Joint Efforts

With a battery of treatments available, aches and pains of arthritis can be eased

Colette Bouchez

Colette Bouchez

Published on May 17, 2003

SATURDAY, May 17, 2003 (HealthDayNews) -- It can begin with stiffness in the joints you use most -- your hips, knees, lower back or fingers. Soon, however, you may start to experience real pain.

The problem is osteoarthritis and if you've just turned 50, you might be experiencing your first bout with this common problem.

"Age 50 is a transition point where the vast majority of people first start noticing symptoms," says Dr. John Klippel, medical director of the Arthritis Foundation.

As one of the most common of the more than 100 different types of arthritis, osteoarthritis is caused by a natural wearing away of cartilage, the cushion that lies between joints. As the cartilage breaks down, bones can rub against each other during even simple movement, leading to inflammation and, ultimately, pain and stiffness.

Currently, the Arthritis Foundation reports some 20 million Americans are facing the effects of osteoarthritis every day. With May designated as National Arthritis Month, officials are spreading the word that a battery of treatments exist to ease sufferers' pain.

While osteoarthritis may be a natural part of the aging process, not everyone is affected in the same way, Klippel says. For some, he says, osteoarthritis can cause extreme pain, while others may hardly feel a twinge. What can often make the difference: Weekend-warrior type injuries to the joints that occur years before symptoms develop.

"Any injury to your joints can set the stage for osteoarthritis later in life, which is one reason professional athletes seem to suffer the most with this problem," Klippel says.

If you're thinking "score one" for the couch potatoes, guess again. People who are inactive throughout their lifetime are also at increased risk, experts say. Other factors that play a role, says Klippel, include heredity and being overweight.

Once osteoarthritis sets in, and particularly once the pain begins, your natural instinct may be to limit movements. Ironically, studies show that staying sedentary can make you feel worse.

"When you don't move, over time you lose muscle mass, so the supporting structures around the affected joint grow weak, and in turn affect flexibility," Klippel says. As a result, pain can increase and movement can become even more difficult.

That's one reason it's important to "push through the pain" and continue as many activities as you can, Klippel says. The good news is there are a variety of medications that can help you do just that.

"If you have mild pain, the most common recommendation is to use Tylenol (acetaminophen) or, if the pain is moderate, an over-the-counter NSAID (non-steroidal anti-inflammatory drug) like Motrin (ibuprofen)," says Dr. Steven B. Abramson, director of rheumatology at New York University Medical Center and the Hospital for Joint Diseases.

Other medications that fall into the second category, says Klippel, include Advil (ibuprofen), and Aleve (naproxen), as well as aspirin.

Although all NSAIDs work similarly to reduce inflammation and pain, they may not work the same for you. Klippel says a little known fact about NSAIDs is that the response to each drug can be highly individual -- with one brand offering little or no relief while another is pure Nirvana. The message here, he says, is if you don't get relief from the first drug, try others in the category, including prescription NSAIDs.

As helpful as these drugs can be, however, they aren't always kind to your stomach. This is particularly true, says Abramson, if you already have gastrointestinal problems, such as ulcers, or you are at risk for internal bleeding. When this is the case, a relatively new class of NSAIDs -- drugs known as Cox 2 inhibitors -- might be the right choice, he says.

"These drugs are more target-specific, reducing joint pain and inflammation without affecting the stomach lining," Abramson says. Medications in this category include Celebrex (celecoxib), Vioxx (rofecoxib) and Bextra (valdecoxib).

The one caveat here: Although studies are still in progress, preliminary data shows Cox 2 inhibitors may not be right for those at increased risk for heart disease.

"In these instances, the older NSAIDs can be used in combination with medications known as proton pump inhibitors (PPI) -- drugs which protect the stomach lining," Abramson says.

In addition to traditional medications, you may also be tempted to try two popular alternative remedies known as Glucosamine and Chondroitan Sulfate. These are substances found naturally in the body that may play a role in cartilage repair and elasticity, experts say.

Derived from animal tissue, some studies have shown these supplements offer pain relief equal to NSAID drugs, without the side effects. In addition, there is some evidence the compounds might slow cartilage damage in people with osteoarthritis, thus reducing disease progression.

The latest research, published in March 2003 journal Rheumatology, reveals that even topical creams containing a Glucosamine-Chondroitan compound may be helpful when applied externally to sore, aching joints.

Currently, a large National Institutes of Health study is ongoing to assess the full value of these supplements, and in several years doctors may know for certain if they can really help. Abramson says most physicians accept them, at least as an adjunct treatment.

In addition to oral medications, there are several types of injections administered directly into the affected joints that, although costly, can prove helpful, particularly when pain involves the knee or hip. These include two forms of a substance known as hyaluronic acid (Synvisc or Hyalgan), as well as injections of anesthetic, which can be given alone or in combination with corticosteroid drugs to help extend pain relief and reduce inflammation, Abramson says.

So how do you know what treatment is right for you? Experts say talk to your doctor first to make certain you have the correct diagnosis before taking any medications.

"People should not automatically assume that because a joint hurts it's osteoarthritis," Klippel says. While often this is the problem, it's worth checking with your doctor before trying to self-treat joint pain or swelling, he says.

More information

To learn more about osteoarthritis, visit the Arthritis Foundation. Or you can check this advice from the National Institutes of Health.

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