Ask the Doctors July 2010 Issue

Women and Arthritis . . . Differentiating Symptoms . . .Oral Pills for Knee Pain

Q. What are the first signs of arthritis? How can I differentiate these signs, or symptoms, from similar symptoms that are associated with other conditions?

The symptoms of arthritis can be vague and confusing. There are more than 100 types of arthritis and related rheumatic conditions, so determining what is causing the symptoms can be difficult.


The two most common forms of arthritis are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis usually first affects the small joints, such as the wrist or fingers, and patients experience morning joint stiffness that gets better in an hour or so. The joints also may be swollen and sore. The adult form of rheumatoid arthritis almost always affects at least three joints, including at least one wrist or finger joint. Rheumatoid arthritis often is symmetrical: If one elbow or knee is affected, the other probably is, too.

Symptoms of osteoarthritis may be similar, but more often affect the large joints, such as knees and hip, first. The most common symptom of osteoarthritis is pain in the joint after repeated use. The pain may get worse later in the day, and the joint becomes stiff with prolonged inactivity.

If you have persistent pain and swelling in multiple joints, make an appointment with your doctor to determine if arthritis is the cause. Early diagnosis and treatment can help slow joint damage and prevent disability.


Are oral hyaluronic acid pills for knee pain as effective as the injected treatment?

Although some preliminary clinical studies suggest that oral administration of hyaluronan has a positive effect on osteoarthritis, it remains to be seen if there is any real benefit to the treatment. There have been no well-controlled studies establishing the effectiveness of oral hyaluronic acid, and currently the optimal amount for oral supplementation is unknown because of a lack of research.

It also is unknown whether hyaluronic acid can be effectively absorbed from the gastrointestinal tract. There have been rare reports of oral supplements causing rashes and skin irritation. Current scientific evidence suggests that injections of hyaluronic acid are more effective for relief of knee pain caused by osteoarthritis.


Why do certain forms of arthritis target women?At least 26.4 million women in the U.S. suffer from arthritis, making it the leading chronic condition among women. In fact, women account for nearly 60 percent of individuals with arthritis.


Physical and hormonal differences may contribute to the differences in the numbers of women and men affected. For example, women have less knee cartilage than men, making their knees more prone to damage and the development of arthritis. In women, the muscles and ligaments surrounding the joints also generally are smaller and not as strong as in men, leaving the joints more vulnerable to injury, which can lead to arthritis.


The most common theory about the development of rheumatoid arthritis being more common in women is associated with changes in the levels of sex hormones, including estrogen and progesterone. These hormones play a critical role in the inflammatory response and in the overall regulation of the immune system. Estrogen levels are higher in arthritic cartilage than in normal cartilage, suggesting that this hormone may be important in the development of arthritis in women.