If you’re over 65, odds are even that you have arthritis. It may amount to nothing more than mild stiffness in the hands or knees or may plague you with several painfully swollen, severely inflamed joints. Either way, however, it needs attention, and it can be helped.
Arthritis, which literally means “inflamed joints,” is as old as mankind. More than 100 different forms of the disease have been discovered, according to the Arthritis Foundation. In older adults, the three most common types are osteoarthritis, rheumatoid arthritis, and gout.
Scientists are beginning to understand some of the causes of the disease, which has mystified researchers for centuries. Defects in the immune system, infections, and heredity are the suspected culprits in some forms of the disease. Previous joint injuries and the natural deterioration of joints over a lifetime also make people more vulnerable.
Many people ignore arthritis or dismiss it as the “aches and pains” of growing older. Others swallow mouthfuls of painkillers instead of seeking medical treatment. Some try unproven remedies such as snake venom or copper bracelets.
None of these strategies, however, is really adequate. Arthritis is a progressive, potentially crippling disease that needs medical attention. Although it has no cure, with the right treatments its debilitating effects can be halted and even reversed.
Osteoarthritis: The Greatest Threat
Osteoarthritis (OA), is a progressive, degenerative joint disease that originates from natural wear and tear on the body’s joints. The disease, which affects more than 16 million Americans, is the most common type of arthritis and the only form directly related to age. Half of all adults over 65 have OA, and the disease is even more common after age 75.
The hallmarks of OA are the breakdown of cartilage (the firm, rubbery material that cushions the surface between the bones in a joint) and the thickening of adjacent bone and soft tissue. As cartilage ages, it begins to split and fray. Bone surfaces in the affected joint can then make direct contact during movement, causing pain. Over time, the cartilage loses its elasticity and wears away completely, leaving the surfaces of the bones totally unprotected.
Generally, OA affects only one or two joints. The hip, knee, hand, and spine are most vulnerable. Sometimes, the condition causes only mild pain and stiffness, particularly toward the end of the day. As OA progresses, fluid normally released into the joint to lubricate and nourish the cartilage begins to accumulate, and the joint becomes swollen. OA rarely results in serious deformity. But unless you make necessary changes in your lifestyle and use medication to relieve symptoms, it can eventually limit your mobility.
We still don’t know why some people develop OA while others are spared, but several factors have been implicated. For example, OA in the hands or hips may run in families. Excess weight has been linked to OA in weight-bearing joints like the ankles and knees. Previous injuries and overuse in sports or work-related activities encourage development of OA in the knees, hips, and elbows.
Symptoms of arthritis (see box) that last longer than 2 weeks should send you to your primary care physician. The doctor will probably begin by asking where your joint hurts, how often it hurts, when the pain began, whether you have noticed any swelling, and whether your regular activities have been affected.
The doctor also will conduct a thorough physical exam and, perhaps, take x-rays to look for bone and joint changes typical of OA. Blood tests may be ordered to rule out the presence of other diseases. Still, the major criteria confirming a diagnosis of any form of arthritis are simply pain and limitation of motion.
Although osteoarthritis can never be completely cured, treatments such as physical therapy, joint protection and, in many cases, medication, can dramatically improve its symptoms. The best treatment varies with each individual. People who are overweight can benefit from weight reduction. Others may gain improvement from muscle strengthening exercises. Some can use devices such as canes or walkers to relieve the stress on affected joints. There are also tricks for sitting down, standing up, and getting in and out of bed that can make life a lot easier, and can be learned from any physical or occupational therapist.
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The Role of Exercise
Exercise—which gives you more energy, helps you keep trim, and makes your bones and muscles stronger—is important for everybody. But for someone with arthritis it offers even greater dividends. Regular activity keeps joints from becoming stiff, strengthens muscles around the joints, and maintains bone and cartilage tissue.
