repairs as they age,which allows the OA process to begin and progress. Researchers are also looking at genetic factors that may contributeto OA.

Who gets osteoarthritis?Osteoarthritis is most common in people over the age of 65. Younger people can develop OA after an injury that affects ajoint.

Both men and women can be affected. Osteoarthritis begins more often in men before the age of 45 and more often inwomen after age 45.

People who participate in activities that involve repeated direct joint impact or twisting have a higher risk of developingosteoarthritis. People who lead a sedentary life are also at higher risk due to muscle weakness and obesity.

Unit 1: Learning Goals

• Understand how osteoarthritisaffects the joints

• Identify symptoms ofosteoarthritis

• Understand how osteoarthritis isdiagnosed

• Identify resources for additionalinformation about osteoarthritis


What are the symptoms of osteoarthritis?Osteoarthritis usually starts slowly and symptoms gradually worsen.Someone with OA may notice:

• Steady or intermittent joint pain that worsens with activity and getsbetter with rest. As the disease progresses, pain may occur even atrest.

• Stiffness or problems moving a joint• Swelling or tenderness in a joint• A “crunching” feeling or the sound of bone rubbing on bone when

moving the joint

When OA affects the hands, small, bony knobs appear on the joints of the fingers. The knobs are called Heberden’s(HEB-err-denz) nodes when they affect the end joints. They are called Bouchard’s (boo-SHARDZ) nodes when theyaffect the middle joints.

How is osteoarthritis diagnosed?No single test will diagnose osteoarthritis. Instead, diagnosis is based on the history of symptoms, a medical examinationand different medical tests.

During the physical exam, the doctor will check the bothersome joints and test muscle strength and reflexes. The doctorwill want to know the degree to which the symptoms affect daily life.

X-rays will provide information about the condition of the joint. The doctor will want to see if the space between the boneshas narrowed and if there are bone spurs or other changes.

Blood tests can show if a joint lubricant called hyaluronic acid is breaking down, which may indicate OA. Blood tests mayalso help rule out other conditions that could be causing the symptoms.

A sample of the synovial fluid may be collected by inserting a needle into the affected joint. Tests on the fluid sample canhelp rule out other conditions. In people with known OA, test results may suggest the severity of the condition.

How can I learn more about osteoarthritis?The resources below will help you learn more about osteoarthritis:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases: http://www.niams.nih.gov/index.htm• U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/osteoarthritis.html• Arthritis Foundation: http://www.arthritis.org/• American College of Rheumatology: http://www.rheumatology.org/• American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/

Talk with your doctor if you do not find satisfactory answers to your questions. Ask your doctor to explain any informationyou do not understand. Record any questions as they arise. Carry your list of questions to your next appointment so youwill remember to ask them.


Treating OsteoarthritisOsteoarthritis (OA) is a condition that gradually worsens over time.Currently, there are no treatments to prevent or stop the disease.However, there are several approaches to reducing pain and disabilityand improving quality of life with OA.

Lifestyle measures are the first step in treating osteoarthritis. The goalsof these measures are to reduce stress on the affected joint and toimprove overall well-being.

Exercise improves flexibility and muscle strength, which helps protectthe joint. Exercise also reduces stress and improves mood, which helpsyou cope more effectively with your condition.

Maintaining a normal weight reduces the amount of stress placed on a joint. Exercise helps you achieve and maintain anormal weight. A healthy diet is also important to maintaining a normal weight.

In addition to helping you maintain a normal weight, a well-balanced diet provides the nutrients your body needs foroverall good health. This helps your joints and muscles function as well as possible.

Modifying the work area or using assistive devices when a task is performed will be helpful when work or leisureactivities repeatedly stress a joint with osteoarthritis. Some people may choose to change occupations or find new leisureactivities that do not place as much stress on a joint.

Shoes with shock-absorbing soles or orthopedic shoes help reduce stress on the feet, knees, hips and back. Flat heelsare also important. High heels change the angle that weight is placed on the knees and hips, causing more stress onthese joints.

What are assistive devices?Some assistive devices help support and protect joints. Others help you perform activitiesof daily living more easily.

