Joint pain is the most common complaint in elderly people and the most common cause of joint pain in the elderly is osteoarthritis but there are many other causes of joint pain such as bursitis, gout, overuse of a joint, fibromyalgia, any injury to the joint, infections and other systemic diseases so consult your orthopedician for joint pain if significant for proper treatment.

In an interview with HT Lifestyle, Dr Sandeep Wasnik, Consultant - Joint Replacement and Orthopaedic Surgeon at Kokilaben Dhirubhai Ambani Hospital in Mumbai, shared, “Osteoarthritis is the most common cause of joint pain in the elderly. Osteoarthritis (OA), also known as degenerative joint disease of the joint, is typically the result of wear and tear and progressive loss of articular cartilage. Osteoarthritis happens when articular cartilage in your joint breaks down and when this happens, the bones in your joint will rub together, causing friction that makes your joint worn out & hurt, become stiff, or swell. It can be either primary or secondary. Primary is due to age-related changes and secondary osteoarthritis is due to known reasons like trauma to the joint and previous surgeries to the joint and others. Osteoarthritis cannot be cured but some treatments can relieve symptoms and will slow your condition’s progress and help you move better.”

He suggested treatment modalities as -

1. Therapy

• Physical therapy -: Exercise is one of the most important & initial treatments for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises that will strengthen your muscles and also include exercises that will improve your general fitness. A physical therapist shows you certain exercises that will strengthen your muscles around the joint, which will increase your flexibility and reduce pain.
• Occupational therapy -: An occupational therapist can help you discover other ways for your everyday tasks without putting extra stress on your already painful joint. For example, A chair in your shower could help you relieve the pain of standing if you have knee osteoarthritis.
• Weight Loss -: Being overweight or obese will make osteoarthritis worse, as it places extra strain on your joints.
• Medications: Medications that can help in relieving the osteoarthritis symptoms, primarily pain, include:
• Paracetamol. Paracetamol has been shown to help people with osteoarthritis knee who have mild to moderate pain. Taking more than the recommended dose of Paracetamol can cause liver damage, So should be used as advised by an orthopedician.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) -: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium taken at the recommended doses, typically relieve osteoarthritis pain.
NSAIDs can cause stomach upset, bleeding problems, and liver and also kidney damage, So should be used as advised by an orthopedician. NSAIDs as topical application over the skin of affected joints, have fewer side effects.

2. Supportive treatments

In addition to lifestyle changes and medications, you’ll also benefit from several supportive treatments that can help reduce your pain and make daily life activities better and easier.

• Hot or cold packs: Applying hot or cold packs to the joints can help in relieving the pain and symptoms of osteoarthritis. For instance, A person can use a hot pack in the morning to loosen up an osteoarthritic joint and can use a cold pack to reduce swelling a few hours later after the activity. This process of application of ice packs can be repeated throughout the day.
• Assistive devices: If osteoarthritis is causing difficulty in mobility or making it difficult to carry out daily life activities, several assisted devices can help. Soles of the footwear with the ability to absorb shock will help relieve some of the pressure on the joints in the legs as you walk. Special insoles will help to spread your weight more evenly. Knee braces and supports also work in a similar way to distribute weight evenly and relieve stress.

3. Surgical and other procedures

If you don’t feel better with conservative methods, you might want to consider procedures such as:

• Corticosteroid injection -: Injecting a corticosteroid into your joint might relieve pain for a few weeks. Your doctor first numbs the area around your joint where the injection needs to be given, then places a needle into the space within your joint and then injects medication. The number of cortisone injections per year is generally limited to two or three because sometimes these can also worsen joint damage over time.
• Lubrication injections -: Hyaluronic acid injections into your joint might relieve pain by providing some cushioning effect in your knee, as it replaces normal joint fluid. Hyaluronic acid is similar to a component normally found in joint fluid.
• Realigning bones -: If one side of your knee is more damaged than the other, an osteotomy might be helpful. For instance, in a knee osteotomy, a surgeon cuts across the bone either above or below the knee joint and then removes or adds a wedge of bone, and then fixes it such that this will shift your body weight away from the damaged or worn-out part of the knee. Similarly in the hip joint also.
• Robotic Total Joint Replacement-: The replacement of a joint is called Arthroplasty. Arthroplasty is a common orthopaedic surgery nowadays that involves replacing the articular surfaces of the joint with a prosthesis. Robotic Joint Replacement aims to improve the quality of life of individuals suffering from moderate-severe stage osteoarthritis by reducing pain increasing function and improving patients' physical activity. With the advent of Robotic, more precision and accuracy are achieved in aligning the bones

Bringing his expertise to the same, Dr Yash Gulati, Senior Consultant - Orthopedics, Joint Replacement and Spine at Indraprastha Apollo Hospitals in New Delhi, shared, "Joint pain can be a debilitating experience, affecting your mobility and overall quality of life. Whether caused by arthritis, injury, or age-related wear and tear, finding effective remedies to alleviate joint aches is crucial. It is very important to find out whether joint pain is due to age related wear and tear or "Green flag Arthritis" or is it due to inflammatory type of Arthritis like rhematoid arthritis s "Red Flag Arthritis"."

He added, “Treatment of both of these in early stages can be very different as the inflammatory type of Arthritis may require special disease modifying drugs. Type of symptoms, involvement of small joints of hand and feet, prolonged stiffness may indicate early inflammatory type of arthritis. Certain blood test can also help diagnose it.”

In early stages of non-inflammatory arthritis, he recommended some of the best remedies to consider -

1. Exercise and Stretching: While it may seem counterintuitive, gentle exercises and stretching can help reduce joint pain and improve flexibility. Low-impact activities like walking, swimming, or cycling can strengthen the muscles around the joints, reducing the stress on them. Additionally, stretching exercises can improve range of motion and promote better joint health.

2. Hot and Cold Therapy: Applying heat or cold to the affected joints can provide temporary relief from pain and inflammation. Heat therapy, such as warm baths or heating pads, can improve blood circulation and relax stiff muscles. Cold therapy, like ice packs or cold compresses, can reduce swelling and numb pain receptors.

3. Over-the-Counter Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate joint pain and reduce inflammation. However, it's essential to follow the recommended dosage and consult a healthcare professional if you plan to use them for an extended period, as they may have potential side effects.

4. Topical Creams and Ointments: Topical pain relievers containing ingredients like menthol, camphor, or capsaicin can provide localized relief by increasing blood flow and creating a cooling or warming sensation. These creams and ointments can be applied directly to the affected joints.

5. Weight Management: Excess weight can put additional strain on weight-bearing joints like knees and hips, exacerbating pain and inflammation. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce the stress on your joints and alleviate discomfort.

6. Glucosamine and Chondroitin: These natural supplements are believed to promote joint health by supporting the formation of cartilage and reducing inflammation. While research on their effectiveness is mixed, some individuals have reported relief from joint pain after incorporating these supplements into their routine.

7. Massage Therapy: Professional massage therapy can help relax tense muscles around the joints, improve circulation, and promote overall relaxation. Techniques like deep tissue massage or trigger point therapy can target specific areas of discomfort and provide relief.

Weight reduction in overweight patient would be extremely important. In a late or end stage arthritis, surgery in the form of joint replacement may be required.

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