Osteoarthritis

Various OTC products are available as creams, gels, ointments, and sprays to temporarily relieve arthritis pain. Products containing the pain reliever trolamine salicylate include Aspercreme and Sportscreme. Products containing one or more of the counterirritant medications methyl salicylate, menthol, and camphor include Eucalyptamint, Icy Hot, and Ben-Gay. Capsaicin (Zostrix, Capzasin-P), a cream made from the seeds of hot chili peppers, may relieve pain in joints close to your skin surfaces, such as your fingers, knees, and elbows.

Acetaminophen (Tylenol, others) can relieve pain but doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild-to-moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. It might be best to limit or abstain from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you’re taking it.

Nonsteroidal anti-inflammatory drugs (NSAIDs) work in two ways. They relieve pain (such as from osteoarthritis and sore muscles), and they fight inflammation (such as from rheumatoid arthritis). NSAIDs range from OTC aspirin, ibuprofen (Advil, Motrin, others), and naproxen sodium (Aleve)  which are also available at higher dosages by prescription to others that are only available by prescription, such as ketoprofen (Oruvail), diclofenac (Cataflam, Voltaren) and nabumetone (Relafen). NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increase your risk of gastrointestinal bleeding.

Considered as effective for managing pain and inflammation as other NSAIDs, COX-2 inhibitors celecoxib (Celebrex) and valdecoxib (Bextra)  may not have the same stomach-damaging effects but are more expensive than generic, nonselective NSAIDs. Side effects may include fluid retention and causing or exacerbating high blood pressure. Some reports indicate that COX-2 inhibitors may be associated with an increased risk of a heart attack.

Tramadol (Ultram) is a centrally-acting analgesic that’s available by prescription. It has no anti-inflammatory effect but can provide effective pain relief with fewer side effects such as stomach ulcers and bleeding than NSAIDs. However, Tramadol may cause nausea and constipation. It’s generally used for short-term treatment of acute flare-ups.

Independent of their antidepressant properties, antidepressants, especially tricyclics, can help reduce chronic pain. Some people with arthritis also experience symptoms of depression. Antidepressant medications can treat the sleep disturbance that can accompany arthritis. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), and trazodone (Desyrel).

Occasionally, your doctor may suggest injecting a joint space with a corticosteroid, which can offer some pain relief and reduce inflammation. Injecting hyaluronic acid derivatives into knee joints (viscosupplementation) can relieve pain from osteoarthritis. Hyaluronic acid is a component of joint fluid, and Hylan G-F20 (Synvisc) and hyaluronate (Hyalgan, Supartz) are derivatives made from cockscomb.

In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint and replaces it with a plastic or metal device called a prosthesis. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger, or ankle joints. Joint replacement is most successful in large joints, such as hips and knees. It can help you resume an active, pain-free lifestyle. In smaller hand joints, it also can improve appearance and comfort and may improve your joint’s mobility.

Other surgical techniques are designed to remove loose fragments of bone or cartilage that may cause pain or cause mechanical problems such as “locking.” The procedure is usually done with an arthroscope, a small tube inserted into the joint, through which the surgeon works. A study reported in July 2002 in the New England Journal of Medicine evaluated some types of arthroscopic procedures in people with osteoarthritis of the knees. The study showed no significant difference in pain relief or improved function two years after the surgery among those who underwent arthroscopic surgery and those who underwent a sham placebo procedure. The majority of the people in the study were men. Additional studies, including women, are necessary to better evaluate the results of this study.

Surgeons can also reposition your bones to help correct deformities (osteotomy).

Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain but has no flexibility.

For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don’t twist or use your joints forcefully.

Rest when you’re tired. Arthritis can make you prone to fatigue and muscle weakness deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn’t interfere with nighttime sleep may help.

Your painful knee may need a brace for support. You might also opt for a cane to take the weight off the joint as you walk. The cane should be used in the hand opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle. Contact your pharmacy or doctor’s office for information on ordering the items that may help you the most.

Make a plan with your doctor for managing your arthritis. This will help you feel that you’re in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.

 Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.

Periodically relax and stretch.

Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.

Don’t push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

Because many complementary medicine methods haven’t been studied extensively by researchers using mainstream scientific methods, it’s difficult for the scientific community to evaluate their effectiveness and safety. And with much of today’s research funding coming from the pharmaceutical industry, some “low-tech,” nontraditional approaches to manage diseases such as arthritis may not get as much attention from the research community as they deserve. For these reasons, many Western physicians just don’t know enough about these methods to endorse them. Nonetheless, a growing body of evidence indicates that complementary medicine practices could have a role in treating and managing some diseases.

Common forms of complementary and alternative medicine for the treatment of osteoarthritis include:

Acupuncture

Copper jewelry

Homeopathy

Magnets

Some studies have shown the positive effects of nutritional supplements such as glucosamine and chondroitin sulfate preparations on osteoarthritis. Studies are ongoing on people who have osteoarthritis to compare the results of using glucosamine with those of using chondroitin sulfate and of using a mixture of the two. Don’t use glucosamine if you’re allergic to shellfish. Glucosamine may raise your blood insulin level if you have diabetes. Chondroitin sulfate may affect blood levels of warfarin (Coumadin) if you’re taking that medication.

Be careful when considering alternative therapies. Many are expensive, and some may be harmful. Before taking any complementary medications or dietary supplements, talk with your doctor to learn about potential dangers, particularly if you’re taking other medications.