Splints and braces help align joints and properly distribute pressure. They are mostcommonly used when osteoarthritis affects the hands, wrists, knees, ankles or feet. Splintsand braces are used during activity and also while resting.

Canes, crutches or walkers may be beneficial for people with advanced osteoarthritis thataffects mobility. These devices reduce the risk for falls and injuries due to falls. People whoare at high risk for falling may also choose to use specially designed hip protectors to helpguard against hip fractures.

Splints and braces must be specially fitted. Use of an improperly fitting splint or brace cancause more harm than good. General devices such as canes and walkers must beselected and adjusted based on height. If a device is not adjusted to the person using it,discomfort, fatigue and possibly falls can occur.

The list of assistive devices for activities of daily living is long and varied. Eating utensilswith modified handles, jar openers, key turners, shoe inserts, bathroom equipment, suchas raised toilet seats and handrails, footstools and bookstands are a few examples of thedevices available.


• Identify self-care measures fortreating osteoarthritis

• Identify medical treatments usedfor osteoarthritis

• Learn when surgery may be usedto treat osteoarthritis

Physical therapistsand occupationaltherapists can helpyou identify devicesthat may be mostuseful for you.

They can alsoprovide training forusing a device tohelp insure you getthe most benefitfrom the device.


Can supplements and herbal remedies help osteoarthritis?Glucosamine and chondroitin sulfate are substances naturally found inand around cartilage in the joint. These substances may play a role inthe maintenance and repair of cartilage.

Some research has shown that use of glucosamine and chondroitinsulfate helps reduce pain in people with osteoarthritis. Other researchsuggests that use of these supplements may slow cartilage damage.However, there is not yet any conclusive evidence.

Calcium and vitamin D are important for strong bones. Strong bones areimportant to reduce the risk of falls and injuries that could cause moredamage to the joints affected by osteoarthritis.

Researchers are studying the possible benefits of other supplements for people withosteoarthritis. These include fish oil and omega-3 fatty acids, vitamin B3 (niacin), vitamin Cand isoflavones.

Always talk with your doctor before using a supplement or herbal remedy. Glucosamineand chondroitin sulfate may cause side effects and can cause problems if used with othermedicines or by people with certain health conditions.

You can learn more about supplements by visiting the U.S. Food and Drug Administrationwebsite. The address is: http://www.cfsan.fda.gov/~dms/supplmnt.html

What medicines are used to treat osteoarthritis?There are no medicines to prevent osteoarthritis or stop it from becoming worse. However, there are many medicines torelieve symptoms. You can learn more about medicines for osteoarthritis in Unit 4.

When are corticosteroids used to treat osteoarthritis?Corticosteroids (COR-tee-co-STER-oids) are also known as glucocorticoids (glue-co-COR-tee-coids). These medicinesare only used if there is inflammation in the joint. Corticosteroids relieve pain by reducing the inflammation.Corticosteroids are injected directly into a joint. Injections are limited to two or three treatments per year due to concernthat long-term use may cause problems. Oral corticosteroids, such as prednisone tablets, are not used to treatosteoarthritis.

What is hyaluronic acid?Hyaluronic (hi-a-lu-RON-ic) acid is a substance that occurs naturally in the joints. It acts as a lubricant for slow movementand absorbs shock to the joint during fast motions. In people with osteoarthritis, the fluid gets thinner and does notprotect the joint very well.

Hyaluronic acid is used to treat osteoarthritis of the knee in people who do not get relief from exercise, physical therapyor simple pain medicines. This medicine is injected directly into the knee joint. Excessive weight-bearing activity, such asstanding for long periods or heavy lifting, must be avoided for about 48 hours after the injection is given.

Always talk with

your doctorbefore using a

supplement or herbal remedy.

A well-balanced diet provides the nutrients your body needs for overall good health.This helps your joints and muscles function as well as possible.


When is surgery used to treat osteoarthritis?Surgery is usually considered a last measure for relieving pain andimproving function in people with osteoarthritis. Surgery may beperformed for the following reasons:

• To remove loose pieces of cartilage or bone from the joint if they arecausing problems with joint function

• To smooth out (resurface) the bones in the joint• To reposition bones in the joint• To replace the joint

Several factors influence the decision to use surgery. These include:

• The level of disability and the degree to which it interferes with daily living• The intensity of pain• The patient’s age• The patient’s occupation

The type of surgery performed depends on what the surgery is intended to accomplish. The following are surgicalprocedures that may be performed on people with osteoarthritis.

