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Doctors' Answers to "Frequently Asked Questions" - Arthritis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Severe Osteoarthritis and Weight Loss [posted 1/12/99]
Question: I have severe osteoarthritis in both of my knees. I am a male, 6'2" and weigh 316 lbs. I have tried Redux and gained all of my weight back when the government pulled it off the market. I have also tried Fastin with limited results. Are there any exercises that can be effective for weight loss for someone like myself with bad knees?

Answer: Yes, get a referral to a physical therapist to show you.

Arthritis? [posted 1/12/99]
Question: Whenever my hands get cold both middle fingers and one ring finger turn white and lose sensation. The feeling and color doesn't return for about 10 minutes after I get my hands warmed up. Is this connected to the arthritis I was diagnosed with about 10 years ago, as it didn't start happening until after this time?

Answer: It's called Raynaud's Phenomenon. This is spasm of the arterioles of the hands (or feet) to cold, vibration, trauma etc. Sometimes seen in association with connective tissue diseases, but often seen by itself. It can be blocked by use of calcium channel blockers, especially nifedipine. Usually only a nuisance, but can lead to ulcers or gangrene in severe cases.

Arthritis [posted 1/5/99]
Question: I am dealing with arthritis, but my doctor is not sure exactly what type it is. He had done blood test and knows it is some form of rheumatoid arthritis. He has suspected lupus also, but says it can be hard to detect. I am on ' prednisone for the pain and my sed. rate has not dropped below 80. I had heard that bells palsy can be a early sign of lupus. Is this true? I had bells palsy about 3 years ago. I would appreciate any information.

Answer: Not usually connected.

Arthritis [posted 1/5/99]
Question: I have been taking anti-inflammatories for well over a year for my plantar fascitis. The problem is not with my feet since they are doing better, but still have some pain. I need to know if there are any long term effects of these drugs and erection difficulties. I seem to be loosing my erections at times, and the last thing I needed to here was my wife asking if I’m not attracted to her anymore.

Answer: Usually not with the NSAIDS, get this checked with your doctor.

Arthritis Medication for GERD Patient  [posted 12/08/98]
Question: I need an anti inflammatory drug for my osteoarthritis. Iit's in the worse place; big toe, I can't walk well, the joint is gone. I am allergic to ibuprofen, and because of my GERD & colitis the field narrows. I am not interested in strong pain killers. I have had stomach polpys which I believe eliminates Naprocyn. Please help.

Answer: You would have the same reaction in different amounts to all the NSAIDS. This pretty well eliminates most of the treatments. You might try glucosamine or topical Zostrix cream.

Arthritis or Something Else  [posted 12/02/98]
Question: I was diagnosed with reactive arthritis, it started out real gradual but I could tell something was not right. My right arm and leg started to lose strength, and the middle of my back hurt and a burning sensation just to the right of my left shoulder blade. It progressed to were my foot and hand swelled and I ran a low grade fever of 101. He gave me 500 mg Augmentin, 500 mg Biaxin and Relafen. These medications did not resolve the problem then he put me on 4 mg of Methylpred, I felt great the six days I was taking it until I was through taking it. Now I don't have a fever or any swelling but, I still have the burning and pain in my upper back and I don't have all my strength back in my leg and arm. One other thing that you might need to know is it is worst in the mornings when I first get up. Before I went to the doctor it got were I could not hardly walk in the morning after I am up and a round It is not as bad. I am 31 years old and haven't fell and I really don't think I lifted anything wrong. The pain I have fills like My wrist and ankle are swollen.

Answer: Reactive arthritis is almost always symmetrical. Having inflammation on one side would be very unusual, see a Rheumatologist.

Could Arthritis Be Exacerbated by Iron Medication  [posted 11/25/98]
Question: My sister is taking iron pills for her low blood count and her rhematoid artritis seems to be worse. Would taking these pills account for considerably more pain from her arthritis? Thanks!

Answer: Wouldn't think so, but, it is an pro-oxidant and you could make a case for an interaction.

