Arthritis and other rheumatic diseases are one of the most common reasons for visits to a physician. Arthritis is the leading cause of physical disability in the United States and accounts for a huge economic toll of more than $85 billion dollars annually. Most persons over the age of 75 have arthritis involving at least one joint.
The impact of disorders of the musculoskeletal system as we get older is significant. Osteoarthritis, rheumatoid arthritis, osteoporosis, and gout are a few of the conditions that affect our bones and joints. Less common but no less important conditions include polymyalgia rheumatica, polymyositis, and pseudogout.
In today’s blog, I invite your questions about arthritis or other musculoskeletal disorders.
Q: Cheryl, TX - Is acupuncture an effective way to deal with arthritis pain?
A: Dr. O'Neil - Yes, acupuncture has been proven to be an effective pain-reliever. A landmark study was published in the December 2004 issue of The Annals of Internal Medicine that showed that acupuncture was effective in providing pain relief and improving function in people with osteoarthritis of the knee. The study was funded by the National Institutes of Health and conducted by researchers at the University of Maryland School of Medicine.
Q: Maxine, PA - I have had an operation to correct arthritis in my thumb. It worked! After 7 years of not knitting, I'd like to resume. Any problems? How can I avoid having the pain come back from an activity that involves repetitive motion?
A: Dr. O'Neil - Generally the reason for this type of surgery is so we can resume activities that we enjoy. You should check with your hand surgeon to be sure there is no reason to restrict activity. You can try a simple pain medication like acetaminophen for minor pain.
Q: Gloria, FL - What is the best way to manage siatica pain. I have pain starting in the right buttock and goes down to the leg which can cause weakness in standing etc. This pain can occur at night as well. Is there a way to be tested for this kind of pain? Thank you.
A: Dr. O'Neil - Yes. Anytime there is persistent pain it should be evaluated. Often an MRI can determine if there are disc or bone problems that are pinching the nerves. Check with your doctor who might refer you to a back specialist.
Q: Janice, CT - Can the use of Omega-3 fish oil, glucosamine & chondroitin really help the slowing or prevention of arthritis?
A: Dr. O'Neil - Neither product can cure arthritis. However, recent research conducted by the National Institutes of Health called the GAIT study showed that although glucosamine/chondrotin did not help relieve pain of all the participants with knee arthritis, it did seem to help a smaller subgroup with moderate-severe pain. The results of a follow-up study conducted on some of the participants in the GAIT Trial showed that the supplement fared no better than placebo in slowing cartilage loss. Some physicians will try a course of glucosamine/chondrotin for 4-6 months to see if it is effective.
Q: Cori, MO - What is the difference between osteoarthritis and rheumatoid arthritis? My mother was just diagnosed with osteo and I am curious about the difference between the two?
A: Dr. O'Neil - Osteoarthritis is a degenerative condition of the joints. It is the most common type of arthritis. More than 75% of people over age 65 have osteoarthritis involving one or more joints. The hallmark of osteoarthritis is loss of the protective cartilage that covers the surface of the bones. This can lead to pain and inflammation of the lining around the joint.
Rheumatoid arthritis (RA) is a disorder of the body’s immune system. The exact cause is unknown, but genetic and environmental factors play important roles. Over 2 million Americans are affected by RA. About 2% of persons over the age of 65 have RA. Some individuals may develop the disease when young. However, RA may have its onset in later life. It is characterized by marked stiffness of the joints especially in the morning and often severe pain involving the shoulders, wrists, and hands. As the disease progresses, there may be marked swelling of the joints and untreated the joints may actually be destroyed. Thankfully, new medicines have been developed that may improve the course of the disease.
Q: Margaret, MA - Is it wise to take Tylenol and or Glucosamine MSM for arthritis?
A: Dr. O'Neil - Tylenol may be helpful-it is a pain reliever. Be sure you take less than 4 grams per day which is 8 extra strength capsules. Check with your doctor to be sure there are no contraindications. As far as MSM we don’t know the long term effects. The active ingredient are glucosamine and chondrotin so I would not recommend the MSM unless your doctor recommends otherwise.
Q: Ruth, MA - How long does the pain relief from acupuncture last?
A: Dr. O'Neil - Individual results may vary since our perception of pain varies from one person to another. Some people will have will have sustained relief, some may get partial and some may not get any benefit.
Q: BJ, TX - Dr. O'Neil, I am a 43 yr. old man. Recent tests showed that I have advanced degenerative arthritis in every lumbar disc. What is the best course of treatment for this condition?
A: Dr. O'Neil - BJ I would suggest that you check with your doctor about a physical therapy and activity plan. Medication can sometimes be useful, but your doctor will have the advantage of your x-ray studies and knowledge of other health conditions you have.
Q: Martha, CT - What is the best exercise for someone with arthritis?
A: Dr. O'Neil - It depends on the joints involved and the type of arthritis that you have. You may want to talk to your doctor about seeing a physical therapist who can prescribe a program that is specific to you. Pool therapy is often very helpful.
Q: Ruth, MA - What is "necrosis of the spine"? Can you please explain? Does surgery help?
A: Dr. O'Neil - Necrosis means that some tissue has been seriously damaged. The question, Ruth, is what is the cause? Sometimes x-rays and MRI scans may be helpful. I can’t tell you whether surgery is helpful in your case. A specialist must evaluate your individual case.
Q: Lacey, LA - I can't tell if the pain I feel in the morning in my back and hands is from arthritis or just the aging process. I live on a computer almost 8 hours each workday. I often have hot swelling and redness in my fingers with resulting gnarling of the joints. Other than simple pain meds like Aleve, is there anything else I can do? Ice? Heat?