Arthroscopy uses miniature instruments inserted through tiny incisions (cuts). An arthroscope is a miniature telescopethat is inserted into the joint. After the joint is filled with fluid, the surgeon is able to see the inside of the joint and performtasks, such as removing particles from the joint (debridement) or cleaning the joint (lavage or irrigation). Other problemscan also be corrected with arthroscopy.

Osteotomy involves reshaping the bones of the knee to improve alignment. This procedure may be performed if damageto the cartilage is limited to one compartment (section) of the knee. The bones are repositioned so weight bearing isshifted away from the damaged part of the knee.

Arthroplasty is the medical term for joint replacement. Part of a joint may be replaced, or the total joint may be replacedwhen osteoarthritis is so severe that normal functioning is impossible. Hip replacement and knee replacement are themost common procedures. Other joints may be also replaced, including shoulders, elbows, wrists and fingers. Somejoints, such as those in the spine, cannot be replaced. Some people are not good candidates for arthroplasty. Theseinclude people who have severe osteoporosis or who are obese. Other medical conditions, such as neurological (brainand nerve) disorders, are also taken into consideration.

Doctors who perform surgery on the bones and joints are called orthopedic surgeons. You can get more informationabout surgery for osteoarthritis from the American Academy of Orthopaedic Surgeons. The web address is:http://orthoinfo.aaos.org/

DID YOU KNOW?Support groups for osteoarthritis are available in many communities.

Ask your doctor for more information.


Pain ManagementPain is a common symptom with osteoarthritis. Fortunately, there aremany self-help measures you can use to relieve pain.

The first step to relieve your pain is understanding your pain and how ifaffects your life. Knowing what affects the pain will help you control itmore effectively. This can be accomplished most easily with a pain diary.

What is a pain diary?A pain diary is a record of your experience with pain. A pain diary willhelp you and your doctor understand your pain and its impact on yourlife. The diary can also help you determine if your treatment plan isworking as intended.

To keep a pain diary, record the following information:

• When the pain started• What you were doing when the pain started• A description of the pain (dull, ache, sharp, stabbing, burning, throbbing, etc.)• The severity of the pain, where “1” is very mild and “10” is very severe• Treatment for the pain. List the name and amount of medicines you used (e.g. Tylenol,® 250

mg) and other treatments, such as ice, heat, deep breathing, relaxation, etc.• How well the treatment worked. Indicate if the pain was completely relieved, improved or did not

change.• How the pain affected your life. Indicate the degree to which you had to miss or limit work, social or

family activity or household tasks because of the pain.

It is important that the information in your pain diary be as accurate and complete as possible. Record information in yourdiary on the same day you experience the pain. It is easy to forget or confuse information if you wait several days beforewriting it down.

A blank diary form is included on page 10. As you search for additional information about osteoarthritis, you may discoveranother form that you would prefer to use. You may even prefer to design your own! Regardless of the form you use, besure to share it with your doctor during your scheduled appointments.

What are some self-help measures I can use to relieve pain?Thinking about pain can affect pain severity. Distracting activities keep you from focusing on the pain, which can makethe pain less intense. Pursue hobbies and participate in fun activities that require your attention.

Pain is a type of stress. Your body responds to pain in the same way it responds to other forms of stress. Muscles tighten.Heart rate increases. Breathing becomes fast and shallow. These reactions can worsen pain, leading to a vicious cycle.

Relaxation techniques can reverse these effects and lessen your pain. One easy relaxation tool is focusing on slow, deepbreathing. Progressive muscle relaxation and imagery are other techniques you may wish to learn. Ask your doctor forthe names of health professionals in your area who can help you master these techniques. You can also learn moreabout relaxation to manage pain at the Arthritis Foundation. The web address is: www.arthritis.org.

