Monday, September 7, 2015

Arthritis Advice


Arthritis Advice
Multiple Responses:
When joint cartilage wears away, bone rubs against bone, causing osteoarthritis. Sounds painful? It is.

Osteoarthritis seriously impairs the quality of life for 27 million Americans. Given that osteoarthritis is so disabling, painful, and common, lots of quack “cures” are out there, from shark cartilage to copper jewelry to snake venom.

But here are 13 natural remedies that research suggests may actually help ease arthritis pain.

Weight loss
The best remedy—maintaining a healthy weight, and losing weight if necessary—is not the easiest.

Still, every pound you pare off means 4 pounds less pressure on your knees, says Laura Robbins, senior vice president of education and academic affairs at the Hospital for Special Surgery in New York City.

Some people will see their symptoms disappear if they lose 10 to 20 pounds, says Roy Altman, MD, a rheumatologist and professor of medicine at the University of California, Los Angeles.

Physical activity is essential for people with osteoarthritis, whether it means walking around your apartment if you’re a fragile older person or swimming laps if you’re in better shape.

People used to think that exercise made arthritis worse, but the opposite is true—unless you’re pounding the pavement. (Runners with knee osteoarthritis should cut down on mileage, try to cross-train, and run on softer surfaces like tracks and dirt paths.)

Exercise programs should include both aerobic exercise—like walking, swimming, or biking—and strengthening exercises, such as isometric and isotonic exercises, Dr. Altman says.

Many people find that acupuncture helps relieve pain and disability due to arthritis; several studies have found benefit from the procedure.

“Several trials show acupuncture to be helpful for many people with osteoarthritis,” says Dr. Altman. “It’s not helpful in everybody.”

There is some evidence that suggests that glucosamine alleviates arthritis pain, but the type of glucosamine matters.

“There continues to be a lot of controversy about it. There’s a fair amount of data that glucosamine sulfate is beneficial, but glucosamine hydrochloride is not,” Dr. Altman says. “Almost all of the products that are sold here in the United States are glucosamine hydrochloride. There are no trials demonstrating that glucosamine hydrochloride benefits people with osteoarthritis.”

In the studies that did find benefit for glucosamine sulfate, Dr. Altman says, patients took 1,500 milligrams once a day, which resulted in better absorption in the body than splitting the dose.

Early research found that this supplement was promising when combined with glucosamine. However, more recent studies indicate it’s not effective.

Although some studies suggest that chondroitin sulfate slows arthritis progression, it hasn’t been shown to help symptoms, says Dr. Altman. Studies that found the supplement helpful used 800 milligrams or 1,200 milligrams daily.

“They’re really pretty safe,” Dr. Altman says of the supplements. “The one thing about them is there’s no major side effects. They’re fairly well tolerated.”

Other supplements
Other supplements have shown promise, but the evidence just isn’t that strong, says Dr. Altman.

Industry-funded studies have found benefits for avocado soybean unsaponifiables (ASU), which are made from avocado and soybean oils, in patients with hip and knee arthritis. But such studies aren’t as reliable as those funded by groups that don’t stand to gain financially.

There’s some evidence that rose hips and highly concentrated ginger could be helpful, Dr. Altman says.

Although fish oil has anti-inflammatory properties, more research is needed.

Topical remedies
Strong-smelling mentholated rubs and creams may make your skin tingle, but many have limited value for osteoarthritis, says Dr. Altman.

However, there are some creams now available that have proven benefit, he adds. Diclofenac gel, sold in the U.S. as Voltaren Gel or Pennsaid by prescription (but available over the counter in Europe), is a nonsteroidal anti-inflammatory drug that can ease osteoarthritis pain in the knees, ankles, feet, elbows, wrists, and hands. It hasn’t been evaluated in osteoarthritis of the spine, hip, or shoulder. (Dr. Altman is a consultant for Novartis, the maker of Voltaren Gel.)

Capsaicin cream
Capsaicin cream can also relieve osteoarthritis pain, and it’s available without a prescription.

It’s made from the substance that gives chili peppers their heat.

Nobody knows how it works, although one theory is that the cream relieves pain by depleting the nerve ending of pain-impulse-transmitting chemicals known as “substance P” and calcitonin gene-related protein, Dr. Altman says.

Electrical energy can be used to help ease pain and swelling in arthritic joints in a couple of different ways. Physical therapists often employ transcutaneous electrostimulation, or TENS, which involves placing electrodes around the affected joint and delivering electromagnetic pulses through the skin.

And there’s electroacupuncture, in which the provider uses needles at acupuncture points that are attached to electrodes to pass an electric charge through the acupuncture needles.

There’s some evidence that both approaches can help provide at least short-term pain relief and also ease joint stiffness.