Possible Arthritis [posted 11/13/98]
Question: I recently visited my dr with severe wrist pain. He ruled out a break and carpal tunnel. I was tested for lymes (due to other symptoms) Negative, will retest in 3 weeks due to tick problem on dog (dog is inoculated- I am not) . My wrist pain is sudden (came literally overnight 5 weeks ago,) often acute, I now sleep with a brace on but never had one symptom until the beginning of August. Dr. gave me relafen. I am only 30, could arthritis just happen over night? Could it be anything else we did not think of? I am also very tired, have a weird lump feeling in my throat as well

Answer: Is it one wrist or both? Inflammatory arthritis is usually symmetrical(both wrists). Asymmetrical arthritis would usually be gout, pseudogout, or osteoarthritis. Carpal tunnel can also give these symptoms.

What is Post-Viral Arthritis [posted 11/6/98]
Question: I've just been diagnosed with "post viral arthritis". Do you have any idea what this is and what the course of treatment is? Is this something that will go away on its own?

Answer: This is an autoimmune attack of your bodies immune system against your joints. Apparently triggered by infection which turns on the immune system. They usually last a week or so;but, in unusual cases can last for significant periods of time. Severe ones like Lyme Arthritis can be permanent depending on the agent that causes the infection (Lyme is not a virus;but a spirochete).

Rheumatioid Arthritis & Daypro [posted 10/21/98]
Question: I was recently diagnosed with Rheumatoid Arthritis. The doctor put me on Daypro 6oo mg. once a day but I was not instructed if I was to take it every day or just when I hurt or had a lot of swelling. What are the side effects from this drug and should I take it everyday? Does it help control the symptoms or the spread of the arthritis?

Answer: You should probably take it every day. It is an anti-inflammatory as well as a pain medication and belongs to the class of drugs called non-steroidal anti-inflammatory medications. General side effects of this class of drugs are mainly GI, heartburn, gastritis, bleeding ulcers, diarrhea. However, usually used if your GI system can handle it as the first line treatment for RA. If your doctor didn't/can't explain this to you, explore another physician. This is usually a disease that needs treatment over many years and you will be better off having someone you can communicate with.

Osteoarthritis & Depression [posted 10/20/98]
Question: I have fibromyalgia osteoarthritis and bursitis in both my hips,I have also been evaluated by a psychiatrist with having major depression. my question is I'm in severe pain all the time and can't seem to get relief. I take meds and depression meds to my lower back is very painful. I exercise in the water warm pool three times a week I'm trying my best have you any suggestions? I have hypothyroidism and premature hysterectomy as well.

Answer: Are you on estrogen? Probably would help if you are not. Secondly, antidepressants such as amitriptyline are regularly used with fibromyalgia and chronic pain syndromes. If you haven't tried these, might be worth a try.

Arthritis - Glucosamine/Chondriotin [posted 8/12/98]
Question: How effective is this combination in treating arthritis? I have heard that it actually helps to rebuild the degenerating cartilage. Is it true that NSAIDS and pain killers just deaden the pain and reduce the inflammation but do nothing to rebuild? Are there any known side effects?

Answer: There is a best selling book which touts this as a solution. Suffice it to say that it may work, but is untested scientifically. I don't think that it does you any harm (other than financially) and I do have some patients who think that they are better. Your other statements of the effect of NSAIDS are correct. Currently there is little data on long term side effects. From my clinical experience it is minimal/none, but not rigidly tested.

Rheumatoid Arthritis and Antibiotics [posted 7/27/98]
Question: I was diagnosed with rheumatoid arthritis about 4 years ago at the age of 25. I have taken many things such as plaquenil and methotrexate, which did not seem to help much. Right now I am on 15 mg of Prednisone a day and Alleve twice a day. I am curious about the use of antibiotics against this disease. I have read about it, but have not asked my rheumatologist yet. I think he was upset that I went off the methotrexate and plaquenil. I went off of them to try and have a baby. Please supply any information you have on the use of antibiotics for rheumatoid arthritis.

Answer: There is an upcoming school of thought that says that Rheumatoid Arthritis is triggered by an infection. Consequently, treatment with antibiotics may help. This has been done and certainly isn't a big deal. The results are generally negative. This is because the process is triggered by an infection, but not sustained by it. I suspect that many inflammatory arthritis have different triggers. However, once the trigger is pulled they have a life of their own. Consequently, treating the initiating cause won't help. An example where this is very clear is Lyme Disease. The arthritis is started by an infection. Early treatment is helpful in preventing the arthritis. However, after a time, antibiotics will not affect the course of the arthritis. If you desire a course, big deal. Try a drug like Biaxin which is broad spectrum and would get organisms like Lyme agent. I assume you have been tested for Lyme, etc.?