A: Dr. O'Neil - Although pain may be common with aging we don’t want to write it off as being the aging process. Usually it is attributable to soft tissue damage or arthritis. Aleve can help as it is an anti-inflammatory medication but some people need to be careful with this. Heat and cold can help-a physical or occupational therapist may be helpful.
Q: Renee, MA - Does Massage Therapy help with the pain of arthritis? Any places more than others, e.g. knee more than hip or shoulder more than neck?
A: Dr. O'Neil - Yes, studies have shown that massage maybe especially beneficial for knee arthritis, and maybe effective for neck shoulders and hips. We need more research for these other areas. In general massage is an effective pain reliving modality.
Q: Ruth, MA - Can my overall body temperature be affected by the inflammation of arthritis? I always feel hot.
A: Dr. O'Neil - Generally, arthritis other than infectious (septic) arthritis should not cause a fever. However there is a difference in the perception of feeling hot and having a fever. This can be caused by other conditions such as an overactive thyroid gland - you should mention this to your doctor.
Q: Holly, WI - Arthritis can affect an individual of any age, correct? Why, however, is it a more common ailment for older adults?
A: Dr. O'Neil - There are many different types of arthritis including juvenile arthritis in youngsters. Generally arthritis is more common with aging because of wear and tear on joints and there may be genetic factors at play as well. The prevalence of rheumatoid arthritis increases with age although it often has its onset in young women.
Q: Sam, MA - Are there any new medications available or under development that might replace VIOXX?
A: Dr. O'Neil - There are currently medicines in the same class that are available such as Celebrex. These medicines, as well as over-the-counter NSAIDs such as ibuprofen and naproxen, should be taken only with doctor’s advice. The risks and benefits must be carefully weighed.
Q: Ruth, MA - Is stenosis related to arthritis?
A: Dr. O'Neil - I presume you are talking about lumbar spinal stenos is. It is related to degenerative disc disease and arthritis in the spine. Thsi causes narrowing of the canal around the spinal cord and compression of the nerve roots resulting in pain or leg weakness.
Q: Francis, MA - Does breaking your bones make you more likely to develop arthritis?
A: Dr. O'Neil - Not always. If there is a fracture in the joint, for example a fracture of the knee, it can cause “post-traumatic” arthritis. Fractures of long bones such as the femur usually do not result in arthritis. Technically arthritis means inflammation of the joint.
Q: Susan, MA - For the past 2 years I've experienced swelling in my left leg and foot. Periodically my entire leg & foot will go to sleep. I don't experience "PAIN" but it is definitely uncomfortable. Is there a correlation between these symptoms & arthritis?
A: Dr. O'Neil - Susan, you need to have that evaluated as there can be a host of reasons for it.
Q: Ruth, MA - My feet, up to above my ankles, feel numb - especially at night, when I feel like I have on socks. Is this going to be a life long thing or is there a way to improve or eliminate the condition?
A: Dr. O'Neil - Ruth, it sounds like you have a peripheral nerve problem that can have a host of causes. Treatment depends on the cause. Be very meticulous about your foot care, do not walk barefoot and be careful of water temperature in your bath. Be sure you have had this evaluated by your doctor.
Q: Carol, IL - Is arthritis hereditary?
A: Dr. O'Neil - Most forms of arthritis seem to have a hereditary component. However, it is important to remember that there are many different types of arthritis and some types of arthritis seem to have a higher genetic risk than others. For example, if your parents had osteoarthritis, the likelihood is greater than 50% that you will have it. The genetic risk for rheumatoid arthritis is significantly less than that. Approximately 40% of persons with gouty arthritis report a family history of gout.
Q: Sara, IL - What role does diet play in arthritis?
A: Dr. O'Neil - Some forms of arthritis seem to have a connection with diet. Gout is probably the best example. This condition is associated with marked pain and swelling of a joint as a result of deposition of uric acid crystals in the joint. Gout is associated with higher levels of alcohol, meat, and seafood ingestion. Organ meats such as liver, kidney, and sweetbreads are best avoided. Sardines and anchovies should be restricted as well. Alcoholic beverages should be eliminated or very limited. Consult with your doctor. Another less common type of arthritis can occur in association with a condition called celiac disease (also called sprue). Elimination of gluten which is a constituent of wheat will cure the arthritis. Recent research in rats has shown that green tea may significantly reduce the severity of rheumatoid arthritis, so there is hope that this will prove true for humans as well. Green tea is rich in antioxidants so may have other health benefits as well.
Be aware of scientifically unsound (quack) claims that special diets, foods, or supplements can cure or cause arthritis. These claims often appear in magazine articles, books, and infomercials. Usually someone is trying to sell you something that is not based on good research. Free information based on good science is available from the Arthritis Foundation.
Q: Lott, AL - Do you recommend use of Voltaren Gel to relieve knee pain of Arthritis?
A: Dr. O'Neil - Studies have shown that topical anti inflammatory medicines like this may be helpful. Get your doctors advice on this. Your doctor will know if it is safe for you.
Q: John, IL - What is Gout?
A: Dr. O'Neil - Gout is an inflammatory arthritis related to deposition of uric acid in the joint. It usually presents as a painful red big toe, but may affect other joints as well.
Q: Lauren, TN - Lately I feel fine when I go to sleep but I have hip and lower back pain when I wake up. Should I get a hard or soft mattress when I go shopping?
A: Dr. O'Neil - You want to find a mattress that provides good back support that will help prevent soreness in the muscles. There has not been a lot of research, but one study shows that medium to firm hardness is the most effective. Have a good balance between comfort and support.
Dr. O'Neil - I enjoyed being with you again today and look forward to next months blog on April 30th at 12 Noon CST. We will discuss stress, anxiety and depression.
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