Chiropractic therapy won’t help with osteoarthritis. But what it is useful for, says Dr. Altman, is treating the muscle spasms that often accompany the condition.

For example, if you have acute lower back pain, chiropractic manipulation can break up the muscle spasm and scar tissue, easing the pain.

Heat and cold treatments can also be helpful for easing these muscle spasms, which aren’t only painful, but can interfere with sleep.

Physical therapy
Most of the time you don’t need to see a physical therapist, Dr. Altman says. Still, in some cases physical therapy can be invaluable.

For example, a person who is so weak that he or she has trouble getting out of a chair can benefit from physical therapy, and possibly even have PT adminstered at home.

But the therapist should be experienced in treating osteoarthritis. “Many physical therapists are used to treating stroke patients or sports injuries or other things where they’re used to pushing people a lot,” Dr. Altman says. “Physical therapy for osteoarthritis needs to be more gentle.”

Assistive devices
Shoe inserts, canes, splints, braces, and other devices that can help redistribute your weight to take the load off an arthritic joint or hip can be very beneficial, says Dr. Altman.

They are particularly helpful, for example, if someone has become knock-kneed or bow-legged as a result of having arthritic knees; unloading braces can help restore normal weight distribution, reduce pain, and prevent your arthritis from getting worse.

While evidence for the benefits of shoe wedges is mixed, according to Dr. Altman, some people will find them helpful, especially if they have leg length discrepancies greater than a half-inch.

It’s not a therapy, but learning more about arthritis is actually a powerful weapon.

It’s crucial that you understand osteoarthritis and what your limits are—and aren’t, says Dr. Altman. There is a lot of good information on the Web, he adds, from the Arthritis Foundation and Centers for Disease Control and Prevention, for example.

You also need to find a doctor, whether it’s your primary-care physician, an internist, or a rheumatologist (a specialist in diseases of the joints), who can take the time to work with you to develop an exercise plan and answer your questions, he says.

“In some physicians' offices where they only have seven minutes to see you, you’re not going to get that education.”

Looking after and caring for someone with arthritis is a challenge. You need to get the balance right between providing support and motivation and giving your friend, family member or colleague independence. You’ll need to figure out when it’s a good time to offer help and when it’s a good time to stand back.

The most important thing is to realise that there are no rights and wrongs in caring for someone who has arthritis, and there are many ways of coping with arthritis. There are four main ways you can help someone with arthritis: understand their condition, talk with them, help with treatments and offer advice on benefits.
The four main ways a carer can help

The effect of arthritis on mood
It’s normal for people with arthritis to experience a wide range of emotions. Encourage them to focus on positive experiences and think about what they can do rather than things they have difficulty with.

People with chronic conditions such as arthritis are more likely to be diagnosed with clinical depression. If you’re worried that the person you’re caring for may be affected by depression, encourage them to seek help from their doctor.

Arthritis and confidence
Having arthritis can make some people feel less self-confident. Your support, if wanted, can increase their confidence and help them to keep an active social life. Keeping up their personal appearance, as well as regular socialising, can help keep self-confidence levels high.

Helping with pain and stiffness
  • If a particular activity is causing problems, encourage the person you’re caring for to find a different way of doing it. An occupational therapist can give advice on aids and adaptations that may help.
  • Hold a hot-water bottle or an ice pack (or bag of frozen peas) against the painful joint for 10–15 minutes. Wrap them in a towel to avoid burning the skin.
  • Find non-physical ways of occupying the mind. Relaxation, massage and yoga can help ease pain and tension.

Encouraging exercise
  • Encourage daily exercise to keep the joints moving to minimise pain and stiffness – swimming and cycling are good activities.
  • Speak to a physiotherapist if you need advice about exercise.
  • Join in the exercises so they’re more of a social activity and less of a chore.
  • Start gradually and increase the amount over time as the body adjusts to the increased activity.

Fighting fatigue
Some people find the fatigue caused by arthritis is more difficult to cope with than the pain. You can help to reduce fatigue by:
  • spreading, pacing and planning activities, especially during a flare-up – this can also help reduce pain and stiffness as well as increase the chance of activities being carried out successfully
  • encouraging regular exercise
  • setting up a regular sleep pattern.

Understanding the role of drugs
Drugs, such as painkillers, non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs), are one of the main treatments for arthritis. The person you care for should speak with their doctor about the types of drugs that may be suitable for them. Together, they’re in the best position to weigh up the benefits and possible side-effects of taking drugs. Everyone is different, so if one drug isn’t working a different one might.

If the person you care for has an inflammatory arthritis, it’s important that they start drug treatment quickly because the sooner they begin treatment, the more effective it’s likely to be. The person you care for must follow their doctor’s instructions when taking drugs.