In research studies, exercise has been shown to decrease pain and the need for medication while allowing people with OA to continue a normal lifestyle. A daily walk or swim, a round of golf, regular tennis matches, or a program that includes range-of-motion (stretching and flexibility) exercises can keep your joints working more efficiently so you can continue your favorite activities. By contrast, a sedentary lifestyle not only allows arthritis to progress, but also can lead to other health problems such as heart disease.
Older people with OA often stop exercising because they misinterpret the meaning of pain. If an activity causes an increase in pain for 1 to 2 hours afterward, that’s a signal to modify or adapt the exercise—not to stop it altogether. Pain helps people to gauge a safe amount of exercise. Don’t ignore the message; but don’t overreact either.
Not just exercise, but proper exercise, is key. When you move, be sure to use the affected joints. These are like rusty hinges: you have to keep oiling them or they’ll freeze up. Perform range-of-motion exercises, in which the joint is moved as far as possible, every day. Don’t “favor” one knee or hip; this is likely to reduce overall body strength.
Current research also indicates that some people with OA can safely perform conditioning exercises such as fitness walking without aggravating arthritis-related symptoms. That’s important, because conditioning exercises help to improve the heart rate, keep muscles toned, and even counteract depression.
The secret is to start small, then gradually stretch the activity bit by bit. If you begin riding a stationary bike, give yourself permission to stop after 1 minute. When starting to walk, set your sights on a half block—since you also have to return—and increase the distance by a half block a week. Pacing yourself this way helps to break in the new routine.
The buddy system reduces the number of exercise dropouts. Encourage friends and family members to join you in a walking program or swimming class. Make it family time rather than enforced exercise time. Remember, too, that local chapters of the Arthritis Foundation offer aquatic and exercise programs, such as pace (“People with Arthritis Can Exercise”), that are tailored to the needs of those with arthritis.
Joint protection. Whether participating in a formal exercise program or simply accomplishing daily tasks, you need to minimize the stress on affected joints. The goal of joint protection for people with OA is to provide stimulating activity while limiting the risk of injury.
Joint stress can be reduced by lightening the amount of weight placed on a joint—for example, by exercising in water, using a rowing machine, or riding a stationary bike. People with OA also should avoid such activities as high-impact aerobics and should keep down their speed to avoid provoking pain or swelling. Using strengthening exercises to warm up before an activity also helps protect joints by increasing fitness and endurance.
Joint protection also means positioning grocery bags, household appliances, tools, and other items to avoid excess joint stress. People with OA should try to avoid carrying anything that weighs more than 10 percent of their body weight. In addition, it’s best to carry an item such as luggage on the same side as the affected joint and distribute the weight of a large container, such as a basket, between both hands. A good rule of thumb is to use the largest or strongest joints to support an object. For instance, grocery bags should be braced with forearms or palms instead of fingers.
A physician or physical therapist can recommend sturdy shoes and insoles to cushion arthritic feet or reduce the impact of walking on affected hips or knees. Some people with OA may be advised to wear a specially fitted splint on an affected joint when sleeping or resting. Walkers and canes also can help balance weight and reduce pressure on hips or knees.
Correct posture helps prevent irritation of arthritic joints. Keep your back reasonably straight when lying, standing, walking, or lifting. Whenever possible, sit in a straight-backed chair with armrests and try not to slump. Most of all, change position frequently to prevent stiffness. When watching television or traveling by car, for instance, take a 5- minute break every hour to stretch and walk around.
Rest. Exercise should always be balanced with rest. People with osteoarthritis need whole body rest, joint rest, and emotional rest. Alternate heavy or repetitive tasks with easy ones. Plan rest breaks during walks and other daily activities. When you’re lying down, provide adequate support for affected joints. The key is to avoid exhaustion without standing or sitting in one position too long.
Heat and cold. Many people with OA find that heat or cold affords temporary relief of pain and stiffness. Heat or cold also can be used to warm up for an activity.
