STEVE INSKEEP, host:
And now let's learn more about osteoarthritis, which has become one of the nation's leading causes of disability. It affects 20 million adults.
NPR's Allison Aubrey looks at some procedures that are helping people to get relief.
ALLISON AUBREY: If you happen to be driving down the road right now, or maybe just making a pot of coffee, take a second to notice your thumbs. Chances are you're probably using them. The opposable thumb sets us apart as humans, enabling us to grasp and squeeze. Fifty-two-year-old schoolteacher Katie Cohen says she always took her thumbs for granted, until the pain of osteoarthritis set in.
Ms. KATIE COHEN (Schoolteacher): Just day to day things: holding the toothpaste, squeezing the toothpaste tube. And it was very painful just to do anything. And I learned a lot to use two fingers instead of my thumb.
AUBREY: Which helped her get by - temporarily. But by last spring, she says teaching her second graders became more difficult.
Ms. COHEN: Like grabbing papers or opening a book or holding something up, like a chart, it just would hurt.
AUBREY: Doctors recommended a couple of treatments in addition to the Tylenol-ibuprofen routine. First, she tried a stabilizing hand brace or splint, which help a little. Next came steroid injection.
Ms. COHEN: A cortisone shot in your thumb is extremely painful. Then it just, you know - even after that, it just didn't feel that much better.
AUBREY: Completely frustrated, Cohen went to see hand surgeon Terrence O'Donovan, who told her about a relatively new procedure, which she agreed to have. He explained that during an hour-long outpatient surgery, he would make a small incision near the base of her thumb. Then he'd implant a small piece of biodegradable polyurethane-urea material, where the two bones in the joint come together.
Dr. TERRENCE O. DONOVAN (Surgeon): It's taking the bone off the bone. That's the key here, is that we definitely want to get the bone off the bone, 'cause that's what's happening.
AUBREY: O'Donovan explains that for many people the pain of arthritis creeps in when the cartilage that cushions and separates the bones wears out. He says the new polyurethane prosthesis, which he implants surgically, serves as a replacement. Holding a diagram of this implant, he say the new space created in the joint by the artificial prosthesis relieves the pain, and he says eventually the idea is that the prosthesis serves as a frame that may help the body's own tissue to re-grow.
Dr. O'DONOVAN: It's a material like a graft material, and it's - the fact that it's urea means that the body can attach to it, and then over time it will basically eat it up and then be replaced by its own tissue.
AUBREY: O'Donovan's never actually seen or tried to measure any new tissue growth in his patients, and the company that manufactures the device has limited evidence from biopsies to document the growth of a building block of cartilage, but not cartilage itself. Given the uncertainty, O'Donovan says he focuses on the benefits he can measure in his patients. In the short term, up to two years after surgery, he says all of them have experienced significant reduction in pain. And one published study comparing this procedure to the more invasive bone-removing operation found the implant leaves patients with greater grip and pinch strength. As for patient Katie Cohen, she's back in the classroom and says she's pretty much pain-free.
Ms. COHEN: You know, I can grab anything, hold anything, squeeze anything. Before, it was very painful.
AUBREY: Occasionally a repetitive task such as stapling lots of papers in a short time can lead to soreness. But she says it's manageable. Now with her thumb repaired, Cohen's began to focus on the pain in her arthritic knee.
Ms. COHEN: That's probably next for the - the big, the big knee job.
AUBREY: But before she rushes off to surgery, she's trying an alternative: injections of a viscous fluid called Hyalgan, which is a derivative of a natural acid found in healthy joints. Orthopedic surgeon Marc Connell says in the last few years, Hyalgan, as well as a similar product called Synvisc, have shown to be fairly effective in holding pain.
Dr. MARC CONNELL (Orthopedic Surgeon): Essentially what these products do is act as a joint lubricant to decrease friction inside the joint to allow the joint to function more normally and to hurt less.
AUBREY: A review of published studies show the pain relief is significantly better than placebo and more long-lasting than steroid injections, but rarely does the effect hold up beyond two years, partially because the injected fluid drains from the joint. This is why eventually Marc Connell says many of his patients do end up in surgery.
Allison Aubrey, NPR News, Washington.
INSKEEP: And that's your health on this Thursday morning. You can read about blood tests and other ways your doctor can help determine what's causing your aching joints at NPR.org/yourhealth.
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