What's New 

Author: Dale J. Duthoy, M.D.
Clinic: Banning Avenue Clinic

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     With the recent withdrawal of Vioxx (and possibly other arthritis medications from the market), this is a good time to review other options for treating the sometimes very painful and debilitating condition osteoarthritis. Osteoarthritis, also called 'wear and tear" arthritis or degenerative joint disease, occurs when the cartilage surfaces of a joint wear out. This results in eventual spur formation and "bone on bone" rubbing. Most any joints may be affected but common sites of osteoarthritis are the knees, hips, spine and hands.

The cause is not well understood, but contributing factors include injury to a joint and a familial tendency to this disease. Obesity can hasten the course of joint deterioration and increase pain. There are over 20 million Americans fighting osteoarthritis.

 

     Non-medication options for treatment should not be overlooked. Icing a sore joint can decrease pain and swelling. Rest for a particularly inflamed joint is advisable; however, exercise is an essential component for good joint health. Swimming, walking, weight training, hiking and many other activities can decrease pain and improve function. Ask your physician to help you establish an exercise program designed around your arthritis. Weight loss can aid especially lower extremity and lumbar pain.

 

     Over-the-counter (OTC) medication can be an excellent option. Acetaminophen (Tylenol) works well for lesser pain and has few side effects. Glucosamine and chondroitin have been used with some success, especially in arthritic knees. Be aware that glucosamine may slightly affect blood sugar and chondroitin can increase the effect of blood thinners. Ibuprofen and naproxen are non-steroida) anti-inflammatory drugs, or NSAIDs, and can decrease the pain and inflammation of osteoarthritis. The NSAID class of drugs is not with-out side effects or risk. Medications in this class can cause stomach ulcers with bleeding, some liver and kidney complications, and an increased tendency for bruising and bleeding. Please discuss OTC medication use with your doctor or physician's assistant.

 

     Vioxx, Celebrex and Bextra are NSAIDs that were specially developed to try to avoid stomach ulcers and bleeding, and indeed they seem to cause less trouble in that area than older NSAIDs. They are not consistently stronger or more effective than equivalent

doses of the older drugs of this class. Of course the recent discovery that Vioxx increases the risk of heart attacks has led to its withdrawal from the market. At this time, Celebrex, Bextra and Naproxen are being closely watched.

 

     Please be aware of the risks and benefits that any medication carries. Report side effects promptly to your physician. No medication is without some risk!

 

     When other treatments are ineffective, steroid joint injections may offer some benefit. Surgery, including joint replacement may be the best choice.

 

     Ask your physician to help you craft a plan to deal with osteoarthritis so you can continue a healthy active lifestyle!