What you can do about arthritis

Half of all adults  and two-thirds of obese adults  will develop arthritic knees during their lifetime, researchers estimate. Yet, despite those growing numbers and the considerable pain and disability the condition causes, treatment remains frustrating and confusing.

Medical therapies for osteoarthritis, including pills, rubs, and shots, offer limited benefits and can cause side effects. New research findings seem to dash any hopes that the most popular supplements thought to combat arthritis do any good. And while joint replacement surgery can help many people with advanced disease, recent reports have raised concerns about one form of the operation.

“No one therapy is as effective as we’d like,” says Roy D. Altman, MD, a professor of medicine at the University of California, Los Angeles. “So, patients are often best served by combining treatments.” And because people respond differently to the treatments, they often have to mix and match until they find a combination that works for them. Below, we examine the choices to help you decide which ones might work for you.

Lifestyle changes

Wear-and-tear injuries and excess weight can erode the cartilage that lines the bone surfaces between joints. That causes aching, stiffness, and swelling in the joints, and sometimes, a grating sensation. If you experience any of these symptoms for more than two weeks, consult a doctor, who should rule out other causes of joint pain, such as gout or rheumatoid arthritis. If you have osteoarthritis, start with these measures: 

• Weight control. The first scientifically proven thing you can do to ease arthritis pain is simply to lose weight. Shedding just 10 pounds of excess weight can take about 40 pounds of pressure off the knees, research suggests, and dropping 15 pounds can cut knee pain in half. If you are overweight, try to lose at least five percent of your body weight, especially if you have arthritis in weight-bearing joints.

• Physical activity. Exercise strengthens the muscles around your joints; strong muscles keep joints from rubbing against one another, which wears down cartilage. Exercise relieved the pain of knee arthritis as effectively as medication in a recent Cochrane review of 32 studies. Aerobic exercise keeps joints flexible and lubricated, while strength training builds the supporting muscles. Aim for at least 30 minutes a day, five days a week of low-impact aerobics such as walking, water exercise, and cycling, plus two days of strength training.

 • Supportive devices. Ask your doctor about a cane, crutch, or walker to take the load off painful hips and knees. Braces can ease pain in people whose arthritis is mostly on one side of a knee. Experts suggest first trying a ready-made knee sleeve with straps and a knee-cup opening. It should fit comfortably, neither too tight nor loose. If that doesn’t help, ask your doctor about a customized brace.

 • Heat and cold. To relax muscles and soothe stiff, sore joints, apply a moist, hot pad or a warm, damp towel, or take a warm bath or shower. To reduce acute pain and swelling, use ice packs.

Alternative therapies

 Nontraditional treatments are widely used for arthritis despite inconclusive evidence. The following measures might help, but make sure you inform your doctor first.

• Glucosamine and chondroitin. In a landmark meta-analysis of 10 placebo-controlled trials of glucosamine and chondroitin that researchers said should “close the book” on whether these popular supplements actually help arthritis sufferers, Peter Juni, MD, of the University of Bern in Switzerland, and colleagues concluded, ”Our findings indicate that glucosamine, chondroitin, and other combinations do not result in a relevant reduction of joint pain or affect joint-space narrowing compared with placebo … We believe it unlikely that further trials will show clinically relevant benefit of any of the evaluated preparations.”

Despite the researchers’ suggestion that their meta-analysis might be the last word on glucosamine and chondroitin, a possibly even more definitive trial is already underway: Results are expected any time soon from the Long-Term Evaluation of Glucosamine Sulfate (LEGS) study, which will also test chondroitin with glucosamine among 600 arthritis patients.

In the meantime, Dr. Juni and his team conceded in the British Medical Journal (September 16, 2010 issue), “We see no harm in having patients continue these preparations as long as they perceive a benefit…” Given that these supplements are expensive, however, arthritis sufferers may want to consider options  such as dietary changes and exercise  that science has not debunked.

