Osteoarthritis is the most prevalent rheumatic condition. It presents mainly when people reach their 50’s to early 60’s, affecting all people differently. Most often the hands, knees, hips, spine, and big toes are involved. Other areas that may be affected include the wrists, elbows, and shoulders.
Unfortunately you cannot change your age, but there are other modifiable factors that you can change to lessen the likelihood of developing osteoarthritis. Obesity increases your chances, as it puts extra pressure on your joints. Others include occupation and, though rare, genetic factors.
How do I know if it is osteoarthritis?
The most common complaints of osteoarthritis include morning stiffness and pain with activity. For those suffering from morning stiffness, you may notice that with movement the stiffness decreases. This is known as “gelling”. Pain may be most notable with activity and ceases when the active involvement of that joint ends. Osteoarthritis may be described as “deep and aching” and does not affect the body symmetrically, unlike rheumatoid arthritis.
If this description depicts your symptoms, you may be a candidate for self-treatment. However, it is advised to meet with your physician within 10 days of beginning any self-treatment for further follow-up and to rule out a more serious medical condition. Self-treatment is not appropriate if you have any of the following:
• Pain that does not cease with rest
• Pain lasting more than 10 days with treatment
• Certain medical conditions such as diabetes and congestive heart failure
• On a blood thinner, such as Coumadin®
• Pain that is symmetrical (example: both knees or both elbows equally affected)
What treatment options are available?
• Diet and weight loss
Excess weight increases the load on your weight-bearing joints. Loosing as little as 10% of your total body weight can be very helpful.
• Heat/cold treatments
These treatments can reduce pain and aid in maintaining and restoring the range of motion in affected joints. Warm baths or water soaks may be useful for pain and stiffness. The use of heating pads should be cautioned due to the risk of burns. Exercise regimes that focus on stretching and strengthening can improve physical functioning.
Over-the-counter (OTC) Options
If you find that the non-drug treatment options are working or need further relief until you may be seen by your physician, there are a few OTC options available.
Typically Tylenol® (acetaminophen) should be tried first because it is inexpensive and effective. Tylenol® is more appropriate than Motrin® and Aleve® for people suffering from gastrointestinal issues, acid reflux, or on a blood thinner. The recommended daily dose is 650mg four times a day. This particular strength is marketed as Tylenol® Arthritis. It can take anywhere from two to three weeks to see a maximum effect. The maximum recommended daily dose is 4000mg per day, so be sure to check other products that you are taking to make sure that they do not contain acetaminophen (common in many “Cough and Cold” products). Do not exceed 2 to 3 alcoholic beverages per day while taking Tylenol®. The most common side effects include upset stomach and nausea, but overall it is very well-tolerated.
If Tylenol® is ineffective, a non-steroidal anti-inflammatory such as Motrin® or Aleve® may be tried. Do not take one of these medications if you have acid reflux, past or current stomach ulcer(s), are on a blood thinner, or have a history of kidney impairment without first speaking to your physician. These medications decrease pain and inflammation. The recommended starting dose of Motrin® is 2 tablets three times daily with food. If one agent in this class is tried and does not provide the proper relief another may be tried. The recommended dose of Aleve® is 1 tablet three times a day with food. Side effects may include upset stomach, heartburn, and nausea. If you have tried a treatment for at least 10 days without relief, seek medical treatment.
Glucosamine and chondroitin have received much attention for their role in helping with the symptoms of osteoarthritis. Both can generally be found in single products and may be effective in reducing pain, improving mobility, and even promote cartilage health. Glucosamine is derived from oyster and crab shells and chondroitin from shark and bovine cartilage. If you have an allergy to any of these substances, do not take glucosamine and chondroitin supplementation. The recommended dose of glucosamine is 1500 mg per day and chondroitin 1200 mg per day. Combination products are produced in fixed doses that will enabled you to reach these recommended doses. It may take 2 to 3 weeks for a maximal response. Check with your physician before trying this supplementation if you have diabetes or another serious medical condition, as rarely increases in blood pressure, cholesterol, and blood glucose have been noted with its use. The most common adverse effects are usually gastrointestinal and include intestinal gas, abdominal cramping, and bloating.
Topical therapies may include products such as those listed above in the chart. Many of these products have ingredients that include methyl salicylate, camphor, menthol, or capsicum. These products are intended to be applied no more than 3 to 4 times daily. Some products effect is a cooling sensation or heat. One of the most widely known products is Capzasin®. When applied to the skin it produces a feeling of warmth or slight burning. With continued use (at least 14 days) the irritation to the skin decreases or resolves. Therefore it should be used on a daily basis to keep pain from returning. Safety considerations with topical products include skin rashes, burning, and stinging. Never apply a topical product to broken skin. Also, when using a product that produces a heat sensation, heating pads, tight, or occlusive bandages should not be placed over the product after it is applied.
For those of you wishing to try natural remedies there are several available. Peppermint oil can be used topically to treat arthritis pain and may be similar to products containing menthol. Common reactions include skin irritation or rash. Devil’s claw is taken by mouth and may improve pain tolerance when used in combination with non-steroidal agents like Motrin®, as does stinging nettle. There is evidence that oral or topical use of stinging nettle leaf extract may improve symptomatic pain associated with osteoarthritis. Side effects from stinging nettle may include gastrointestinal upset, sweating, and allergic skin reactions. SAMe (S-adenosyl-mehtane) is a supplement that is comparable to non-steroidal medications and may be associated with fewer adverse effects than Motrin® or Aleve®. However the response is delayed and is much more costly than other options.
Before starting any supplementation or OTC therapy, check with your pharmacist to make sure it will not interact with any of the other medications you are taking. Always follow package directions accordingly and if you have any further questions, contact one of you local Foster’s pharmacist.