Arthritis [posted 7/23/98]
Question: I have had a bone scan done on my foot which revealed arthritis. I have had a cast put on my foot, which resulted in tremendous relief. As soon as the cast was taken off excruciating pain followed. The Physician says no surgery for relief, so what am I to do for the pain?

Answer: I'll need some more information-like did the bone scan show anything else? What joints were involved? What does the physician say he/she is treating?

Arthritis and Knuckle Cracking
Question: Will I really get arthritis if I crack my knuckles?

Answer: Osteoarthritis is due to overuse of any joint. To the extent that "cracking" does this, the answer is yes. However, for practical purposes, no.

Arthritis and Serum accumulation
Question: My mother suffers from serum accumulation in her ankles and knees. The rheumatologists say she does not have any arthritis. This accumulation results in pain and tension in and around the effected joints. It’s worse when she is standing up for long periods and also when it is hot and humid outside. Exercise does not help much, and she does wear bands around her ankles to help with the building pressure. Would you know what could help?

Answer: Has she had an intraarticular injection of steroids? If this really helps then she has some sort of inflammatory process. Also, has she had a sedimentation rate checked? This is a non-specific measure of inflammation and will be normal for osteoarthritis but elevated for most other types of inflammatory arthritis.

Rheumatoid Arthritis with Cerebral Palsy
Question: I am a 41-year-old female with severe quadriplegic cerebral palsy. The spasticity is being treated with Xanax, as Dantrium caused immediate and severe hepatitis. Two years ago, I was also diagnosed with rheumatoid arthritis. NSAIDs and Prednisone alone were ineffective, so disease-modifying agents were added. I first tried Cuprimine, which helped for a time, then stopped helping. I then tried one of the anti-malarial drugs, which did not help and caused disturbances in my vision. For the past year, I have been taking oral Methotrexate (2.5 mg 3 times a week), Deltasone (5 mg daily), and NSAIDs like Relafen and Daypro. The rheumatoid arthritis is progressing, both in severity and in the number of joints affected. I'm having increased difficulty even transferring to and from my wheelchair. I'm also having increasing problems with pain and fatigue.

Answer: Actually, the sequence of drugs is the usual one we try with Rheumatoid Arthritis. Other than advance the dosage of methotrexate you face increasingly more toxic drugs. Some people have tried Cytoxan or Immuran-- both initially anti-cancer drugs like methotrexate. You might want to get a second opinion from a national level figure. Your rheumatologist can arrange this consultation.

Psoriatic Arthritis
Question: A 51 year old male has been diagnosed as having Psoriatic Arthritis in most of his joints for the last four years. He is currently on Methotrexate (20 mg once a week), Parlodel (7.5 mg), Relafen (750 mg 2 times daily), Lorcet, Prozac (20 mg), and Ambien (10 mg every night). He continues to have constant and serious arthritis flare ups. He has been experiencing constant drowsiness, depression, fatigue, lack of appetite, grouchiness, and sexual dysfunction. He was also recently diagnosed with Fibro Myalgia. Do you have any advice? Do you know what is causing his symptoms? Could it be a drug interaction? Do you know of any other treatments available for his arthritis?

Answer: Psoriatic arthritis is a painful and disabling condition. Fortunately, only about 5 % of patients with psoriasis develop this progressive, destructive arthritis. There are several treatment options. Methotrexate seems to be one of the better options. I suspect that his sexual problems are due to prozac. Different anti-depressants might be of use. Fibromyalgia is often seen in people with chronic pain from any source. It seems to be related to the inability to sleep (or get deep sleep) due to the pain. It really is a separate problem from the psoriatic arthritis. Massage therapy and acupuncture are occasionally of great help.

Question: What is the best treatment for Osteoarthritis?

