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Young and Invincible?

"Working Years with Osteoarthritis"
By: Melissa Montellano-Ngo, MDYoung and Invincible?

YOLO. “You Only Live Once,” this was the mantra of J.D., an adventure-seeking, single, 30-year-old office employee. He joined marathons, played basketball, and went out-of-town every chance he got. Recently, he was promoted, he is at the top of his game.

After participating in the company marathon, J.D. felt a sharp paoin in his right knee. It was relieved by paracetamol. Several weeks passed of continued exercise and sports activities he then had progressively, dull to sharp pain in his knees and hips at night. He felt stiffness and heard popping sounds around his knees. 

One day, his right knee was swollen and even standing was difficult leaving J.D. with no choice, but to file sick leave from work. Upon the insistence of his girlfriend, J.D. reluctantly consulted a physician thinking there was nothing seriously wrong with him - he was young and fit after all.

“What arthritis? I am just 30 you know!? Arthritis is for senior citizens.” J.D. couldn’t believe it. He was diagnosed with osteoarthritis. 

What is osteoarthritis?

It is inevitable for the physique to show signs of wear and tear, thus aches and pains. Osteoarthritis (OA) is the most common type of arthritis and is often encountered by the elderly, however, younger individuals below 40 years old can also be afflicted. Apart from advanced age, factors such as overuse, trauma, obesity, metabolic disease, congenital malformations, premature menopause, and genetics place both men and women at risk of developing OA. Runners and athletes are more prone to joint injuries.

Due to stress and overuse, the joints become unstable and the articular cartilages become denuded. Joint cartilage loss results to bone rubbing against another bone which causes pain, swelling, stiffness, and restricted joint movement. Typically, the joint damage occurs in the hands, lower back, neck, and the weight-bearing joints such as the hips, knees, and feet.

OA in the workplace

Osteoarthritis is a bothersome disorder. Because of the pain, OA can deprive working adults a restful night’s sleep, impair daily activities, and overall negatively impact the quality of life - during their supposedly productive years. In the FOMO era (fear of missing out), patients find the inability to participate in social and family activities distressing, resulting in isolation and sometimes, depression.

Pen, keyboard, and mouse are some of the important tools for work but with hand arthritis, they can be very difficult to use. A person with hand OA will have joint stiffness, difficulty moving their fingers, weak grip, tenderness or swelling knuckles or wrists. The condition will limit a worker’s productivity. Exercises such as knuckle bends, fists, finger touches and wall walking may be helpful for hand OA. Lifestyle adjustments such as using tools with padding and applying hot and cold compress may also have some benefits as well. 

Knee and Hip OA may force people to give up their work since even simple daily activities such as climbing stairs and walking are difficult for them. Hip OA can cause disabling pain in the groin, thigh, buttocks or knees. Joint stiffness is common when getting out of the bed or sitting for a long time. Swelling and stiff knees can make bending and straightening very difficult plus excess body weight gives extra pressure to the joints. Some severe osteoarthritis cases require invasive procedures to repair the worn out cartilages.

Osteoarthritis is a chronic condition. It is important for the affected to accept that OA is a progressive degenerative joint disease for which, at the moment, there is no magic cure. Nonetheless, with education, medication and lifestyle changes, pain can be managed and further joint damage may be prevented.

Medical treatment for osteoarthritis

There is no one-size-fits-all approach to OA treatment. Varying degrees of pain tolerance, damage severity, and underlying medical conditions are all considered in the care of the patient. Treating osteoarthritis aims to improve the person’s mobility and lifestyle, the advice of a physician is essential to provide proper pain management and to avoid further harm. Here are some tips:

  1. Wash your hands thoroughly with soap and water after the application of topical analgesics. This is to prevent contamination and irritation of the mouth, nose, eyes, or other mucous membranes.
  2. Topical formulations should not be applied to other skin preparations, areas with a wound or irritated skin. Note that these should not be applied on large areas of the body and package instructions should be carefully followed. 
  3. Improper or the frequent and exceeding dosage of paracetamol (acetaminophen) can cause liver damage, especially for those imbibing alcoholic drinks.
  4. Painkillers will not be beneficial if ingested sometime after drinking alcohol.
  5. Non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase inhibitors (COX-inhibitors) target both pain and inflammation for mild to moderate cases. NSAIDs may cause gastric irritations and ulcers and the doctor may recommend antacids or other medications to protect the gastrointestinal tract.
  6. The doctor may prescribe opioid analgesics for moderate pain. The use of such is closely monitored to avoid overdose and drug dependence. It is inadvisable for those driving, operating heavy machineries and drinking alcoholic beverages due to its side-effects.
  7. There are other options for the management of osteoarthritis, such as oral steroids, hyaluronic acid, Glucosamine, and chondroitin sulfate but they are generally not approved by medical societies as appropriate treatments for OA.

Long-time osteoarthritis management may lead to patient’s drug tolerance to oral pain killers. Some experts recommend a drug holiday and then reverting to a lower class of analgesic such as paracetamol or switching to a topical medication. Unresponsive patients may be injected with a steroid in between the joints or intra-articularly to reduce pain and inflammation in young individuals and athletes preferring short-term relief.

Taking medications the right way

To maximize the potential benefits of medications and avoid adverse effects:

  • Choose a topical over oral preparations.
  • Check for potential allergens.
  • Opt for the lowest effective dose.
  • Adhere to the recommended daily dose.
  • Limit the length of treatment.
  • Do not combine analgesics or different NSAID medications.
  • Abstain from alcoholic drinks.
  • Avoid ingesting pain medications with caffeinated beverages.
  • Be cautious of supplements not prescribed by physicians.
  • Do not take or apply any analgesic without the advice of a physician during pregnancy.
  • Inform the physician/s about all medications and supplements taken.
  • Consult a medical professional regularly.

Other practical advice to alleviate the pain from OA and increase mobility include:

  • a diet rich in antioxidants and omega-3 fatty acids
  • weight loss of at least 5%
  • low-impact sports such as aerobics, swimming and walking
  • stretching and muscle-strengthening exercises
  • warm compresses or showers for stiffness
  • rest and ice packs for swollen joints
  • use of braces
  • physical therapy

The right management of OA not only means freedom from pain but also means mobility for daily activities. True, it is a painful condition, but it is treatable as long as the affected person, the patient’s family, and the healthcare professionals work hand in hand to address the issues encountered during treatment. Despite the chronicity of OA, a positive outlook and proper care can allow people suffering from the condition to lead productive lives and take each day in stride.

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