Every treatment occasionally causes side-effects, but the risk of these can be reduced by following the doctor’s advice. If you’re worried, or think that they may be causing side-effects, take the person in your care to see their doctor.

Encouraging a healthy diet
It’s important to eat a balanced diet with plenty of fruit and vegetables for good general health. People with arthritis should keep to a sensible weight as being overweight will increase the stress on the joints. Some people with arthritis do seem to benefit from changing their diet, though there’s no single diet that helps with all types of arthritis.

Talking to them
Good communication is essential between carers and the people they care for. It’s important that you both discuss how you’re both feeling. You need to agree how to work together so that they’ll feel able to ask if they need extra help and to turn it down if they don’t. Sometimes you may have to stand back and watch your partner, child, friend or colleague struggle to achieve a goal that’s important to them. Try to respect their wishes, allowing them to maintain their self-esteem. Communication will also help you judge how the person you’re caring for is feeling and so you can respond in a sensitive way. They’ll need to feel supported and reassured that you don’t resent the responsibility falling on you.

What is arthritis?
The more you understand about arthritis, the more you’ll be able to provide effective care and support.

Doctors often divide the different types of arthritis into two groups:

What causes arthritis and related conditions?
Most musculoskeletal conditions are caused by several factors acting together, for example the genes passed on from your parents and environmental factors such as previous injury. Research supported by Arthritis Research UK has gone a long way towards finding the causes of most of the common forms of arthritis, but there’s still a lot to be done.

What is the outlook?
Most forms of arthritis differ a lot from day to day and from one person to another, so it’s difficult to predict the outlook. Many types of arthritis are long-term (chronic) disorders which can’t yet be cured. People with arthritis can experience flare-ups, which may be related to things like viral infections, but they’ll often happen for no clear reason. This unpredictability can make arthritis difficult to live with.

How does it feel to have arthritis?
Arthritis affects different people in different ways, and there are no right or wrong ways to feel. The problem with the pain of arthritis is that it can sometimes carry on for a long time and dealing with it day after day isn’t as easy.

As arthritis symptoms are unpredictable, those with the condition need to find their own way of coping. Learning about the disease is an important factor, and a specialist rheumatology health professional will often help with this.

The word "arthritis" makes many people think of painful, stiff joints. But, there are many kinds of arthritis, each with different symptoms and treatments. Most types of arthritis are chronic. That means they can go on for a long period of time.

Arthritis can attack joints in almost any part of the body. Some types of arthritis cause changes you can see and feel—swelling, warmth, and redness in your joints. In some kinds of arthritis, the painand swelling last only a short time, but are very uncomfortable. Other types of arthritis might be less painful, but still slowly cause damage to your joints.

Common Kinds of Arthritis
Arthritis is one of the most common diseases in the United States. Older people most often have osteoarthritis, rheumatoid arthritis, or gout.

Osteoarthritis (OA) is the most common type of arthritis in older people. OA starts when tissue, called cartilage, that pads bones in a joint begins to wear away. When the cartilage has worn away, your bones rub against each other. OA most often happens in your hands, neck, lower back, or the large weight-bearing joints of your body, such as knees and hips.

OA symptoms range from stiffness and mild pain that comes and goes to pain that doesn't stop, even when you are resting or sleeping. Sometimes OA causes your joints to feel stiff after you haven't moved them for a while, like after riding in the car. The stiffness goes away when you move the joint. Over time, OA can make it hard to move your joints. It can cause a disability if your back, knees, or hips are affected.

Why do you get OA? Growing older is what most often puts you at risk for OA, possibly because your joints and the cartilage around them become less able to recover from stress and damage. Also, OA in the hands may run in families. Or, OA in the knees can be linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.

Rheumatoid arthritis (RA) is an autoimmune disease, a type of illness that makes your body attack itself. RA causes pain, swelling, and stiffness that lasts for hours. RA can happen in many different joints at the same time. People with RA often feel tired or run a fever. RA is more common in women than men.

RA can damage almost any joint. It often happens in the same joint on both sides of your body. RA can also cause problems with your heart, muscles, blood vessels, nervous system, and eyes.

Gout is one of the most painful kinds of arthritis. It most often happens in the big toe, but other joints can also be affected. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender.

Eating foods rich in purines like liver, dried beans, peas, anchovies, or gravy can lead to a gout attack in people with the disease. Using alcohol, being overweight, and taking certain medications may make gout worse. In older people, some blood pressure medicines can also increase the chance of a gout attack. To decide if you have gout, your doctor might do blood tests and x-rays.