Can ice or heat relieve osteoarthritis pain?When a joint is inflamed, applying cold (like an ice or cold pack) for 20 to 30 minutes can help relieve pain. A package offrozen vegetables makes a handy substitute if you do not have an ice pack. Ice or cold packs should never be applieddirectly to the skin. Wrap ice or a cold pack in a cloth before using it next to the skin.

Hot soaks, warm towels and heating pads can help relieve pain and stiffness. Limit heat use to 20 minute sessions anduse mild heat to prevent burns. Never use heating pads while sleeping.

In general, ice is used after activity that could aggravate osteoarthritis. Heat is used before an activity and to relax andloosen tissues and stimulate blood flow to the area. Talk with your doctor or physical therapist for more information aboutusing ice and heat.


• Identify information to record in apain diary

• Identify self-care measures forrelieving pain

• Understand precautions for usingcomplementary and alternativetreatments

Start your pain diary.

Go to page 10or create your own!


Researchers are studying the possible role of CAM therapies, such as acupunture, with painmanagement. Although early findings suggest acupuncture may help some patients, noclear statements can be made regarding benefit from CAM therapies at this point.

If you are considering a CAM therapy, learn all you can about the product or service.Health information is abundant, especially in this day of the Internet. It is important thatyou evaluate information carefully before deciding to use a particular product orservice. Always consider the following when evaluating information:

Who is providing the information? Information provided by government agencies, suchas the National Institutes of Health, and universities are generally trustworthy sources.

Is there any reason to believe the information is biased? More thorough research of thetopic should be conducted when the primary intent of information is to sell a product.

Is the information up-to-date? Look for a publication date. When looking at websites,remember, “date modified” and “last updated” do not necessarily refer to theinformation. Contact the site’s sponsor to determine when the information was lastrevised if this is not explicitly stated.

Once you have information you believe is trustworthy, talk with your doctor. Yourdoctor can help you decide if the therapy may be worth the time and expense.

When should pain medicines be used?There are many medicines that may provide relief from osteoarthritis pain. You canlearn more about these medicines in Unit 4.

In general, pain medicines are recommended when other measures do not providesufficient relief. The medicines are then used in addition to the other pain reliefmeasures.

If you use pain medicines, do not let the pain become too severe before taking themedicine. The medicine may not provide relief as well if the pain is too severe. Talkwith your doctor about using your pain medicines in the most effective manner.

Where can I find more information about managing pain?The resources below will help you learn more about managing pain withosteoarthritis:

• American Pain Foundation: http://www.painfoundation.org/• Arthritis Foundation: http://www.arthritis.org/conditions/Pain_Center/default.asp

Talk with your doctor if you do not find satisfactory answers to your questions. Ask your doctor to explain any informationyou do not understand.

What are complementary and alternative medicine treatments forpain?The National Center for Complementary and Alternative Medicine(NCCAM) defines complementary and alternative medicine (CAM) as “agroup of diverse medical and health care systems, practices, andproducts that are not presently considered to be part of conventionalmedicine.” Complementary therapies are used along with conventionalmedicine. Alternative therapies are used instead of conventionalmedicine. The treatments classified as complementary or alternativetherapy continue to change as research determines the safety andeffectiveness of each treatment.

Be wary ofproducts orservices claiming…

Quick or miracle cures

Limited availability

Use of a secretformula

Use of informationsuppressed by thegovernment or medicalgroups

Effectiveness for awide range ofproblems

If you areconsidering a CAM therapy,

learn all you canabout the product or

service.

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Medicines for OsteoarthritisCurrently there are no medicines to prevent osteoarthritis (OA) or stop itfrom becoming worse. However, there are many medicines to relievesymptoms of OA.

The following are some of the medicines commonly used in treatingosteoarthritis:

AcetaminophenAcetaminophen (Tylenol®) is the first choice for treating mild to moderate pain of osteoarthritis. Acetaminophen does notreduce inflammation. Like all medicines, there are risks associated with its use. People with liver problems, who drinkalcohol heavily, or who use blood-thinning medicines or nonsteroidal anti-inflammatory drugs (NSAIDs) should usecaution when considering taking acetaminophen. Talk with your doctor or pharmacist for more information about usingacetaminophen.

