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Take, for example, the quadriceps, the large muscles on the front of the thighs that help raise and lower the legs. "It's common knowledge that patients with osteoarthritis of the knee will have weakness in the quadriceps," says Dr. Kenneth Brandt, a rheumatologist at Indiana University in Indianapolis. For a long time, physicians assumed this was because their patients' pain prevented them from exercising. But five years ago, Brandt and his colleagues began studying a group of 400 elderly people living in central Indiana and discovered, much to their surprise, that weakness in the quadriceps in some cases preceded the advent of osteoarthritis.
It makes sense. The stronger the muscles, the greater the load they take off the joint, thus limiting damage to the cartilage. Brandt's group is trying to determine whether healthy seniors who strengthen their quads by doing exercises with elastic bands can delay, or possibly prevent, the disabling consequences of osteoarthritis in their knees. Professor Mohd Farooque, former head of orthopedics at the All India Institute of Medical Sciences in New Delhi, says this is particularly applicable in Asia: "In the West, arthritis is seen much more in the hip, but here it is much more in the knee. This is because we sit like Buddha, we squat on the toilet, we kneel to pray, and it puts the knee under extreme stress. If it's a daily activity, the muscles and joints adjust. But if people, say, don't pray as often as they might, then it can do a lot of damage."
However the arthritic process gets started, the damage to the joint eventually begins to grow. That's when the body's immune system gets into the act. White blood cells rush into the joint and release destructive proteins that chew up the pieces of damaged tissue. This so-called inflammatory process, which is often but not necessarily accompanied by swelling, works well when the body needs to fend off an acute attack, say, from invading viruses or bacteria. But when the problem is chronic, as in osteoarthritis, the white blood cells might overreact, repeatedly releasing so many "mopping up" proteins that even healthy tissue is laid waste. In rheumatoid arthritis, the immune-system response is particularly aggressive.
So what can you do? The first step for most patients is to try to get some immediate relief. About 15% don't seem to experience inflammation; for them, over-the-counter painkillers like acetaminophen (Tylenol) are often all that's necessary to control their symptoms. Things become more complicated when inflammation is involved. Western standbys like aspirin or ibuprofen are pretty good anti-inflammatories, but long-term use can trigger dangerous side effects such as internal bleeding. Traditional remedies abound as well: acupuncture, massage, hot-spring baths, herbal ointments and more targeted (and dubious) palliatives such as sour plum juice (in Taiwan) or deer horn and tiger's penis (in China). Newer drugs, such as COX-2 inhibitors Vioxx and Celebrex, tend to be more effective but aren't yet available in all Asian countries.
Some researchers believe there is too much emphasis on drug treatments for osteoarthritis. "There are other things that can improve symptoms as much as pills," says Indiana University's Brandt. Losing weight as little as 4.5 kilos can make a difference, for example, as can strengthening the muscles that surround a joint. Certain exercises, such as tracing circles in the air with the arms, have also proved helpful at keeping the joints from stiffening and losing mobility. Many arthritis sufferers swear by the dietary supplements glucosamine and chondroitin. Preliminary studies suggest they might relieve pain, but the jury's still out on whether they actually promote the growth of new cartilage.
Sometimes surgery is unavoidable. Each year doctors in the U.S. perform 270,000 knee replacements and 170,000 hip replacements. In Asia, countries like Singapore and Japan—where medical care is sophisticated and patients are relatively wealthy—lead the way. But the number of surgeries performed is rising all across Asia.
No single approach works best for everyone. As with any chronic condition, there are always some things you can't control. But there's still a lot you can do for yourself. That's the lesson Kazuko Hayashi, a 71-year-old housewife from the city of Kamakura, west of Tokyo, has learned. She has osteoarthritis in both knees. When the pain started, at the age of 60, she figured it was a by-product of her youthful days of competitive volleyball and swimming. "I thought it was an old people's disease," she says, "but I see many younger people having the same problem." Her doctor recommended knee replacement surgery, but she's hoping to avoid it, opting instead for three sessions a week of electromagnetic therapy and massages. For exercise, she walks in a swimming pool, and she's trying to shed six kilos. Hayashi is also waiting for the day researchers know enough about what triggers osteoarthritis to come up with more effective treatments. "There is a surgery to remove wrinkles; there must be a good treatment being developed for arthritis. I should live long and wait for it." Everybody else should pay attention to those twinges.
- With reporting by Joyce Huang/Taipei, Huang Yong/Beijing, Noah Isackson/Chicago, Alex Perry/New Delhi, Constance E. Richards/Asheville, Sean Scully/Los Angeles, Nelly Sindayen/Manila, Hiroko Tashiro/Tokyo and Sophie Taylor/Hong Kong