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None of these processes occur in isolation. "Everything is failing together," says Dr. David Felson, a rheumatologist at Boston University. "That includes bone damage, the responses to that, muscle weakness, inflammation of the lining of the joint and ligament disruption." It follows that to be successful, any treatment will have to deal with all these factors.
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 pain killers like acetaminophen (Tylenol) are often all that's necessary to control their symptoms. Things become more complicated when inflammation is involved. Old standbys like aspirin or ibuprofen are pretty good anti-inflammatories, but long-term use can trigger dangerous side effects like internal bleeding. Newer drugs, such as COX-2 inhibitors Vioxx and Celebrex, are safer but no substitute for some of the long-term changes you may need to make.
Indeed, some researchers believe there's too much emphasis on drug treatments for osteoarthritis. "It's clear that there are other things that can improve symptoms as much as pills," says Indiana University's Brandt. Losing as little as 10 lbs. 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. That's not to say that Brandt discounts the benefits of drugs altogether. But they're more effective, he argues, when combined with lifestyle changes.
One person who is sold on a more holistic approach is Larry Nun, 56, a computer analyst who lives in Franklin, Ind. Nun first noticed the soreness around his kneecaps when he was still in his 30s. A couple of accidents, one of which required surgery to repair torn cartilage, didn't help matters. Ten years ago, Nun, who stands 6 ft. 4 in. and weighs 345 lbs., adopted some of Brandt's exercise routines and resolved to lose weight. (One of the most effective ways to cope with sitting for long stretches, he found, was to warm up his legs with a series of leg raises before standing.) Now Nun's knees act up only when he's not moving. "I'd say I've been able to control it," he says. "And I know it's not getting worse."
Meanwhile, a lot of effort has gone into figuring out how to replace damaged cartilage. Many arthritis sufferers swear by the dietary supplements glucosamine and chondroitin. Preliminary studies suggest that they may relieve pain, but the jury's still out on whether they actually promote the growth of new cartilage. The first approved biotech cartilage implants have hit the inevitable stalemate: once the new cartilage is in place, it's subject to the same destructive forces that chewed up the original cartilage. In addition, transplanted cartilage does not seem to adhere very well to existing tissue, though researchers are trying new approaches to get around that problem.