The joint's a rockin: keeping arthritis at bay. .

Sore, aching knees, hips, fingers, back. Pain after too much activity. Pain after too little.

Eventually, almost everyone gets osteoarthritis. Sometimes it's the result of decades of wear-and-tear on the shock-absorbing cartilage that prevents bone from rubbing against bone. Sometimes it starts sooner, after an injury to the knees or other joints. (Rheumatoid arthritis has similar symptoms, but it's an autoimmune disease that usually strikes younger people.)

"By the age of 70, nearly everyone has osteoarthritis, though not all suffer the symptoms," says Roland Moskowitz, professor of medicine and director of the Northeast Ohio Multipurpose Arthritis Center at Case Western Reserve University School of Medicine in Cleveland.

Can eating certain foods cause--or aggravate--osteoarthritis? At one time or another, soy, dairy products, potatoes, tomatoes, eggplant, and peppers have all been implicated. But there's no good evidence that they, or any other foods, have anything to do with arthritis. Even so, if you think something you're eating is making your joints ache, cut it out and see if you feel better.

Beyond food, "there are steps that everybody can take to try to prevent, or at least slow down, the onset and progression of osteoarthritis," says Moskowitz.

1. Control your weight. Do the math. "Every ten pounds of extra body weight puts 30 to 50 pounds of extra stress across the knee for every step you walk," Moskowitz points out. Most knees can't sustain that burden without something eventually giving way or wearing out.

It doesn't take much weight loss to have a big impact.

"In the Framingham Knee Osteoarthritis Study, overweight women who lost an average of 11 pounds over a ten-year period cut their risk of symptomatic osteoarthritis of the knees by more than half, compared with women who didn't lose weight," says rheumatologist David Felson, professor of medicine and public health at the Boston University School of Medicine. (1)

"If you already have osteoarthritis, being overweight will probably increase your symptoms," says Moskowitz. "But if you lose weight, we believe that you can keep the disease from progressing as much."

2. Avoid injury or too much stress on the joints. "Injuries to joints can lead to arthritis very early on, or they can increase the risk of developing arthritis later in life," says Lynn Millar, a physical therapy and exercise expert at Andrews University in Berrien Springs, Michigan.

"Even when you just sprain a joint, there's a trauma that occurs around, and sometimes within, the joint that seems to increase the potential for arthritis," she explains. "Breakdown in the cartilage can occur, and it progresses from there."

Warming up can minimize the risk of injury during physical activity. "It prepares the muscles to absorb the force of impact," says Millar. "Your chances of twisting something like an ankle are reduced if your body is warmed up and ready for activity."

You can also damage a joint during a repetitive activity like running if the joint isn't properly aligned, says Millar. If, for example, you favor one side of one foot when you jog, over time you can stress your ankle. "That can lead to arthritis if it's not corrected," she adds.

How can you tell if you're over-stressing a joint? "Many people will experience pain," says Millar. "But they ignore it, or try to treat it themselves with painkillers or little inserts for their shoes."

While you can't always avoid trauma to the joints, "you can make sure your joints are properly rehabilitated after an injury," says Millar. "Otherwise the problem may worsen and arthritis will become more likely.

"Proper rehabbing doesn't mean just waiting until the joint is no longer painful and then going back to your normal activity," she cautions. "It's making sure you strengthen the muscles around the joint and that you do some exercises that improve what we call its 'proprioception." That's the sensation that goes from the muscles back to the brain.

In other words, you've got to repeat the movement until, without thinking, you can do it in a way that minimizes the risk of re-injuring the joint.

Skip these steps, says Millar, and you could permanently damage the joint.

3. Maintain good muscle tone. "You want to make sure that the muscles are strong around any joint you're routinely putting stress on," says Millar. Researchers don't have solid proof that good muscle tone will delay arthritis, but they think it will.

"When the muscles around a joint are weak," she explains, "there's more force being transmitted through the joint."

For example, says Moskowitz, "keeping your quadriceps and hamstrings good and strong can slow down the onset or progression of osteoarthritis of the knee." The stronger the muscles in the front and back of the thighs, the greater the load they can take off the knee. (Moskowitz's advice assumes that your knee is properly aligned and stable. If it isn't, recent studies suggest that strengthening the thigh muscles could worsen your arthritis.)