NSAIDs (nonsteroidal anti-inflammatory drugs)NSAIDs relieve moderate to severe pain and reduce inflammation. Some NSAIDs are available only by prescription(Naprosyn,® Motrin® 800 mg). Many others are available over-the-counter (aspirin, ibuprofen, naproxen sodium, Aleve,®

Motrin,® Advil®). There are risks associated with using NSAIDs. The risk is greater for people age 65 and older. The risk isalso greater for people with a history of asthma, stomach problems, ulcers, gastrointestinal bleeding, heart disease orcongestive heart failure. NSAIDs cannot be used with certain other medicines because NSAIDs affect the way the bodyuses or eliminates these medicines. Talk with your doctor or pharmacist before using a NSAID.

COX-2 inhibitorsCOX-2 inhibitors (Celebrex®) are a new type of nonsteroidal anti-inflammatory drug that cause fewer gastrointestinalproblems than the traditional NSAIDs. COX-2 inhibitors are available by prescription only. There are risks associated withtheir use and people who use a COX-2 medicine should be monitored for serious side effects. Talk with your doctor aboutthe risks and benefits of using a COX-2 inhibitor.

Other medicinesThe following medicines may also be used in treating osteoarthritis:

• Topical pain-relieving creams, rubs or sprays are applied directly to the skin. Some contain salicylates (sa-LIS-ill-ates)and skin irritants. Salicylates alter the ability of nerve endings in the skin to detect pain. Skin irritants cause sensationssuch as hot or cold that distract from the pain. Many of these products (Icy Hot,® Arthritis Hot®) are available over-the-counter. Products containing capsaicin (cap-SAY-sin) (Zostrix®) may relieve inflammation in addition to providing painrelief.

• Opioids are also known as narcotic pain medicines. These medicines are used to manage severe pain when othertreatments do not provide sufficient relief. Narcotic pain medicines are only available by prescription. Examples includeoxycodone (Percodan,® Percocet,® Oxycontin®) and hydrocodone (Vicodin®). These medicines can be addictive and theiruse is monitored closely and may be restricted.

• Tramadol (Ultram®) is a prescription medicine that relieves pain. It is similar to narcotic pain medicines but it is not asaddictive. This medicine is sometimes used in combination with acetaminophen (Ultracet®).

• Corticosteroids (COR-tee-co-STER-oids) are also known as glucocorticoids (glue-co-COR-tee-coids). A doctor injectsthese medicines directly into a joint. They relieve pain by reducing inflammation. Corticosteroid injections are limited to 2or 3 treatments per year. Oral corticosteroids, such as prednisone tablets, are not used to treat osteoarthritis.

• Hyaluronic acid (hi-a-lu-RON-ic) is used to treat osteoarthritis of the knee. A doctor injects this medicine directly into theknee joint. This treatment is called viscosupplementation (VIS-ko-sup-lee-men-TAY-shun). Hyaluronic acid injections maybe considered for people with osteoarthritis in the knee for whom acetaminophen, NSAIDs and COX-2 inhibitors do notprovide relief.


• Recognize medicines that may beused in treating osteoarthritis

• Identify things you can do toensure you are using yourmedicines safely

• Identify important facts youshould know for each medicineyou use



How can I ensure I am using my medicines safely?Knowing all you can about your medicines will help you use them moresafely. Begin by understanding the names of your medicine.

All medicines have two names. The brand or trade name belongs to asingle manufacturer of the medicine. The generic name refers to theactive ingredient in the product. All companies use the same genericname if they manufacture that medicine, and then give their uniquebrand name to the product.

Learn the generic name, especially if there is more than one brandname product with that medicine. This allows you to more easilyrecognize and avoid medicines that may have caused problems inthe past.

It is easy to confuse medicine containers. Always read the labelbefore taking the medicine. This means you should never take amedicine in the dark! If you do not want to disturb someone byturning on a bright light, use a small flashlight to read the medicinelabel.