 • Acupuncture. Some research suggests this helps some people. But the best studies, in which some people get real acupuncture and others get sham procedures (where practitioners insert needles into non-acupuncture points or use blunt needles without penetrating the skin), have found only marginal benefits.

 • Massage. Eight weeks of massage therapy relieved painful knees for participants in a small trial published in the Archives of Internal Medicine. However, if massage hurts, stop the treatments  and don’t massage a joint that’s very swollen or painful.

Medications

Drugs can be added if lifestyle measures aren’t enough. Over- the-counter (OTC) acetaminophen (Tylenol and generic) is the first-line drug because it has fewer risks than any other pain relievers. But even it poses some risks. Excess dose can damage the liver, so don’t take more than 4,000 mg a day. People who drink heavily or have liver disease should not take it. If acetaminophen doesn’t help, other options include the following drugs:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Pain relievers, such as ibuprofen (Alaxan and others) and naproxen (Naprosyn, Flanax), are often the next step because they also quell inflammation. But prolonged use of these drugs increases the risks of gastrointestinal bleeding, stomach ulcers, and heart problems. Other NSAIDs, such as celecoxib (Celebrex and others), are somewhat gentler to the stomach but some research suggests it might pose slightly greater cardiovascular risks. People who have had a heart attack or are at a high risk for one might consider naproxen which appears to be safer on the heart. Those who are vulnerable to ulcers can take NSAIDs with an acid-reducing drug known as a proton-pump inhibitor (PPI).

• Creams and gels. Topical treatments might be more useful for people with arthritis in smaller joints that are closer to the surface. OTC capsaicin creams are available, made from chili peppers, which may reduce mild pain. Topical medications containing NSAIDs, such as nimesulide (Sulidin gel), diclofenac (Voltaren emulgel), and ketoprofen (Fastum gel), are easily available in the Philippines. British guidelines, in fact, recommend trying topical medications before other drugs. Creams containing salicylates (such as Bengay Arthritis) don’t reduce arthritis pain, according to the Agency for Healthcare Research and Quality (AHRQ).

• Injections. Shots of anti-inflammatory steroids are an effective short-term remedy for moderate to severe pain and swelling in the knees and hips, particularly during flare-ups. But you should not get more than three to four shots a year, since frequent injections might cause further joint damage.

• Hyaluronic acid (Synvisc, and others), a joint lubricant that’s injected into the knee, might provide modest and longer relief for some people, but it usually doesn’t reduce pain or improve knee movement, according to the AHRQ.

• Opioid painkillers. These strong pain relievers can cause serious side effects, including addiction. But some people appear less likely to become dependent on tramadol (Tramal and others), a weak opioid that can be used when other arthritis treatments have failed. While tramadol is modestly effective, older people have difficulty tolerating its side effects, such as dizziness, drowsiness, and nausea.

Surgery

If nonsurgical options are not sufficient, it might be time to talk with an orthopedic surgeon about joint replacement. Though the procedure can have complications and doesn’t always restore complete mobility, hip and knee replacements often successfully relieve pain, and recent advances  including minimally invasive total joint surgery  have sped recovery time and yielded longer-lasting implants.

However, there have been recent reports about severe tissue damage from all-metal artificial hips. Those devices have been widely used because they’re thought to be more durable and stable in hips rather than the traditional combination of metal and plastic. But when the metal parts rub against each other, they generate microscopic metal particles that appear to have toxic effects on surrounding tissue in a small but growing percentage of patients, resulting in pain, a large, swollen mass around the hip, known as pseudotumor, and death of tissues. These reports have increased dramatically in Great Britain, where they’ve used metal-on-metal hips for a longer time.

 There’s no need to let arthritis control your life when  as never before  doctors are discovering ways for you to control arthritis, reduce its symptoms, and halt its progress effectively and safely. Hopefully, today’s article provided you with a practical guide to help you select wisely and rewardingly from these expanding treatment choices.