are boom times for companies that make products that aim to treat
osteoarthritis, the leading cause of disability in the United States. This
wear-and-tear disease is keeping many specialists busy, as well, including
physical therapists, movement specialists, acupuncturists and surgeons who
operate on arthritic joints.
Advice on how best to treat arthritis is now coming from so many different
quarters that it often causes more confusion than clarity.
But there is one point of agreement. The wrong way to respond to the pain and
stiffness of arthritis is to stop moving. A neighbor of mine did just that, and
within a year he was living in a wheelchair and had to be carried up and down
Regular moderate exercise is critical to retaining mobility of arthritic
joints, and exercise to build the strength of supporting muscles is the best way
to reduce the painful stress and the disease progression.
A Hierarchy of Therapies
Long before surgery on arthritic joints becomes an issue, a host of nondrug,
drug and herbal remedies can often relieve the pain and disability. Only after
these have been given a fair trial, and only if arthritis is far advanced and
interferes with normal activities, is it time to consider surgery, the more
First and foremost, for arthritis in a weight-bearing joint like the knee or
hip, it is crucial to achieve and maintain a normal body weight through diet and
low-impact exercise. The force on the knee with each foot strike is two to three
times as great as the body weight, so weight loss of just 11 pounds takes 22 to
33 pounds off the knee.
Other helpful measures for reducing knee pain include avoiding stressful
activities like prolonged standing, kneeling, squatting and stair climbing.
Going down stairs is often more painful than going up.
Braces that unload stress on the knee are also helpful, as is a walking
stick, used in the hand opposite that of the affected knee or hip.
Shock-absorbing shoes, heel wedges, periodic applications of ice packs insulated
by cloth, and moist heat on the affected joint are useful as well.
Most people with arthritis can benefit from sessions with physical therapists
who can demonstrate and teach muscle-building and stretching exercises to
Acupuncture may also help, though the results of a government-sponsored,
well-designed study of its effectiveness are not yet available.
Although it is tempting to ask doctors to prescribe the latest and most
expensive prescription drug to hit the market, a more reasonable approach starts
with less glamorous low-cost over-the-counter options.
The first and safest drug to try is acetaminophen, sold as tablets or
capsules and now available in long-acting extra-strength versions for people
Next come the low-potency nonsteroidal anti-inflammatory drugs, aspirin,
ibuprofen and naproxen.
But these and other more potent nonsteroidal drugs like indomethacin and
etodolac can cause bleeding, bruising and gastric ulcers and are best taken in
enteric-coated versions on a full stomach along with a drug like misoprostol (Cytotec),
a histamine blocker like Tagamet or Zantac or a proton-pump inhibitor (like
Prilosec or Prevacid) to protect the stomach lining.
Another nonsteroidal anti-inflammatory drug, meloxicam (Mobic), has been
shown in some studies to be less likely than other drugs in this class to cause
gastric ulcers and susceptibility to bleeding and bruising.
There are also topical agents like methylsalicylate or capsaicin, a hot
pepper derivative; menthol; oil of wintergreen; camphor; and eucalyptus oil that
can mask arthritic pain, but only in the area where they are applied.
Topical ibuprofen and naproxen are available over the counter in Europe.
Topical agents have the advantage of causing no bodywide side effects, though
some can cause rashes and blisters on sensitive skin.
The newest drugs to capture the attention of people with arthritis are the
cox-2 inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx). Although no more
effective than nonsteroidal anti-inflammatory drugs, they have a lower risk of
gastrointestinal side effects, although they may slow the healing of existing
These are not yet available in generic versions and are thus very expensive.
Furthermore, none of the cox-2 inhibitors have been used long enough on a
chronic basis to be certain of their long-term safety.
Keep in mind, too, that all drugs can interact with other medications. Be
sure to tell your doctor about every drug you take, including low-dose aspirin,
as well as any chronic condition you may have, like liver or kidney disease.
Also, be sure to follow the doctor's instructions about having periodic blood
tests while taking arthritis medications.
Those needing more potent pain relief may benefit from narcotic-containing
analgesics like acetaminophen with codeine or oxycodone, which are associated
with side effects like dizziness, drowsiness and constipation and may cause
dependence over time.
So-called dietary supplements offer another option that may be taken alone or
along with other arthritis drugs. Most popular among them are glucosamine and
chondroitin sulfate, often sold in combination tablets or capsules with
instructions to take three a day.
Other than a possibility of somewhat loose stools in the first few weeks of
therapy, they have no known side effects. Several clinical studies, not always
pristinely conducted, have indicated that glucosamine alone or the two in
combination can relieve arthritic discomfort and may delay or halt its
The National Institutes of Health is conducting a proper study of their
Some evidence also supports another dietary supplement, SAM-e, for arthritis
pain, as well as mild depression. For arthritis, 200 to 400 milligrams of SAM-e
are taken three times a day. With all supplements, do not expect noticeable pain
relief for three or four weeks.
Dietary supplements can be quite costly and are not covered by medical
insurance. Neither are their quality and potency regulated by the Food and Drug
Administration. So bargain hunting may be a bad idea. It is best to choose
products made by reputable companies like Nutramax and Schiff.
When oral or topical remedies are not enough to control arthritic pain, an
injection of cortisone into the affected joint can bring short-term relief, for
weeks or months. Because cortisone can cause further joint deterioration, the
injections can be used just three or four times a year.
Another option is a series of injections of hyaluronate (Synvisc and Hyalgan),
intended to replace the lubricating fluid in the knee joint. The medication can
relieve pain for most sufferers for six months or longer. The therapy is
expensive and may not be covered by insurance, so check first.
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
DISCLAIMER: All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice. The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.
Copyright 2013 by Vaccination News, A Non-Profit Corporation. All Rights Reserved. This content may not be copied unless permission in writing from Sandy Gottstein has been obtained.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"