Warning Signs
You might have some type of arthritis if you have:
  • Ongoing joint pain
  • Joint swelling
  • Joint stiffness
  • Tenderness or pain when touching a joint
  • Problems using or moving a joint normally
  • Warmth and redness in a joint

If any one of these symptoms lasts more than 2 weeks, see your regular doctor or one who specializes in treating arthritis, called a rheumatologist. If you have a fever, feel physically ill, suddenly have a swollen joint, or have problems using your joint, see your doctor right away.

Treating Arthritis
Getting enough rest, doing the right exercise, eating a healthy, well-balanced diet, and learning the right way to use and protect your joints are keys to living with any kind of arthritis. The right shoes and a cane can help with pain in the feet, knees, and hips when walking. But make sure the cane is fitted by a professional. Don’t borrow one from a friend or neighbor. There are also gadgets to help you open jars and bottles or to turn the doorknobs in your house.

Some medicines can help with pain and swelling. Acetaminophen might ease arthritis pain. Some people find NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen, naproxen, and ketoprofen, helpful. Some NSAIDs are sold without a prescription, while others must be prescribed by a doctor. Be very careful about possible side effects of some NSAIDs, whether sold with or without a prescription. Read the warnings on the package or insert that comes with the drug. Talk to your doctor about if and how you should use acetaminophen or NSAIDs for your arthritis pain. The U.S. Food and Drug Administration has more information about drugs such as those mentioned here.

Osteoarthritis (OA). Medicines can help you control the pain. Rest and exercise may make it easier to move your joints. Keeping your weight down is a good idea. If pain from OA is very bad, there are shots your doctor can give you.

Rheumatoid arthritis (RA). Treatment can help the pain and swelling. This might slow down or stop joint damage. You may feel better and find it easier to move around. Your doctor might also suggest anti-rheumatic drugs called DMARDs (disease-modifying antirheumatic drugs). These can slow damage from the disease. Other medicines known as corticosteroids (like prednisone) can ease swelling. These are strong medicine and should only be taken with a doctor’s prescription. Another kind of drug, called a biologic response modifier, blocks the damage done by the immune system. These may help people with mild-to-moderate RA when other treatments have not worked.

Gout. The most common treatment for an acute attack of gout is NSAIDs or corticosteroids. They can bring down the swelling, so you may start to feel better within a few hours after treatment. The pain usually goes away within a few days. If you have had an attack of gout, talk to your doctor to learn why you had the attack and how to prevent future attacks. If you have had several attacks, your doctor might prescribe medicines to prevent future ones.

Exercise Can Help
Along with taking the right medicine and properly resting your joints, exercise might help with arthritis symptoms. Daily exercise, such as walking or swimming, helps keep joints moving, lessens pain, and makes muscles around the joints stronger.

Three types of exercise are best if you have arthritis:
  • Range-of-motion exercises, like dancing, might relieve stiffness, keep you flexible, and help you keep moving your joints.
  • Strengthening exercises, such as weight training, will keep or add to muscle strength. Strong muscles support and protect your joints.
  • Aerobic or endurance exercises, like bicycle riding, make your heart and arteries healthier, help prevent weight gain, and also may lessen swelling in some joints.

The National Institute on Aging (NIA) has created the Go4Life® campaign to help you start and stick with a safe exercise program. You can learn all about it by going to There you’ll find exercises, tip sheets, personal success stories, and more! You can even keep track of progress in your exercise program. You can also order Go4Life® materials in English and Spanish by calling the NIA at 1-800-222-2225 (toll-free).

Other Things To Do
Along with exercise and weight control, there are other ways to ease the pain around joints. You might find comfort by using a heating pad or a cold pack, soaking in a warm bath, or swimming in a heated pool.

Your doctor may suggest surgery when damage to your joints becomes disabling or when other treatments do not help with pain. Surgeons can repair or replace some joints with artificial (man-made) ones.

Other Remedies
Recent studies suggest that acupuncture may ease OA pain for some people. Research also shows that two dietary supplements, glucosamine and chondroitin, may help lessen moderate to severe OA pain, but they seem to have no effect on changes to cartilage in the knee. Scientists continue to study these kinds of alternative treatments. Always check with your doctor before trying any new treatment for arthritis.

Many people with arthritis try remedies that have not been tested or proven helpful. Some of these, such as snake venom, are harmful. Others, such as copper bracelets, are harmless, but also unproven.

How can you tell that a remedy may be unproven?
  • The remedy claims that a treatment, like a lotion or cream, works for all types of arthritis and other diseases.
  • Scientific support comes from only one research study.
  • The label has no directions for use or warning about side effects.
  • The person recommending the treatment profits directly from your purchase of the medicine.
  • People who are now completely well are presented to you as having the same problems you have (this is called anecdotal evidence).

Talk To Your Doctor

Pain and arthritis do not have to be part of growing older. You can work with your doctor to safely lessen the pain and stiffness and to prevent more serious damage to your joints.

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