Soaking in a warm bath, taking a hot shower, swimming in a heated pool, using a heat lamp or sauna, or applying a heating pad or hot pack helps to relax aching muscles and reduce muscle spasms. Especially after exercising, some people prefer to use ice compresses or cold packs to numb a joint so they don’t feel as much pain.
Whichever you choose, remember to be careful. Don’t use either treatment for more than 20 minutes at a time, and let your skin return to normal temperature between applications. Never use heat with topical ointments or creams since this can result in a serious skin burn.
 | Normal joint: Where two bones meet, our bodies normally provide a simple and effective lubricating system. Ligaments binding the bones together form a capsule within which a thin membrane called the synovium exudes a fluid lubricant. For good measure, the ends of both bones are cushioned by a smooth layer of cartilage.Osteoarthritis: In this form of arthritis, trouble begins when the protective cushion of cartilage between the bones slowly degenerates. As it disappears, the synovium and the ends of the bones thicken within the joint, leading to the aching stiffness that characterizes the disease.Rheumatoid arthritis: The culprit here is the synovium, which for unknown reasons becomes swollen and inflamed, leading to irreversible damage to the joint's capsule and protective cartilage. Eventually the unprotected ends of the bones themselves begin to erode. |
Weight Control
Anyone with OA should stay as close as possible to his or her recommended weight. From midlife onward, a woman’s greatest risk factor for osteoarthritis of the knee is excess weight. Older people who are overweight also face increased risk of other health problems such as diabetes and heart disease, which can complicate OA treatment.
This doesn’t mean that overweight people with OA should starve themselves or start a crash diet. Overweight older women of average height who reduce their weight by just 10 percent— 15 pounds for a 150-pound woman—can significantly lessen stress on arthritic joints. If you need to lose more, it’s best to ask your doctor for a customized weight-loss program.
No diet can cure osteoarthritis, but a well-balanced diet low in fats and cholesterol certainly contributes to overall good health. The secret to losing weight is to eat fewer calories and increase physical activity. A diet emphasizing fish and poultry, fresh fruits, vegetables, and whole grains while limiting red meat, fats and sweet desserts can help keep weight under control.
Medications
Among people over 45, more medicines are taken for arthritis than for any other ailment, according to the U.S. Food and Drug Administration. A mild over-the-counter product such as acetaminophen (Tylenol and others) remains the safest choice for older adults with mild symptoms. Two tablets or capsules generally are taken every 4 to 6 hours, as needed. Despite recent publicity about the increased odds of kidney disease among daily users of acetaminophen, doctors say that older adults need not be concerned, since the problem takes many, many years to develop. There is, however, a different reason for caution if your daily routine includes three or more drinks containing alcohol: Acetaminophen has been known to cause liver damage when used under these circumstances. Check with your doctor if you feel you’re at risk.
In addition to acetaminophen, some over-the-counter ointments offer short-term relief of minor arthritis pain. These ointments are rubbed over painful joints, but they do not reduce swelling and should not be used for long periods of time.
