THE CLINIC: OA Options, Self-Administered and Otherwise

QUESTION:

What are the latest and best self-administered treatments for arthritic

joints (especially ankles and hips)?  Do you know of any effective herbal remedies, over-the-counter medications, hot/cold treatments, or the like?

 

Frank Burman

Phoenix, AZ

 

ANSWER:

Although it seems like new treatments for every medical condition seem to

appear every week, there are not a great deal of new treatments for

osteoarthritis (OA) in the past year or so. My recommendations to patients

include:

 

1.  Maximize flexibility and strength. Other joints in the same limb are

affected by the loss of motion in an arthritic joint. As muscle strength

increases, there is decreased stress on the joints. Although stiffness and

pain are usually present when exercise is started, symptoms commonly subside

during the course of exercise.

 

2.  Try both heat and ice. Some people get much more relief with one

compared to the other; a pattern of heat prior to activities and ice

afterwards works for many people.

 

3.  Maintain an appropriate weight. Too much weight means greater stress on

joints. 

 

4.  Appropriate footwear. Shoes should have good support and cushioning.

 

5.  Braces. A simple knee sleeve may provide some improvement in comfort. An

unloader brace applies valgus stress to the knee and may be beneficial for

someone with medial compartment arthritis.

 

6.  Medications and supplements. The data on supplements is mixed. There was

good support for the use of glucosamine, though a meta-analysis study in the

New England Journal of Medicine last year did not demonstrate positive results. I have a

number of patients who report improvement in joint pain while taking

glucosamine. The form of glucosamine—pill vs. liquid—does not seem to

matter, but liquid is much more expensive. Studies are being performed on

chondroitin, ginger, and multiple other supplements. There is some reported

improvement in pain with these supplements. NSAIDs are effective for

decreasing pain, but chronic use increases the risk of renal or hepatic

toxicity. Lab tests should be monitored if NSAIDs are taken on a chronic

basis. Acetaminophen  plays a role in pain control. Chronic use may cause

hepatic toxicity, especially when used in conjunction with alcohol.

 

7.  Injections. Cortisone injections may provide temporary relief from pain

(weeks to months) and can be beneficial in ameliorating symptoms. This treatment should be used sparingly, however.

 

Hyaluronic acid injections (Synvisc, Supartz, Hyalgan) can be quite helpful

in decreasing pain. At this time, these are only approved for use in knees, so

insurance will not cover this treatment for injection into other joints.

 

8.  Surgery. When pain is severe and other measures have not been working,

this is a long-term solution. Prostheses are being improved and have a

longer life span.

 

Cathy Fieseler, MD

Tyler, TX

 

 

ANSWER:

As far as self-administered, non-prescription treatments,

the first and foremost treatment would be glucosamine/chondroitin, two

triple-strength or three double-strength tablets per day. Capsaicin, ibuprofen

(Advil, Aleve, Nuprin, Mediprin), Tylenol (Extra-Strength or

Arthritis-strength), and topical salves like Tiger Balm, Ben Gay, or Mobisyl

could also be considered. Heat brings blood to an area and is a vasodilator,

so it can help before exercise or activities, while ice acts as a

pain-reliever by vasoconstricting, and is therefore best used after

Activities, or if the joint is too painful.

 

There are also homeopathic remedies such as Arnica (in pill or gel

form) that can be purchased in health food stores and/or homeopathic

pharmacies.

 

Mark McKeigue, DO

Flossmoor, IL

 

 

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