Arthritis part 2: How to take care of daily stiffness, pain

Editor’s note: This is the second of two articles providing a current overview of arthritis.

While the symptoms of arthritis often wax and wane, the underlying disease is generally progressive. What’s a patient to do when bringing stiffness, pain and a limited range of motion into their busy, daily routine?

Dr. Emilio Gonzalez, who serves as both director and chief of the University of Texas Medical Branch’s Division of Rheumatology, explained the options.

First for rheumatoid arthritis (RA), Gonzalez had good news. Recent clinical work has made it possible for many sufferers to see the ailment go into remission.

“This is accomplished with the disease-modifying, anti-rheumatic drugs,” he said. “A similar approach is present for gout.”

So by infusion or other techniques, many RA patients can live mostly symptom free. But the story is different for osteo arthritis (OA).

“We badly need better and newer therapies to manage OA,” Gonzalez said. “The ultimate prognosis in a given case depends on the type of arthritis, the severity of it, individual genetics and the pattern of joint distribution such as a few joints versus multiple joints, etc.”

But he has good news for OA sufferers as well.

“OA is not necessarily progressive if one loses weight and stops engaging in the type of activity that could potentially continue to make the disease worse, such as, aggressive skiing, bicycling or jogging if one suffers from significant knee problems,” he said.

His prescription for adults who wish to stay active without aggravating their aging joint? Swim. It’s the best exercise option offering both aerobics and low-impact joint care.

The doctor’s advice for OA self-management then, is to lose weight as needed, swim and carefully use pain medications. Of these, Gonzalez said that acetaminophen (Tylenol, Datril) was the safest, but not necessarily the most effective. Other over the counter drugs such as aspirin and ibuprofen (Motrin) can have substantial side effects when used at maximum dosage for any length of time.

“The use of such drugs can be problematic, and their long term use should be avoided in patients with underlying renal, hepatic or cardiac disease, such as congestive heart failure, for example,” he said. “This is an area where patient education is important since OTC pain relievers are freely available. In dealing with OA, some rheumatologists, including myself, recommend nutraceuticals, for example, supplementation with glucosamine-chondroitin sulfate. We also recommend checking vitamin D blood levels and if insufficient or deficient, replacing it with oral vitamin D3.”
Hot and cold compresses and other nonmedical therapies may also be worth a try, especially for flare-ups.

Self-diagnosis and treatment could be both ineffective and even dangerous. For instance, painful joints might result not from OA or RA, but actually be induced by another, undiagnosed problem, such as Crohn’s disease, hepatitis C virus, lupus or even the skin disease, psoriasis.

In these cases, treating the symptoms without expert insight could lead to the continuing progression of the more serious underlying problem, but controlling these diseases might eliminate the apparent arthritis they can cause.
Stopping smoking, good nutrition, staying active with low-impact activities and seeing a specialist all add up to a better prognosis than was available to generations past.

“However, in this day and age, and given the myriad effective treatments now available for RA, there is no reason anymore for any patient to end up crippled by this disease,” Gonzalez said. “This requires early diagnosis and prompt therapeutic intervention of course.”

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