Arthritis symptoms sometimes vanish by themselves, then reappear weeks, months, or years later. Many people with arthritis associate such spontaneous remissions with the use of unproven remedies such as "alternative diets" or "miracle" treatments. The success of these remedies is mere coincidence. In fact, some are actually harmful, while others are useless. The safety of many others is unknown.Four out of five people with chronic conditions such as arthritis try an alternative therapy at some point, often without a physician's knowledge. One danger in doing this lies in neglecting conventional treatments while experimenting fruitlessly with the latest megavitamin or health food cure. Also, while some unconventional remedies such as copper bracelets may be harmless (though worthless), others can result in serious complications.When considering an alternative therapy, it's important to look at scientific evidence. For example, acupuncture has now received the endorsement of the National Institutes of Health, which in 1997 concluded that it may be used as an alternative treatment for management of the pain of osteoarthritis. It is believed that proper insertion of acupuncture needles into specific points on the body releases pain-killing opioid peptides with a very low risk of side effects. Acupuncture alone won't provide a lasting remedy for arthritis, but as part of a complete arthritis management program, it provides many people with significant relief.Similarly, in a recent clinical trial, people with RA who took high doses of fish oil—a substance typically deficient in the modern Western diet—were rewarded by improvement in their symptoms. Some patients were able to discontinue NSAIDs without experiencing a flare-up of symptoms. Their general health also improved, including a reduction in blood pressure. (These results, however, could have been coincidental, so further testing is needed.)Other potential remedies under investigation include biological substances such as monoclonal antibodies and interleukins, laser surgery, homeopathy, and biofeedback. These therapies show some promise in certain situations but need a great deal more study before they can be considered authentic treatments for arthritis.By contrast, some alternative remedies contain substances that can actually harm your health. A recent study analyzing Chinese herbal medications ("Chinese black balls") found they contained large quantities of potent prescription drugs, including ingredients such as caffeine, diazepam (Valium), hydrocortisone, lead, mefenamic acid (Ponstel), and prednisone. Because high dosages of these potions are typically recommended—6 to 12 pills per day—such ingredients can produce life-threatening complications.Dimethyl sulfoxide (DMSO), another alternative promoted for arthritis relief, is a solvent similar to turpentine. There are no controlled studies demonstrating the safety and effectiveness of this product in relieving swollen, inflamed arthritic joints. In fact, DMSO can harbor bacterial toxins that can enter the bloodstream even when it's applied as an ointment. The substance is especially dangerous if used as an enema.When confronted by an alternative therapy, it's important to look for evidence of serious scientific study, and to check out the product with your doctor. Tip-offs of a potentially bogus remedy include:
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain and reduce inflammation as symptoms of OA become more severe. These drugs block the production of prostaglandins, chemicals in the body that cause pain and inflammation. Some NSAIDs require a prescription, others do not. NSAIDs need a few days to a week to begin their anti-inflammatory work. Their full benefits may not be felt for 2 to 3 weeks.
NSAIDs are generally divided into two groups: salicylates and nonsalicylates. Both groups of drugs have similar pain-relieving effects, but they have somewhat different potential side effects. Aspirin (Bayer, Bufferin, and others) is the most commonly used over-the-counter salicylate, while ibuprofen (Advil, Nuprin, Motrin, and others) and naproxen (Aleve) are the most popular nonsalicylates. Both are available in tablet or capsule form and may be taken every 4 to 8 hours as needed. Newer “extra strength” and “arthritis formula” products contain more medication in each tablet than regular doses and need to be taken only once or twice a day. A new NSAID called meloxicam (Mobic) offers another alternative for those who either find no relief from, or experience side effects from the older NSAIDs on the market.
While NSAIDs provide much-needed pain relief, they can cause serious side effects in some people. The most common reactions include stomach ulcer and other gastrointestinal disorders such as heartburn, nausea, stomach pain, vomiting, or diarrhea. Individuals over age 60 are at greatest risk of these complications, especially if they have a history of ulcers or abdominal pain, or have previously used antacids. These side effects are even more common in smokers and those who drink alcohol while taking NSAIDs. Occasionally, gastrointestinal bleeding can occur, signaled by black or bloody stools. Less frequently, NSAIDs can cause headaches, dizziness, and blurred vision.
An anti-ulcer drug called misoprostol (Cytotec) has been approved to treat serious stomach disorders and prevent ulcers in arthritis sufferers taking therapeutic doses of aspirin or other NSAIDs. In one medical study, misoprostol reduced the number of serious upper gastrointestinal complications by 40 percent. This medical breakthrough is significant because gastrointestinal complications can be fatal in older people. However, misoprostol itself can cause diarrhea and related problems, so some people with minor side effects continue to rely on coated aspirin tablets or long-acting aspirin products, despite the possibility of gastrointestinal problems. An arthritis remedy that combines an NSAID with misoprostol in a single pill is now available under the brand name Arthrotec.