You can stave off or reduce lower-back and neck pain by keeping your back and trunk muscles strong (see "Exercise vs Arthritis"). If your muscles aren't strong enough to keep you sitting up straight, it puts a heavier load on your vertebrae.

"And you need a strong trunk in order to do activities with the knees and hips," adds Millar. To relieve stress on the shoulder, you want to strengthen both the chest and upper back muscles. To protect the hips, it's the hip flexors and the gluteal muscles that need strengthening.

And don't forget your hands. "There are finger exercises you can do--like squeezing a rubber ball--to strengthen the muscles in the hand and decrease potential problems there," says Millar, who has written a book on exercise and arthritis that has been endorsed by the American College of Sports Medicine. It's scheduled to be published this fall.

Dealing with Arthritis

If you have osteoarthritis, "there are things we can do to slow down the progression of the disease that can make a big difference," says Moskowitz.

"If the pain is there for a week or ten days, but then goes away, there's no need to rush to a doctor." But if there are more days of pain than not, see a doctor to determine whether your pain is due to osteoarthritis or something else. Other possibilities: tendonitis, pseudo-gout from calcium deposits, or some mechanical problem with the joint.

"It's best to have your osteoarthritis diagnosed by a rheumatologist, who can help you figure out what you can do to reduce the discomfort and slow down the disease," says Moskowitz.

The most likely suggestion: over-the-counter or prescription drugs or supplements (see "Should You Take an Arthritis Supplement?").

No matter what treatment you decide on, one thing is clear: "When your joints start to get stiff and a little achy from arthritis, don't hold them still," says Lynn Millar.

"Most of the research shows that people who do 'range-of-motion' exercises every day have less pain and stiffness than those who don't," she adds. "Move your joints through their full range regularly and you may find that you're waking up with less pain in the morning."

Swimming or water aerobics decreases arthritis pain, increases range of motion, and improves cardiovascular fitness. "The nice thing about aquatic exercise is that it 'unloads' the joints," says Millar. In other words, it allows them to move without being pulled down by gravity.

Even if exercise doesn't diminish arthritis pain, "it will help to maintain a person's quality of life and ability to function," says Millar. "It may even help restore functions that may have been lost temporarily."

Among the best exercise programs:

* Arthritis Foundation Aquatic Program. Developed by the YMCA and the Arthritis Foundation, this popular aquatics program is offered nationwide.

* PACE (People with Arthritis Can Exercise). The gentle activities in this program help make joints more flexible, increase range of motion, and strengthen muscles. The Arthritis Foundation says that participants report less pain and depression.

* Arthritis Self-Help Course. The Arthritis Foundation's six-week course, which was created by Stanford University, has helped patients reduce their joint pain by 20 percent and their visits to physicians by 40 percent. (2) It covers exercise, pain, medications, diet, and how to deal with anger, fear, frustration, and depression. Not interested in a course? The material is available in "The Arthritis Helpbook" (Perseus Books, 2000).

To find out what programs are available in your area, go to www.arthritis.org/events/getinvolved/ProgramsServices /ArthritisSelfHelp.asp and type in your zip code. Or call the Arthritis Foundation at [phone].

It's not clear how well chiropractic services, massage, and other alternative therapies work.

The National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) is funding two acupuncture trials, one at the University of Maryland in Baltimore and the other at the University of Pennsylvania in Philadelphia. Both are still recruiting patients, "so it's too early to say if acupuncture works," says Moskowitz. (For more information on the trials, go to www.clinicaltrials.gov.)

(1) Ann. Intern. Med. 116: 535, 1992.

(2) Arthritis Rheum. 36: 439, 1993.

RELATED ARTICLE: Exercise vs arthritis.

"Muscle is the most important protector of joints," says Tufts University exercise expert Miriam Nelson. "Cartilage only absorbs shock that gets past the muscle. Without strong muscle, cartilage wears out much sooner."

These two exercises, adapted from Nelson's "Strong Women and Men Beat Arthritis" (Penguin Putnam, 2002), can help strengthen the muscles in your lower back, buttocks, and hamstrings.

