Does anything help arthritis?
Most people over 40 have some arthritis in their joints. It's a wear-and-tear phenomenon caused by inflammation and degeneration in the joint.
Osteoarthritis is not Rheumatoid Arthritis. It does not lead to the severe deformity that is often seen with Rheumatoid.
Pain and swelling are what brings patients to their doctor, but the earlier symptoms of morning stiffness and reduced movement may be present for years before this.
In fairness arthritis is the everyman problem. Most people over 40 have arthritis visible on x-rays, but don't have symptoms.
Studies show that one in four people over 55 will have an episode of persistent knee pain, but only one in six of these actually go to their GP with this complaint. So arthritis is a common and often neglected problem of many people.
Does anything work for arthritis? Is there any effective treatment that can make a difference?
This week the British Medical Journal had a major revue of arthritis, and the treatments that can help. Surprisingly despite all our advances in medicine in recent years, we are no closer to a cure for arthritis.
There were great hopes for the newer arthritis tablets of five years ago, like Vioxx and Celebrex, but these have all been found to have risks, especially to those with unsuspected heart disease. They're also not suitable for patients with stomach ulcers and high blood pressure, as they can cause problems.
In fact arthritis tablets are okay only for short periods. They are not meant to be continued indefinitely. They can cause more problems than they solve.
Arthritis is more common in joints that have received an injury and is more common in certain occupations. Those in the construction industry are more likely to develop arthritis, because of the weight-bearing phenomenon. Likewise being overweight will worsen arthritis.
So what about solutions? Anti-inflammatory tablets like Difene, Mobic, Brufen and Mesulid are now used commonly for flare-ups, but they really should not be used continuously, except under certain conditions.
Simple pain killers like Paracetamol are now the most recommended regular treatments. Glucosamine, which strengthens cartilage, has been shown in some studies to reduce the rate at which arthritis develops, and therefore should be offered to patients with persistent arthritis.
Dona is the commonly available preparation, which is available through prescription. Chondritin is another product that might help.
Steroid injections into joints, and aspiration to remove fluid, can be useful in severe episodes of joint pain, for example in the knee, but the benefit may only be temporary. Nowadays with the growing risk of MRSA, it is also probably wiser to avoid joint injections if possible, and reserve them for severe cases where nothing else is helping.
Likewise the newer injection, Hyaluronan, gives some temporary benefits, but there is conflicting evidence of any long-term improvement.
Physiotherapy can help improve movement and function, when stiffness is a problem. So too can life-style changes around work and leisure. Over-use of joints through sport or work can worsen arthritis, and sometimes more sensible alternatives need to be found.
Curiously swimming will improve movements of stiff joints, without adding to the load transmitted through the body.
Surgery too has a very limited role. Joint replacement (knees and hips) are the final treatment and should be reserved for severe cases where incapacity is huge and growing.
These operations are very successful, but carry significant risks because of clots, bleeding and infections like MRSA. They should not be undertaken lightly.
In its review of treatments the BMJ concludes that non-medical treatments should be used first in arthritis, before offering drugs. They suggest a sensible diet, maintaining a good body weight, avoiding obesity, limiting alcohol, taking regular exercise, and limiting activities that will worsen the problem.
In the real world, patients will not be happy initially with this approach. Most people want immediate pain relief. They will work on their weight and life-style later.
So there is often a trade-off between giving anti-inflammatory medicines, and the patient undertaking to lose weight, or whatever else needs doing.
Often it is a case of risks and benefits. Pain relief is the first task of the doctor. We may not be able to cure, but we can relieve pain.
The risks from treatment may outweigh the benefits, but it is up to each individual patient to make their own choices, once they are informed fully.
Arthritis is unfortunately a common problem, and there are no quick fixes. Using drugs sparingly can be the best method of treatment over the long term. Remember that arthritis itself is not life-threatening, but the treatments can be.
Try the simple things first. Don't put your doctor under pressure to prescribe stronger medicines. He or she has good reason to be reluctant about this. It is called: your best interest.
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Tuesday 22 May 2012
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