In any event, anyone using NSAIDs should get regular checkups, and report any side effects promptly. In many cases, the problem can be relieved by reducing the dosage or changing from a salicylate to a nonsalicylate. Taking NSAIDs with food also reduces stomach distress.
COX-2 inhibitors (Bextra, Celebrex) offer another solution to those prone to stomach distress. A new type of NSAID, they have the same painkilling effects as the older drugs, but without as many gastrointestinal side effects. Like older NSAIDs, these drugs fight pain and inflammation by inhibiting the effect of a natural enzyme called COX-2. Unlike the older medications, however, these drugs do not interfere with a similar substance, called COX-1, which exerts a protective effect on the lining of the stomach. The new drugs are therefore less likely to cause bleeding and ulcers during sustained use.
Corticosteroids such as dexamethasone (Decadron) and prednisone (Deltasone) can reduce inflammation caused by OA. These powerful drugs closely resemble cortisone, a natural hormone produced by the body. They are available in tablet form or can be injected directly into a stiff, swollen joint.
Although corticosteroids rapidly relieve pain, swelling, and redness, they often produce serious side effects— especially in users over 65. These medications can lower resistance to infection and cause indigestion, weight gain, loss of muscle mass and strength, mood changes, blurred vision, cataracts, diabetes, osteoporosis, and high blood pressure.
Other medications. While estrogen replacement therapy (ERT) is not prescribed specifically for arthritis, many women taking estrogen also report pain relief. Doctors are not exactly sure why this occurs, but many studies have confirmed a relationship between female hormone levels and the severity of arthritis. Doctors suspect that the relief some postmenopausal women experience from ERT may be similar to that experienced by younger women during pregnancy.
Over-the-counter supplements containing glucosamine sulfate, or glucosamine in combination with chondroitin sulfate, have gained considerable popularity recently thanks to their ability to provide many osteoarthritis sufferers with significant relief. Glucosamine and chondroitin are both naturally occurring components of cartilage, and researchers believe that their synthetic forms may slow the breakdown of cartilage in the joints. The supplements have already earned high scores in European and Asian studies, and the National Institutes of Health have commissioned U.S. studies to confirm their efficacy. Side effects of the supplements appear to be minimal.
Another remedy based on the body’s natural chemistry is hyaluronic acid, a joint lubricant known to be depleted by inflammation. It is available as an injectable extract (made from rooster combs) marketed as Hyalgan or Synvisc. This treatment, also known as “visco-supplementation” provides pain relief for osteoarthritis, particularly of the knee, with minimal side effects. People who are allergic to eggs, however, should not take this drug.
During an arthritis “flare,” when pain is particularly acute, physicians sometimes prescribe a narcotic pain reliever such as Tylenol with Codeine. Nevertheless, many doctors now recommend that prescription medications be used for OA only if over-the-counter NSAIDs or acetaminophen, together with lifestyle measures, don’t offer relief. Because older adults often take multiple medications, each additional prescription has a much greater chance of producing a serious drug interaction.
| If a joint becomes too painful to tolerate, doctors today can simply replace it. The new artificial joint—known medically as a prosthesis—will eliminate the pain, and can be expected to last for up to 20 years. Don't underestimate the gravity of the decision to operate, however. Almost 10 percent of those who undergo the surgery will eventually need a second operation. Recovery takes from 4 to 6 weeks. And the artificial joint will never withstand the kind of punishment that the original could take: vigorous athletics will be out of the question. |  |
Joint Surgery and Replacement
Joint replacement surgery is often recommended for people with intractable pain that can’t be managed by any other combination of therapies, and for those with a true loss of function that can’t be regained through physical therapy, such as the inability to drive due to osteoarthritis in the hip or knee. More than 150,000 total joint replacements are performed each year in the U.S. Arthritis accounts for 90 percent of all total knee replacement operations—the most commonly performed joint replacement.
