Managing Your Arthritis
By Henry Clayton Thomason, III, M.D.
With the increasing age of our population, more and more people will eventually become affected by arthritis. Likely you or someone you know already suffers from the disease. In the last several years, many treatment options for arthritis have become popular. While the myriad of options may seem overwhelming at first, there are a few basic things that people can do as well as several medications, both over the counter and by prescription, that can decrease the disability caused by arthritis and help alleviate some of the symptoms.
Over 80 percent of people over 50 years of age have some evidence of arthritis by X-ray. As the baby boomers begin to contribute to this population, many more of us will begin to have the aches and pains and swelling of our joints secondary to arthritis. Osteoarthritis, the most common form of the disease, is defined by a gradual wearing down of the articular cartilage, or bearing surface, in various joints. This means more pain and stiffness and a decrease in our overall quality of life. What things have been proven to help patients with arthritis?
There are several things that people can do to alleviate the symptoms of arthritis without taking a single drug. The first, and often most obvious, is to maintain a healthy lifestyle. Obesity has been shown to contribute to the wear and tear of joints over time, so weight loss is important. And once arthritis has begun to develop, obesity can accelerate wear.
We also can modify our activities. Jogging is a popular sport for many, but for people with arthritis, it is painful and may even contribute to further joint damage. Consider changing that painful exercise to biking or swimming to keep the cardiovascular benefits of exercise but to decrease the impact on the joints.
In addition to lifestyle changes, there are many nutritional supplements on the market targeted toward arthritis. This category is vast and very complicated. Many of us have heard of glucosamine and chondroitin sulfates. These are nutritional supplements aimed at replacing some of the lost cartilage in our joints. The science behind how these drugs work is poorly understood, but more than seventy-five percent of people taking them report a decrease in symptoms from arthritis.
Other natural substances and nutritional supplements that have been suggested to help include fish oils with omega-3 fatty acids, soybeans, zinc, vitamins, and antioxidants. Much more study is needed on all of these to show efficacy, but most have few side effects and may help. Follow the instructions and dosing on the labels and try them for a month before deciding if they help or not.
There are many over the counter medications that are designed to help with the treatment of arthritis. Acetaminophen is one of the more commonly used medications and has been proven to be efficacious for pain relief associated with the disease. Is has few side effects and, if taken properly, can alleviate some of the pain.
Naproxen and ibuprofen, two of the more commonly known non-steroidal anti-inflammatories (NSAIDS) also have been shown to be helpful in the treatment of arthritis. They help by not only decreasing the pain associated with the disease, but by decreasing the swelling and inflammation as well. They unfortunately have several side effects and frequently irritate the stomach and are therefore not tolerated by all patients. In addition to gastrointestinal upset, they prolong the bleeding time in a patient and should not be taken around the time of surgery.
Besides over the counter oral medications, there are many heat rubs and creams on the market. These help decrease the pain of a particular joint and have few side effects. Scientists believe the warmth they provide is the source of the pain relief as well as some modification of substance P, a mediator in the pain pathway.
Aside from the many medications available without a prescription, most arthritis modifying medications can only be obtained from your doctor. The NSAIDs mentioned above are only a few of the many traditional NSAIDs available on the market, and most require a doctor’s prescription. They all have the common side effects of an upset stomach and a prolonged bleeding time, and one may work better for a given individual than another, but they all have proven efficacy.
The COX-2 selective inhibitors, a subset of anti-inflammatories designed to decrease the gastrointestinal irritation while still decreasing inflammation, have been become popular in recent years. They, too, are not without side effects and in the last few months one, rofecoxib, has been taken off the market, and two others, celecoxib and valdecoxib, have come under scrutiny, all for possibly increasing the risk of cardiovascular events. Celecoxib has more recently been strongly endorsed by the FDA and the American Academy of Orthopaedic Surgeons for patients without known cardiovascular and is still being prescribed by many physicians. For those patients felt appropriate for these drugs by their physician, these medications can really improve their quality of life.
When nutritional supplements and medications and topical ointments no longer help, the next treatment modality available is injections into and around joints. No one really relishes the thought of getting a shot, but when oral medications do not seem to work, or when you need to get through an arthritic flare, shots can be the answer. The most common type is a cortisone, or corticosteroid, shot. This delivers a dose of anti-inflammatory medicine to the site of the problem and can have instant effects.
The other common injection used to treat arthritis is hyaluronic acid. This application consists of a series of three to five injections weekly and is designed to replace the lost cartilage in the arthritic joint. Science does not know the exact mechanism of action, but hyaluronic acids do have proven efficacy for those with early arthritic changes and symptoms.
Obviously, there is no one set way of treating osteoarthritis, nor is there one best way for any individual. Please ask your doctor what may be best for you before trying any of the options, even those not requiring a prescription, as many have certain side effects not suitable for everyone. Many more, even the over the counter medicines and nutritional supplements, can interact with other medicines one may be taking and interfere with their effectiveness. Most of us will eventually have some of the aches and pains associated with arthritis, but we do have a vast arsenal of options to help us fight it.