Do you remember the Tin Man in the movie The Wizard of Oz? He got caught in a rainstorm and couldn't get to his oil can. Eventually, he rusted up and could hardly move.

People who have arthritis at times feel like the Tin Man.

Osteoarthritis usually affects the weight-bearing joints such as the knees and hips but it can affect any joint. It attacks cartilage, the rubbery tissue that covers the end of your bones and provides cushioning and lubrication.

There are many forms of arthritis. The term, in fact, refers to over 100 different conditions. The word arthritis means inflammation of the joints. All forms of arthritis affect the joints and other connective tissues in the body, such as ligaments and tendons. Arthritis affects an estimated 40 million Americans, the majority of them suffering from osteoarthritis. Other common types of arthritis are rheumatoid arthritis, gout, bursitis, tendonitis and fibromyalagia.

When people say arthritis, they are usually referring to osteoarthritis. In this article, we will focus on the causes, symptoms and treatment of osteoarthritis. If you, or someone in your family has osteoarthritis, you certainly do not have to feel like the Tin Man. If you take care of yourself and receive the correct medical treatment and advice you need, you can lead an active and healthy life.

The following questions and answers about osteoarthritis are based on an interview with Professor Jacob Menchell, a specialist in internal medicine, geriatric medicine and metabolic bone disease.

Q. How does osteoarthritis affect the joints?

A. Osteoarthritis is often described as "wear and tear arthritis." It is also known as "degenerative joint disease." It rarely develops before age forty. But most people have some degree of the disease by the time they reach seventy-five. It is as common with women as with men, although men often develop it at an earlier age. Osteoarthritis usually affects the weight-bearing joints such as the knees and hips but it can affect any joint. It attacks cartilage, the rubbery tissue that covers the end of your bones and provides cushioning and lubrication. The surface of the cartilage and the edges of the bones become compressed and irregular. The joint surfaces may rub against each other and small pieces of bone or cartilage can float in the joint space.

Q. What are the symptoms of osteoarthritis?

Osteoarthritis is characterized by pain, stiffness and swelling in the affected joint.

A. Osteoarthritis is characterized by pain, stiffness and swelling in the affected joint. There are really no rules as to which joints will be affected first, although in most cases it is the weight-bearing joints. Women are often affected by osteoarthritis in the joints at the end of the fingers known as the Heberdens Nodes. Pain is experienced differently by different individuals. What is painful to one person may be just an annoyance to someone else. Arthritic pain that brings you to your doctor's office is much more than the normal achy or stiff feeling you have in the morning. Generally, the pain is first experienced after physical exertion. It can be experienced while performing physical tasks connected with your job. The next stage is feeling pain in the joints when simply moving them or while resting. As the disease progresses, the pain can restrict range of motion in the affected joints, making certain routine activities difficult to perform.

Q. What type of doctor treats patients with osteoarthritis?

A. The best doctor to start with is your own family doctor or internist. He will decide whether to treat you himself or to refer you to a rheumatologist. He may also refer you to a physical therapist.

Q. Who is most like likely to be affected by osteoarthritis?

Those who work in occupations that require a great deal of physical exertion, such as construction workers, are at a higher risk of developing osteoarthritis at a relatively young age. People who are overweight may also develop it early on.

A. Due to our contemporary lifestyle, we put an enormous amount of stress on our joints. Those who work in occupations that require a great deal of physical exertion, such as construction workers, are at a higher risk of developing osteoarthritis at a relatively young age. People who are overweight may also develop it early on. A joint injury from active sports can put you at risk. There are also people who have hereditary conditions or diseases that may affect their bone structure or cartilage. Still, since osteoarthritis is a common disease of old age, most of us will have some form of it eventually.

Q. Can osteoarthritis be prevented?

A. Osteoarthritis cannot be prevented, but people who stay in shape throughout life are less likely to be affected by it then people who don't. Exercising regularly helps strengthen muscles and joints. But certain types of exercise are better than others. For example, jogging is more strenuous than walking, and joggers may develop osteoarthritis earlier. If you are beginning to experience the symptoms of osteoarthritis, it is important to reduce the physical burden to your joints. While exercise is beneficial, you should not exercise too strenuously.

