Arthritis

Arthritis

Take steps to banish the pain of osteoarthritis and live life to the fullest.

Osteoarthritis — a degenerative disease caused by the gradual breakdown of the cartilage that cushions the tips of the bones — affects almost 16 million Americans, most of them over the age of 45.

Osteoarthritis, or OA, usually strikes weight-bearing joints such as the knees and hips, but can also affect the elbows, fingers, neck, spine, and wrists. Joints that have suffered previous injuries or infection appear to be the most vulnerable to the disease, but the simple wear and tear of aging can also aggravate the condition. In fact, half the population over the age of 60 has symptoms of osteoarthritis, while another 10 percent to 20 percent show signs of it on X rays.

Osteoarthritis, which is marked by a degeneration of the cartilage that lines joints and by bony outgrowths, can occur after a joint injury or as a result of joint deformity. The simple wear and tear of aging tends to aggravate the condition. And new research suggests that an imbalance in the enzymes and hormones that normally repair and maintain joints also plays an important role.

Symptoms can be subtle and easily overlooked until one day your fingers may feel too stiff to open a jar, or your hip joint aches so much that it’s uncomfortable to get out of a chair. In addition to stiffness and achiness, other common signs include difficulty reaching or bending and a grating noise as bones rub together.

Though most people first notice the disease in their fingers and knees, osteoarthritis-which tends to run in the family-can affect any joint, including those of the feet, hips, and back. If you’re experiencing joint pain, stiffness, or crookedness, see your family doctor, internist, or an arthritis specialist (rheumatologist) to first find out whether you have the disease. Although there is no cure for OA, there is a lot you can do to fight its effects.

Coping With Pain

In the past, non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, were the first choice of treatment for OA pain. Now, the American College of Rheumatology suggests acetaminophen (Tylenol and others) in doses of up to 1,000 mg four times a day-especially for OA of the knee or hip-as a first line of defense. The reason: Long-term NSAID use may irritate the stomach lining.

But if acetaminophen doesn’t ease pain, an over-the-counter (OTC) NSAID can be the next step. If that doesn’t help, your doctor will most likely prescribe a more potent NSAID, sometimes in combination with a second prescription agent, called Cytotec (to prevent stomach problems).

If your arthritis resists even prescription NSAIDs, doctors may prescribe corticosteroids injected into tissues and joints. These drugs are used sparingly because chronic use can have destructive effects on bones and cartilage.

Two other pain-relief options have recently become available. The first, Synvisc, is a cushioning fluid approved for use in knees (though it may prove beneficial for other joints as well). The drug is injected by a doctor directly into the knee joint. The second new treatment is Hyalgan (sodium hyaluronate), an injectable version of a chemical normally present in high amounts in joints and fluids. In OA sufferers, the quality and quantity of hyaluronate may be poor.

Topical Pain Relievers

Applying heat — via a heat lamp, hot water bottle, heating pad, or moist steam pack — can help relax the muscle tension created by sore and rigid joints. Cold packs can numb sore areas temporarily and ease inflammation and swelling. Massaging the skin over the joints can also reduce discomfort.

Another option is an OTC topical painkiller, available in creams, rubs, or sprays. Most contain counter-irritants, substances that make the skin feel hot, cold, or itchy. Common counter-irritants include camphor, capsaicin, menthol, and salicylates (similar to aspirin).

To use, rub the directed amount into the sore area, avoiding contact with wounds or sores, as well as eyes, mouth, and other mucous membranes. Don’t use counter-irritants more frequently than the directions suggest. Make sure you wear gloves while applying them or wash your hands immediately after use. (If you’re treating hand pain, wait 30 minutes before washing.)

Caution: If you have a history of gastrointestinal disease, alcohol abuse, or regularly consume more than three alcoholic drinks per day, consult your doctor before beginning acetaminophen or NSAID treatment. Regular NSAID use increases the chances of stomach bleeding, a risk that rises even more if you smoke, drink alcohol, take corticosteroids, or have had an ulcer.

Tell your doctor if you have ever had any unusual or allergic reactions to NSAIDs, or if you are allergic to any other substances such as food, preservatives, or dyes. Notify your doctor if you experience a burning sensation in the stomach while taking NSAIDs.

Avoid topical products that contain salicylates if you are sensitive to aspirin. Use them with caution if you have asthma or nasal polyps. Don’t use a heating pad with a counter-irritant; it can lead to a skin burn.

Rheumatrex

Arava

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Azulfidine

Jennifer Bowles

Jennifer is a clinical pharmacologist. She helps doctors of all medical specialties choose medications. Jennifer consults about drug dosage, interactions, and side effects.