Drug information sheets provide information to help you use yourmedicine safely and effectively. An information sheet is providedwhenever you fill a new prescription. This information can also befound at the U.S. National Library of Medicine and National Institutesof Health website. The address is:http://www.nlm.nih.gov/medlineplus/druginformation.html

Read the drug information sheet before you begin taking themedicine! Look at the generic name of the medicine. Have you hadproblems with this medicine in the past? Read the list of things yourdoctor should know. Do you have any of these conditions that youhave not reported to your doctor? If you answer yes to either ofthese questions, talk with your doctor or pharmacist before you takethe medicine!

All medicines have side effects. Learn what side effects you mightexperience by reading the drug information sheet. Some side effectsshould be reported to your doctor immediately. Others may bereported during your next scheduled appointment with your doctor.The side effects you experience and the impact they have on yourability to function will influence your doctor’s decision about whetheryou should continue to use the medicine. Always tell your doctorabout symptoms you experience while taking a medicine.

Trade Generic

Tylenol® acetaminophen

Advil® ibuprofen

Motrin® ibuprofen

Orudis® ketoprofen

Examples of Medicine Names*

*NOTE: Brand names included as examples only, and their inclusion does not mean that these products are endorsed by theauthor. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Know These Facts…

Why is the medicine used?

How do I take the medicine?

What do I do if I miss a dose?

What drugs or foods may interactwith the medicine?

What side effects may occur?

What special precautions should Ifollow?

How do I store the medicine?


Are there special precautions for using over-the-countermedicines?Remember, over-the-counter medicines are medicines! Know the samefacts about medicines you buy over the counter that you do for yourprescription medicines. (See Know These Facts...on the previous page.)

Read the label and follow the instructions for using the medicine. Do nottake more of the medicine or use it for longer than recommended unlessyour doctor has told you otherwise.

Similar over-the-counter products may have different ingredients. Read the label to be sure theproduct does not contain an ingredient you should not take.

People with certain health conditions should not use some over-the-counter medicines. Inaddition, some over-the-counter medicines should not be used because they can reactwith other medicines you are taking. Check the label for warnings about who should notuse the medicine.

Over-the-counter medicines can have side effects. Check the product label for possible sideeffects. Know when you should stop using the medicine and under what circumstances youshould contact your doctor.

Talk with your pharmacist if you are unsure whether or not you can use a particular over-the-counter medicine.

Always tell your doctor and pharmacist about all over-the-counter medicines you take.

Always read the

label before taking the medicine.


Exercise & NutritionThere’s no ignoring it. There’s no denying it. People with osteoarthritiscan improve function and well-being by maintaining an appropriateexercise program and a healthy diet!

What are the benefits of exercise in osteoarthritis?It can be scary to think about exercising when you know you have a problem with one ormore joints. After all, you do not want to cause more problems, right? But exercise hasmany benefits for people with osteoarthritis, such as:

• Increased flexibility, which improves ability to perform daily activities• Decreased pain• Reduced stress and improved mood • Improved general health• Weight maintenance

Exercising regularly is one of the best things you can do for yourself! Exercise can bedone at home where it is convenient and inexpensive. Participating in group exerciseprograms can provide the benefits of exercise and the fun of socializing with others.

What exercises should I do?The best exercise program for you depends on which joints are affected by osteoarthritis.Talk with your doctor, physical therapist or occupational therapist about designing anexercise program tailored to your specific needs. In general, a well-rounded exerciseprogram will include 3 types of exercise:

• Stretching exercises improve joint function and flexibility.• Strengthening exercises improve muscle strength. Strong muscles protect joints from

stress.• Aerobic exercises are also called endurance or cardiovascular exercises. These

exercises improve heart and lung function and overall stamina, which promote healthierjoints.

Always include a warm-up period before beginning your exercises. Warm-up activitiesincrease blood flow to muscles. This provides the oxygen and nutrients the musclesneed to work properly and reduces the risk of injury. Stretching exercises are not a goodwarm-up activity. Stretching exercises should be done after a general warm-up activitythat increases blood flow and warms the muscles. Ask your healthcare provider aboutthe best warm-up activities for your exercise program.

A cool-down period after exercising allows the body to gradually return to its restingstate. This helps you avoid problems, such as dizziness, that can occur if exercise isstopped suddenly. Good cool-down activities include slowing the pace of the mainactivity you are doing for 5 to 10 minutes.