Q. What are the treatments for osteoarthritis?

A. Treatments can be categorized into four groups: anti-inflammatory drugs; physical therapy, surgery, and non-conventional treatments.

1. Anti-inflammatory drugs: These are painkillers such as acetaminophen, aspirin or ibuprofen. Another group of drugs that is prescribed is known as NSAID, non-steroid anti-inflammatory drugs. A number of new and effective NSAID drugs have recently been developed to relieve the pain of arthritis. Sometimes, they create stomach problems, like ulcers and the patient must be under medical surveillance. If the arthritis persists, and other drugs are not effective, steroids might be used. There are many types of steroids and they might be given in low dosage. But there are many side effects associated with steroids, and must be closely monitored.
   

   Exercising regularly helps strengthen muscles and joints. But certain types of exercise are better than others. For example, jogging is more strenuous than walking, and joggers may develop osteoarthritis earlier.

   
   
2. Physical therapy: A professional physical therapist can work with you to strengthen the muscles around the joints and to prevent restrictions of mobility. Your physical therapist can teach you exercises to do at home. She may also use hydrotherapy, a treatment using a heated pool or whirlpool. (You can try giving yourself hot or cold treatments at home too.) In addition to physical therapy, it is important to exercise your muscles and joints by walking. Swimming is also an excellent exercise. You may want to join a class where you will do gentle stretching exercises. The point is to exercise your joints without straining them.
   
   
3. Surgery: In some cases, a person with osteoarthritis tries many treatments to relieve pain and nothing appears to work. Your joints may be damaged badly. Your doctor may suggest joint replacement surgery, or arthoplasty. In this operation the surgeon replaces the diseased or damaged bone with a synthetic substitute. Undergoing surgery may seem overwhelming, but the truth is that a hip or knee joint replacement can give you a new lease on life. About 150,000 people a year have hip replacement operations. This is the most common type of joint replacement. Arthroscopy is a new type of surgery, where an incision is made and a lighted tube is put into the joint, to examine it, and clean out some cartilage fragments causing inflammation.
   
   
4. Natural treatments such as spas and mineral baths can relieve pain and give you a sense of well being. The same is true for reflexology and various forms of massage therapies. If one of these treatments work for you, great! But please be wary of unusual treatments that promise miraculous results.

Q. How does having osteoarthritis affect you emotionally?

A. A chronic disease such as osteoarthritis can make you exhausted or depressed. Make sure to get enough rest and eat a healthy diet. Call your doctor if you have any questions and don't be afraid to talk about your feelings with him. One of the best weapons in your battle against osteoarthritis is knowledge. Understanding what treatments are available to you and having a good rapport with your doctor can give you a sense of control. You can also join a chapter of the Arthritis Foundation where you will meet others who may be feeling the same way you are.

Helpful Websites

• Intelihealth: John Hopkins University's excellent health site. In the Senior Health section there is a clearly written and informative on-line book about arthritis.
  
  
• The Arthritis Foundation: In addition to helpful answers to your questions, the Arthritis Foundation has chapters and activities around the U.S. You can also order books or pamphlets about arthritis. Some of the pamphlets are free.
  
  
• Lycos Health with WebMD: In the Condition Center, there is useful information about arthritis and many links to other related sites.

Books On Osteoarthritis

• Arthritis of the Hip and Knee: The Active Person's Guide to Taking Charge by R. Allen, V.A. Brander and S.D. Stuhlberg. Peachtree Publishers, March'98.
  
  
• Heal Your Hips: How to Prevent Hip Surgery - And What to Do If You Need It by Robert Klapper and Lynda Huey. Wiley, John & Sons, Inc., January '99.
  
  
• The Columbia Presbyterian Osteoarthritis Handbook: The Complete Guide to the Most Common Form of Arthritis edited by Robert P. Grelsamer and Suzanne Loebe. Macmillian Publishing Co., Inc. January '97.
  
  
• Stop Arthritis Now! Healing the Baby Boomer's Disease by Harris H. Mcllwain and Debra F.Bruce. Simon & Schuster Trade, January '96.
  
  
• Coping With Osteoarthritis by Robert H. Phillips, PhD. Avery Publishing Group, Inc. November '90.

Do you have any advice for relieving the pain of osteooartritis?