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Managing Arthritis: Q & A's

The term "arthritis" covers several joint diseases, including rheumatoid arthritis, a chronic inflammation of tissue surrounding the joints, which often begins early in life. Osteoarthritis (OA)—the subject of this article—is more common, and is a chronic degenerative joint disease that usually affects older people. Unlike rheumatoid arthritis, it's not characterized by inflammation, but is a breakdown of cartilage, the tissue that cushions the joints. Think of it as a losing battle between the forces that destroy cartilage (such as wear and tear, or injury) and those that repair it. Loss of cartilage means more friction between bones at the joint. This can cause pain, stiffness, and loss of mobility. Hands, especially finger joints, knees, hips, neck, and lumbar spine are most often affected. OA cannot be cured (it will get better and then worse, for no apparent reason), but it can be managed. You can reduce pain and impairment, and you can improve your quality of life.

Does everybody get OA eventually?

OA is not inevitable, but it is very common. About 70% of those over 65 show some evidence of OA in X-rays. Poor posture and being chronically overweight and/or sedentary may promote OA. So can various occupational or sports injuries, especially repeated knee injuries. Wearing high heels can promote or aggravate OA, which is more common in women than in men. Still, even slim, active people with good posture and no history of injury can develop OA.

Does diet make any difference in preventing or treating OA?

Only in the sense that consuming too many calories can lead to being overweight, which in turn can promote OA and make its symptoms more severe. You'll hear many claims about OA and diet. One of the most persistent is that you should avoid nightshade vegetables such as tomatoes, peppers, eggplant, and potatoes. But these vegetables have important nutrients, and giving them up does not alleviate OA. Dairy products and meat have been blamed—and have also been promoted as cures, along with garlic and molasses. Vitamin and mineral supplements are also touted.

But no dietary/nutritional regimen has ever been shown to alleviate or prevent OA. People with arthritis should have the same healthy diet as other people—one based on fruits, whole grains, and vegetables, and low in saturated fat. Some vitamin and mineral supplements can be healthful, but not against OA.

What about exercise? Should I slow down?

Exercise is your friend, though pain may mean that you have to slow down at times. But "quit" should not be in your vocabulary. The insidious thing about OA is that joint stiffness and pain may make you want to quit, but this can only lead to stiffer joints. Inactivity weakens the muscles that stabilize joints. You need exercise to keep your muscles strong and to build flexibility. Several studies have shown that exercise such as walking and resistance training—if programmed to your level of ability—can reduce pain and improve flexibility.

But you should check with your physician first and possibly get a referral to a physical therapist. The Arthritis Foundation can provide information about the special exercise classes and self-management classes it sponsors. Call 800-283-7800 to find your local chapter, or visit them at www.arthritis.org. Your local Y may also have programs that suit your needs.

What about aspirin, acetaminophen, and the new prescription pain relievers?

If you need pain relievers on a daily basis, you should discuss your options with your doctor. All have risks and benefits. The first line of treatment is usually acetaminophen (such as Tylenol and generics), which does not cause stomach upset or bleeding, but can affect liver and kidney function over the long term, especially in high doses. If acetaminophen doesn't work or stops working, the next option is a nonsteroidal anti-inflammatory drug (NSAID)—aspirin, ibuprofen (such as Advil and Motrin), or naproxen sodium (Aleve). Over the long term, daily use of NSAIDs can cause gastrointestinal bleeding and stomach ulcers in some people, so you should take them under medical supervision. If you are taking blood thinners, such as warfarin, NSAIDs and even acetaminophen will increase their effect.

As an alternative, your doctor may suggest that you try one of the new prescription NSAIDs known as COX-2 inhibitors. They are designed to have the pain-relieving effect of NSAIDs with a lower risk of gastrointestinal bleeding. They do this by stopping production of a pain-causing substance in the body, but they don't interfere with similar substances that act to protect the stomach lining. Some doctors now use them for first-line treatment in people with moderate to severe arthritis pain. But these heavily promoted drugs are expensive, and are so new that the long-term side effects are not completely known. If you have arthritis and are doing well on nonprescription pain relievers, there's no need to switch.

What are other ways to manage arthritis pain?

Heat can help. If your joints are stiff, take a warm bath or shower—this is particularly helpful before exercising. Or apply a heating pad or hot packs to stiff joints.

Nonprescription capsaicin creams (Zostrix, Capzasin-P, and other brands) can also be useful. Capsaicin is the substance that makes chili peppers hot, and when applied to the skin it acts not only as a counter-irritant (creating diversionary pain to mask the real one) but also as a suppressant of pain. You may not notice much improvement until you've used the cream for a week; it must be applied three or four times daily. Some people cannot tolerate it. These creams are not usually kept on the open shelves; ask the pharmacist for them. You might also try creams with methyl salicylate—ask your doctor or pharmacist.

What about vinegar and honey, copper bracelets, gin-soaked raisins, and other remedies?

These never seem to lack for advocates. There's no scientific evidence that any of them can be helpful, but at least they are cheap and harmless. Don't substitute them for effective treatments. Always be skeptical of "cures." There is no cure for osteoarthritis—but one day there may be.
For information of glucosamine, see our Guide to Dietary Supplements.