For the exercise that uses weights, exhale as you lift the weight and inhale as you lower it, even though that's the opposite of what most people would do intuitively.

Back Extension

1. Lie face down with your forehead resting on the floor, legs stretched back, toes pointing back. Stretch back your arms on either side of your body, palms facing up. Tuck your tailbone under you slightly.

2. As you inhale, raise your chest off the floor, keeping your head, neck, and back all in line (see illustration). Don't lift your legs off the floor. Hold the position for 3-5 seconds.

3. Exhale as you lower back to the ground. Keep your shoulders back and your chest open as you rise up and lower down.

[ILLUSTRATION OMITTED]

Reps and sets: Do 5 repetitions. Rest for 15 seconds between each rep.

As the exercise becomes easier:

1. Hold the lifted position for 10 seconds.

2. Hold for 20 seconds.

Hip Extension

1. Lie on the floor on your stomach with your legs extended, toes pointing back. Place your arms in front of your head and rest your head on your hands with your forehead facing down. (You can use a firm bed for this exercise if you're unable to get down on the floor.)

2. Raise your right leg from your hip joint, keeping your leg straight and your trunk stable, toes pointing down toward the ground (see illustration). Initiate the movement from your hip and the back of your thigh. Pause for 1 second when you feel a squeeze in the buttock muscle. (If you feel any pain or a pinch in your lower back, you have lifted the leg too high. Lower it slightly until the pain subsides.)

3. Lower your right leg to the floor.

Reps and sets: Complete 12 repetitions on one side and then repeat on the other side--this is 1 set. Rest for about 30 seconds and then do a second set.

As the exercise becomes easier:

1. When you can do 12 repetitions in good form, add ankle weights, in 1-pound increments per workout, until the intensity reaches a four. *

2. As you become stronger and the intensity falls below a four, increase the weight by 1- to 2-pound increments each workout until you are at a four again.

[ILLUSTRATION OMITTED]

* Intensity of Four: Hard effort. By the time you have completed 6 or 7 repetitions, the exercise has become difficult. While you should be able to do the exercise 12 times in good form, you need to rest afterward.

Adapted from "Strong Women and Men Beat Arthritis," [c] 2002. Used by permission of G.P. Putnam's Sons, a division of Penguin Group (USA) Inc.

RELATED ARTICLE: Should you take an arthritis supplement?

Over-the-counter medications like acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin), aspirin, or Aleve (naproxen) can alleviate arthritis pain. Stronger drugs are available by prescription.

But NSAIDs can cause side effects like bleeding in the GI tract. That's one reason supplements that claim to relieve arthritis pain have become so popular. Among the most common:

* Glucosamine and chondroitin. "Many studies suggest that they're effective at relieving pain in a number of people," says Case Western Reserve University's Roland Moskowitz.

* Glucosamine relieved arthritis pain better than a lookalike (but inactive) placebo in 12 out of 13 well-conducted trials published through November 1999 that were reviewed by the Cochrane Collaboration, an international organization that evaluates the best scientific research. (1) In four other studies, glucosamine worked as well as or better than ibuprofen or other NSAIDs.

Despite its early promise, not everyone is convinced that glucosamine is all it's cracked up to be.

"I used to be a big fan, but now I'm less of one," says David Felson of Boston University. "There have been four studies that were not sponsored by industry during the past four years, and all of them have shown no benefit from glucosamine. That concerns me."

In the most recent one, Jolanda Cibere and her colleagues at the Arthritis Research Centre of Canada in Vancouver recruited 137 volunteers who had been taking glucosamine for about two years and who reported that the supplement was providing "moderate" to "marked" relief. Half of the people were randomly chosen to continue taking glucosamine, while half were given a placebo.

After six months, the glucosamine-takers reported the same amount of pain and flare-ups--and were just as likely to use painkillers--as the placebo-takers. In other words, glucosamine was no better than a sugar pill. The new study hasn't yet been published.

For now, Cibere says, "if my patients want to see if glucosamine helps them, I don't discourage them. But if it doesn't provide relief within two to three months, I tell them there's no point in persisting."