Learn to do recommended exercises correctly. Exercising incorrectly can cause injury.


• Identify the benefits of exercise

• Identify the best exercise programfor you

• Know how to determine your BMI

Exercising regularly is one

of the best things you can do for

yourself!

Did YouKnow?

Water exercise is agreat choice forpeople with OA.Public pools areavailable in manycommunities, andwater exerciseclasses may even be available.


How can I “stick with” an exercise program more easily?Begin by setting realistic goals. Start slowly. Improvements from exerciseoccur gradually. As they do, set new goals.

Make exercise part of your daily routine. Some exercises may need tobe done every day. Other exercises may require a day of rest betweensessions. Talk with your doctor, physical therapist or occupationaltherapist about an exercise schedule. Regardless of which exercises youmay do on a given day, it is easier to maintain an exercise program ifyou perform some part of it every day.

What precautions should I take with exercise?Ask your doctor, physical therapist or occupational therapist for guidelines on exercising when a joint is sore or swollen.Also ask for guidelines for when you should use medicines to relieve pain and inflammation.

Listen to your body. Some exercises will cause discomfort. However, pain is an indication that something is wrong. Stopan exercise if it is causing pain. Do not stop your exercise program! Instead, talk with your healthcare team if an exercisecontinues to cause pain. You may be doing an exercise incorrectly or your condition may have changed such that youneed other exercises.

Why is weight so important for people with osteoarthritis?Every pound of body weight transmits 3 to 4 pounds of pressure to the joints. Extra pounds carried on the body placemore pressure on your joints!

Maintaining a normal weight or losing excess weight will reduce the stress on joints. This may help prevent osteoarthritisin the knee and hip. Achieving and maintaining a normal weight may also help slow progression of osteoarthritis once ithas started.

What is BMI?BMI stands for body mass index. This is a measure of body fat basedon height and weight in adults. You can find more information aboutBMI at the National Heart, Lung and Blood Institute. A BMI calculatoris also provided for your convenience. The address is:http://nhlbisupport.com/bmi/bmicalc.htm

If you do not have Internet access, you can calculate your BMI usingthe steps below.

1. Multiply your weight in pounds by 703.

2. Multiply your height in inches by your height in inches.

3. Divide the first number by the second number.

Talk with your doctor to determine the steps you should take if your BMI is 25 or higher.

BMI Categories

Underweight <18.5

Normal weight 18.5 – 24.9

Overweight 25 – 29.9

Obesity 30 or greater

Example of BMI Calculation

1. 125 lbs x 703 = 87,8752. 67 ins x 67 ins = 4,4893. 87,875 ÷ 4,489 = 19.6

BMI = 19.6 - Normal weight


Dietary needs vary based on your goals. Health conditions and activity levels also affect dietary needs. Talk with yourdoctor or a dietician to determine the best way to meet your nutritional needs. You can also get more information byvisiting the U.S. Department of Agriculture website at: http://www.mypyramid.gov/

Are “natural” or “herbal” weight-loss products safe and effective for people with osteoarthritis?Products labeled as “natural” or “herbal” are not regulated by the Food and Drug Administration and are not usuallytested to determine safety or effectiveness. Always talk with your doctor before using a supplement or herbal remedy.Some supplements and herbal remedies can cause problems if used with other medicines or by people with certainhealth conditions.

You can learn more about supplements by visiting the U.S. Food and Drug Administration website. The address is:http://www.cfsan.fda.gov/~dms/supplmnt.html

REMEMBER! A healthy diet and exercise are the best way to lose weight and keep it off.

What is the Food Pyramid?The Food Pyramid illustrates the elements of a healthy diet.The Food Pyramid is part of the Dietary Guidelines forAmericans. The guidelines were developed by the U.S.Department of Health and Human Services (HHS) and theU.S. Department of Agriculture (USDA) to help people makesmart choices about food and activity.

You also have a responsibility to communicate with the other members of your team. Share your concerns. Only youknow what your concerns are. Once they become aware of the situation, your healthcare team members can help youaddress your concerns more effectively.