The operations are performed by orthopedic surgeons (doctors who specialize in bone surgery). These specialists can replace damaged joints with wear-resistant artificial joints made of metal and plastic. Man-made replacements are available for all major joints, but hip and knee replacements have the best track record for restoring mobility and reducing pain. An artificial joint is good for 12 to 15 years, so you don’t have to wait until you’re 80 to meet the conditions for surgery, medical experts say.
Though patient satisfaction rates for hip and knee replacements are very high, the operations are not without risk. One of every 20 individuals undergoing joint replacement will have a significant problem during or following surgery. Many people also need rehabilitation following surgery to reduce the risk of other health problems. It may be best to wait until you’re certain you’re ready. Motivation is a key to recovery.
Surgery to remove damaged tissue without replacing the whole joint is also an option for some people. It is often done with a special instrument called an arthroscope, which allows the surgeon to view the joint and repair any damage through a small incision. Generally, arthroscopic surgery has a good record of success, and recovery is quick.
Rheumatoid Arthritis: How to Slow Its Progression
Rheumatoid arthritis (RA) is one of the more disabling forms of arthritis, though it varies in severity. RA affects more than 2 million Americans and is 2 to 3 times more common among women than men. Typically, symptoms begin between the ages of 30 and 50. While the cause of RA remains unknown, scientists suspect it may result from a malfunction of the immune system. Some people may have a hereditary tendency to the disease.
Unlike osteoarthritis, RA produces more prominent symptoms in the morning. These include stiffness in muscles and joints, swelling in three or more joints, swelling of the hands and wrists, and swelling of the same joints on both sides of the body (such as both knees or wrists). Fever, fatigue, and loss of appetite may accompany the inflammation.
The onset of RA presents people with many physical and emotional challenges. Such everyday activities as cooking and gardening may require substantial effort. Recreational activities that once were a source of pleasure may lose their appeal. Still, research studies have shown that individuals who receive adequate pain management are able to continue both their household and leisure activities.
Medications
Drug treatment for rheumatoid arthritis begins with the same types of medications used for OA: acetaminophen or over-the-counter NSAIDs such as aspirin or ibuprofen. As the disease progresses, physicians sometimes add a corticosteroid to the treatment plan to relieve pain, swelling, and redness. Prednisone (Deltasone) has been used since the 1950s for short-term treatment of RA in older adults. However, this medication can cause the brittle bones of osteoporosis when used for an extended period.
Products made with capsaicin, a naturally occurring substance in hot peppers, also appear effective in temporarily relieving rheumatoid arthritis pain. When applied to the skin over the affected joints, these products seem to suppress a chemical in the body that increases RA inflammation. Capsaicin (Capsagel, Capzasin-P, Zostrix) is available without a prescription; but it may not be appropriate for people with diabetic neuropathy (see Chapter 24), and its long-term side effects, if any, are unknown.
Increasingly, physicians are turning to more potent medications, sometimes called “second-line” drugs, if NSAIDs fail to control joint inflammation or pain after 4 to 6 months of regular use. Second-line drugs are potent medicines that are likely to affect the liver, kidneys, or lungs over time, but have proven effective in relieving the symptoms of RA. Doctors use these in conjunction with non-drug therapy as part of a comprehensive treatment program.
Gold compounds (also known as gold salts) can help people with mild to moderate rheumatoid arthritis that is progressing slowly. Auranofin (Ridaura) is a capsule taken by mouth, while aurothioglucose (Solganal) and gold sodium thiomalate (Myochrysine) are injections usually given on a weekly basis. These medications may require 2 to 6 months to take effect. Diarrhea often occurs in people who take gold by mouth, while those who receive injectable gold may notice a metallic taste in their mouths. Other, more serious side effects include blood in the urine, bruising, mouth sores, skin rash, and numbness in the hands and feet.