Moskowitz has a different take on the disappointing studies. "Occasional negative reports, published and unpublished, don't change my overall assessment at this time," he says.

"It's not unusual for studies of effective treatments to sometimes show no benefit. Cortisone injections for knee problems are a good example. Some studies show that they work and some don't. It depends on which patients are chosen, what the placebos are, and how the studies are set up."

The record for chondroitin is shorter. It was more effective than a placebo at relieving arthritis pain, according to a meta-analysis sponsored by the National Institutes of Health, which pooled the results of seven trials conducted through 1998. (2)

But chondroitin supplements frequently contain less chondroitin than their labels claim. Three years ago, the on-line firm Consumerlab.com analyzed 15 popular brands of supplements that contained chondroitin. Only seven had the amount listed on the label. (In contrast, all ten brands of glucosamine tested were accurately labeled.)

"Right now, there are enough well-done trials of glucosamine and chondroitin to support its use by people with osteoarthritis, if they can afford it," says Moskowitz. "But we're also doing what we think will be a pivotal study to find out more."

Moskowitz is an advisor to the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which is being funded by the National Institutes of Health. Researchers are testing a daily dose of 1,500 mg of glucosamine, 1,200 mg of chondroitin, or a combination of the two against a placebo in 1,500 people with osteoarthritis.

(GAIT is still looking for volunteers. If you're interested in participating, visit www.clinicaltrials.gov and search for "GAIT.")

* SAM-e. "Government Report Concludes That SAM-e Decreases Joint Discomfort," declared the press release from the Pharmaton Institute for Wellness last December.

Not quite. The RAND Corporation reviewers who were hired by the government weren't as enthusiastic as SAM-e sellers like Pharmaton would have you believe. (3)

Many of the SAM-e studies that RAND looked at suffered from "methodological shortcomings such as small numbers of subjects and poor designs." That's why the report called its own conclusions "limited."

The RAND researchers uncovered only one decent study that tested SAM-e (which is a derivative of the amino acid methionine) against a placebo. In an Italian trial 16 years ago, 572 people who took a high dose--l,200 mg a day--for four weeks reported slightly more pain relief than 139 people who took a placebo. (4)

In eight other studies, SAM-e produced the same "modest" pain relief as NSAIDs like aspirin and ibuprofen. (Seven of the eight used 1,200 mg a day of SAM-e. The eighth used 600 mg.)

"SAM-e's effects are not dramatic," concludes Moskowitz. If you want to try it anyway, you may need to take out a loan: The amount used in nearly all the studies reviewed by RAND--1,200 mg a day--will cost you anywhere from $100 to $200 a month. (To make SAM-e seem less costly, manufacturers typically recommend taking less, though there's little evidence that less works.)

And you may get less than you pay for. About half of the brands tested during the past few years contained less SAM-e than their labels claimed.

* MSM (methyl sulfonylmethane).

A growing number of supplement makers are adding sulfur to their arthritis formulas. "The dietary sulfur in MSM complements the action of Glucosamine and Chondroitin to promote healthy, flexible joints," says Rexall Sundown of its glucosamine-chondroitin-MSM mixture called Osteo Bi-Flex Plus MSM.

Only one small trial has looked at MSM. And it was conducted by an MSM-enthusiast who later wrote a book entitled "The Miracle of MSM."

Ten volunteers who took 2.25 grams of MSM every day for six weeks reported a dramatic 82 percent improvement in pain, compared with an 18 percent improvement in the six people who were given a placebo.

The 2.25 gram (2,250 mg) dose was far more than the 250 to 1,000 mg that most companies put into their glucosamine-plus-MSM supplements.

What's more, the researcher called his work "only a simple preliminary study" that needed to be repeated with larger numbers of arthritis patients. But no further studies have been done.

"There are no good studies showing that MSM is effective for arthritis," concludes Case Western Reserve's Moskowitz.

(1) Cochrane Database Syst. Rev. CD002946: 2001.

(2) J. Amer. Med. Assoc. 283: 1469, 2000.

(3) www.ahrq.gov/clinic/epcsums/samesum.htm.

(4) Amer. J. Med. 83: 66, 1987.