Have you not been following medical instructions? Perhaps you have done something to increase joint pain that youwould rather not admit. Be honest, even if it makes you feel embarrassed or uncomfortable. In these situations, it mayhelp to let your healthcare provider know of your embarrassment or discomfort. Most likely, your healthcare provider hasencountered others with similar situations and can help you feel more relaxed in discussing the problem.

Discuss any objections you may have to recommended treatments. Your doctor or another team member may be able toidentify more acceptable treatments. Tell your doctor if financial or otherconcerns are keeping you from following treatment instructions. Your teammay be able to help you overcome the problems you are having.

Who are other members of my healthcare team?Your healthcare team may include several of the following health profes-sionals:

• Primary care physicians (PCPs) provide general health care and mayrefer patients to specialists as needed.

• Rheumatologists are physicians who specialize in the diagnosis andtreatment of diseases that affect the joints, muscles and bones.

• Orthopedists are physicians who specialize in surgery and other treatment for diseases that affect the bones and joints.• Physical therapists (PTs) assist patients to regain function, improve mobility and relieve pain due to muscle or joint

problems through physical movement and treatment.• Occupational therapists (OTs) help patients regain, maintain or improve their ability to perform activities of daily living.

Use the resources below to learn more about health professionals who may be part of your team.

• American Medical Association, Allied Health Careers: http://www.ama-assn.org/ama/pub/category/14598.html• U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/directories.html


Your Healthcare TeamManaging osteoarthritis is a team effort. Who is the captain of the team?You are!

You know yourself better than anyone else. Only you can describe yoursymptoms and the effect they have on your life.

As the captain of your healthcare team, you have a responsibility tobecome knowledgeable about osteoarthritis and its treatment. This willenable you to make more informed decisions about your care.


• Identify your role on yourhealthcare team

• Identify members of yourhealthcare team

• Learn tips for making yourmedical appointments moreproductive

Skip the Heels!Wearing high heels can be detrimental to your health if you have OA.

Go for flat shoes.

A positiveattitude isimportant intreating OA.


How can I get the most from my medical appointments?Your medical appointment is the time your doctor or therapist hasdevoted to focusing on you. Be prepared. Carry your pain diary andanything else your healthcare provider may have requested you bring toyour appointment. (See Unit 3 for more information about keeping a paindiary.)

Ask questions. Write down questions you want to ask before your appointment so you will not forget to ask them. Ask themost important questions first to be sure there is plenty of time for them to be answered. During the appointment, askquestions about anything you do not understand. You may even want to ask for an illustration to help you understandmore clearly.

In some cases you may want to have someone accompany you to the medicalappointment. A family member or friend can help you remember what is discussed. If youfind you have more discomfort at the end of the appointment, your companion can helpyou return home safely.

Get directions in writing. If your doctor or therapist does not write down the informationfor you, ask for time to write it down. Have the person check that you have writteninstructions correctly.

As you learn more about osteoarthritis, you may have questions or want your doctor’sopinion on information you have found. Be specific. Handing your doctor long articles todiscuss during your appointment may lead to disappointment and frustration. Instead, highlight thesentences that cause you the most concern. Mark the pages so thehighlighted sentences can be found quickly. This will help your doctor answeryour questions efficiently without taking too much time from other needs.

When should I call my doctor?Many medical concerns can be handled over the telephone. Some doctorsprovide instructions for when to call the office. Follow your doctor’s instruc-tions. Be prepared when you call.

If you are calling about an emergency, state this at the beginning of your call.Delay calling about less urgent matters until mid-morning or later. This avoidsthe period when the office staff is extra busy preparing for the day. Call asearly as possible if you need to cancel an appointment for that day.

Remember, every day your doctor receives many calls in addition to patientvisits. To help with this busy schedule, receptionists and nurses are trained tohandle some calls. If you feel you still need to speak directly with your doctorafter talking with a member of the office staff, politely request that your call bereturned when it is convenient.

Organize your thoughts.Write a one-sentencedescription of the problemand the reason for the call.

Have a pad and pencil readyto write any instructions youare given.

Have the telephone numberfor your pharmacy handy.

Preparing to Call

Don’t forgetto bring your pain

diary to yourappointment. See

page 10 to getstarted.


Your Notes

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