Newer second-line drugs. Fewer physicians prescribe gold compounds in light of the emergence of new second-line drugs. Penicillamine (Cuprimine, Depen), taken orally, works much like gold salts to reduce symptoms and retard disease in severe cases of RA. This drug also requires 2 to 6 months to become effective, but causes fewer side effects than gold.
For reasons that are not fully understood, an antimalarial drug called hydroxychloroquine (Plaquenil), taken in tablet form, also relieves inflammation in mild to moderate forms of RA. The medication should be taken with a meal or a glass of milk, and needs several weeks to become effective. Possible side effects include diarrhea, headaches, appetite loss, skin rash, and stomach pain. In addition, people taking this drug need regular eye exams since the medicine can permanently damage the retina (the light-sensitive tissue at the back of the eye). It’s advisable to avoid alcohol while taking this drug.
The latest weapon against RA is a new class of drugs called “tumor necrosis factor (TNF) antagonists.” TNF appears to play a role in the inflammatory process. The antagonists successfully reduce the pain and morning stiffness of RA with few reported side effects. The drugs should not be used by people with active infections or by those prone to infection, such as diabetics. Etanercept (Enbrel) is the first of these agents to reach the market.
Immunosuppressants, or drugs that suppress the immune system, are the last line of defense against RA. Some researchers believe that rheumatoid arthritis is an autoimmune disease in which the immune system attacks the body’s own tissues. Two immunosuppressants, azathioprine (Imuran) and methotrexate (Rheumatrex) have been approved by the Food and Drug Administration for use in RA. In fact, weekly low-dose methotrexate has replaced gold compounds as the most frequently used second-line drug. In comparison with other drugs, low-dose methotrexate is said to act more quickly, result in a greater reduction in inflammation, and have fewer side effects. For those who don’t respond well to methotrexate alone, some doctors are now using a combination of methotrexate and the TNF antagonist infliximab (Remicade). It’s said that this combination reduces structural damage in people with RA and improves their ability to perform the simple tasks that become increasingly more difficult as the disease progresses. If neither gold nor methotrexate work, azathioprine is next in line.
Some physicians also have begun to treat severe cases of RA with sulfasalazine (Azulfidine), an anti-inflammatory medicine used for ulcerative colitis (a chronic, progressive bowel disease); with the anti-cancer drugs cyclophosphamide (Cytoxan) and chlorambucil (Leukeran); and with cyclosporine (Sandimmune, Neoral), typically prescribed after organ transplant surgery to prevent tissue rejection. These medications can cause serious side effects, including mouth sores, infection, fever, chills, sore throat, nausea, diarrhea, and fatigue. Because of their toxicity, these drugs are prescribed only when other alternatives fail to do the job. Nevertheless, they do relieve joint inflammation and can offer hope to someone whose arthritis defies other forms of relief.
A newer, less toxic alternative is the drug leflunomide (Arava). This medication restrains the immune system’s inflammatory action without significantly suppressing its disease-fighting capability. The drug can be taken along with NSAIDs to help retard the damaging effects of rheumatoid arthritis. It’s not prescribed for osteoarthritis.
If arthritis succeeds in restricting your movements, you may need to adjust the way you perform simple tasks like dressing, eating, and bathing. There are many helpful devices and mechanical aids you can have installed in your home to make these tasks easier:
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Exercise
As with osteoarthritis, treatment for RA includes exercise to maintain or restore joint function. The exercise program should include stretching exercises, which increase strength and flexibility while protecting arthritic joints, and aerobic exercises such as walking and swimming. A good warm-up is needed before any formal exercise routine.
Therapeutic exercise in RA is designed to maintain people’s ability to move and function. To build upper- and lower-body endurance, swimming is the most effective activity. Walking, dancing, calisthenics, stationary bicycles, cross-country skiing machines, and treadmills also provide significant benefits. The key is to maintain a regular exercise pattern over time.
Remain as active as possible by adapting your leisure activities to your ability. For instance, if you were an avid runner before the onset of RA, try race walking instead. Make recreational athletics such as golf and table tennis a regular part of your life.
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| Gout is the only form of arthritis that is unquestionably linked to diet, although the number of people whose gout can be blamed entirely on what they eat is small. For a victim of gout, foods high in substances called purines, such as liver, kidney, fish roe, mussels, anchovies, peas, beans, pancreas and brain, add to the existing problem of elevated levels of uric acid in the blood. Drinking too much alcohol and crash dieting can also raise the level of this acid. The uric acid that the body either overproduces or can't get rid of forms into tiny crystals like shards of glass which float in the joint space. When the immune system attacks these crystals, inflammation occurs. |
Diet
While everything from seawater to cod liver oil has been promoted as a remedy for RA, the value of dietary treatments remains controversial. Despite the popularity of one diet that eliminates red meat, additives and preservatives, fruit, and dairy products, experts have never been able to agree on a single, special diet for RA. What works for one patient often fails in another. So, in the end, most doctors simply recommend a healthy, balanced diet.
Still, some scientists believe that food may be a culprit in some people with RA. These patients may be allergic to certain foods, according to this theory, and their symptoms may actually reflect the food allergy rather than the disease. Diets high in calories, protein, and fatty acids also are thought to trigger a reaction from the immune system in people with RA.
Surgery
As with OA, surgical procedures such as hip and knee replacements can help someone with RA to resume normal activities and maintain an independent lifestyle. Immobilized joints can be repaired through plastic surgery, useless joints can be stabilized with fusion, and artificial joints can replace those incapacitated by the disease.
Relief from Gout
Uric acid is a normal human waste product found in the blood. However, when the body produces too much uric acid or the kidneys don’t eliminate it fast enough, crystal-like deposits of uric acid form in and around joints, causing gout.
About 1 million Americans suffer from gout. African-American men, who are more likely to have high blood pressure, also appear to have a greater risk of developing gout. In later years, however, men and women are equally affected by the condition.
Gout is characterized by sudden swelling and pain, often in the big toe. Ankles, knees, elbows, wrists, and hands also can be affected. An acute attack is very painful. Swelling may cause the skin to pull tightly around the joint and become very tender.
In ages past, gout was called the “disease of kings” because the lifestyle and diet of the landed gentry was believed to be the culprit. This is partly true. Diets high in purines (organ meats, fish eggs, sardines, anchovies, beer, and wine) can aggravate gout in people who produce excess uric acid. Alcohol also can trigger a gout attack or make one worse. Eliminating these foods may reduce the chances of an attack, but dietary modifications alone usually won’t cure the disease.
In fact, like other forms of arthritis, gout can’t be completely cured. However, it is possible to get symptomatic relief. In addition to the use of NSAIDs to relieve pain during an attack, medications have been developed that prevent future attacks and joint damage.
The pain and swelling caused by gout are treated with two types of drugs—one to reduce inflammation and the other to lower uric acid levels. Colchicine and probenecid, the generic ingredients in ColBENEMID and Col-Probenecid, work together to block joint inflammation and increase the elimination of uric acid. Allopurinol (Zyloprim, Lopurin) prevents the formation of uric acid in the body. These medications must be taken for several months to work effectively. In fact, they can actually make gout worse if treatment is started during an attack. The most likely side effects include diarrhea, nausea, vomiting, stomach pain, and rash.
Getting on with Your Life
Living and coping with any chronic disease is difficult. If the arthritis is mild, it may have only a minimal impact on your activities and emotions. On the other hand, many people become depressed, angry, and frustrated with the pain and immobility that arthritis can inflict.
Listen to your symptoms; they’re a signal from your body to slow down, rest, and relax. Talk openly with your family, friends, and doctors about your frustrations. Don’t give up your everyday activities, but do set realistic and flexible goals. Search for new ways to find enjoyment through exercise. Ask for help when you need it, and learn as much as you can about arthritis and its many forms of treatment. Remember that there are many people who can help you learn to work, play and enjoy life in spite of arthritis.