Answer: Treatment of osteoarthritis is mainly directed at pain relief. Start with acetaminophen (Tylenol or equivalent), add aspirin (preferably coated or buffered; watch your stomach), and finally in severe cases small doses of codeine or equivalent. Topical treatments like capazein cream and salicylate creams are also helpful. Taking the medication before activity is often of help. There are many patent remedies, most of which appear to be of little help. However, occasional people swear by copper bracelets, zinc tablets, etc. Try them with skepticism.

Degenerative Arthritis
Question: What is degenerative arthritis? That is what my doctor said was causing the pain in my lower back. He recommended ibuprofen. I tried it this morning, but it didn't seem to have any affect. What can I do to help relieve the pain? Can I exercise? If so, what types of exercise? Would this help to strengthen my back?

Answer: Degenerative arthritis refers to the arthritic changes that occur with wear and tear or trauma. This leads to a degeneration of the cartilage surface of the joint, leading to pain. Have you had x-rays to determine if it is degenerative arthritis and do you have osteoporosis or osteomalacia? What was the trauma that led to this arthritis? - or was it merely time. Don't accept a diagnosis of osteoarthritis without a through evaluation. This would usually include a plain CT of the spine and possible bone density measurements depending on your age.

Question: What are the treatment options for osteoarthritis in the lumbar region of the spine? I have been told that I have spinal degeneration. What does that mean? I am 28 years old, and I injured my back 9 years ago. Is that what caused this illness?

Answer: Osteoarthritis is the loss of articular cartilage brought on by "wear and tear" or repeated use over years. Traumatic arthritis refers to a similar process initiated by damage to the cartilage. I suspect this is the problem with your injury. However, the treatment is similar. That is, focus on pain relief. This can be Non-steroidal anti-inflammatories(Motrin, Aleve, many more), acetaminophen(Tylenol), local remedies like Ben-Gay, heat and lately capeszin cream. The back is harder to get to than joints on the hands, knees, etc. Focus on exercise regimens to strengthen the muscles around the back as well as stretching and analgesia as needed. With this kind of problem, you need to focus on daily exercises.

Question: Will my arthritis medication hurt my stomach? If so what can I do about it?

Answer:There are many different types of "arthritis medication". The most common drugs belong to a class called Non-sterodial anti-inflammatories (NSAIDS). This class of drugs can be found on pharmacy shelves as well as by prescription. The most common and usually the most serious side effect of this class of drugs is gastritis. Gastritis is inflammation of the stomach and can progress to ulcers and bleeding. Caution should always be used with these drugs concerning the stomach. A previous history of ulcers or gastritis is a relative contraindication to using these drugs.

Vinegar and Bees Honey
Question: My mother has arthritis. I know of different cases where people have taken vinegar and bees honey. My mother is afraid to try this as she has had a heart bypass, and high blood pressure at times. What she is afraid of is that it will thin out her blood.

Answer:Arthritis comes in two basic types-inflammatory and "wear and tear". The inflammatory type of arthritis are systemic lupus, rheumatoid, and about fifty others. These are treated with specific treatments depending on the type. Diagnosis of these is important since treatments really do vary. Wear and tear or osteoarthritis is by far the most common. It usually occurs in the forties and early fifties and is accelerated with joint damage or trauma. There are as many treatments as there are people. This is because there really is no cure for the loss of cartilage which lines the joints. There are many touted "folk" remedies. My advice concerning these is to try those that do not seem toxic or risky. If it works keep using it. We all have patients who get major relief from some "folk" remedy for arthritis. Unfortunately, these are not reproducible in numerous patients.

Neck "Pops and Cracks"
Question: When I put my head back against my back or to my shoulders, my neck pops and cracks. Sometimes my neck is so stiff and sore, the only relief I have is to try to "pop" my neck. This only helps a little. I have been told that this is calcium buildup and that I will probably have arthritis later. Is this correct? Is there something I can do about the pain when it gets real bad? Vitamins to take? I am 34 years old and in good physical condition.

Answer: Probably calcium buildup from previous neck trauma(falls, whiplash, etc.). Building up the muscles in the back of the neck might help. Consult Jane Fonda's 1st video workout for the upper body workout(light weights). Do these 3-4 times a week.

Question: Is there a new/experimental medicine that is injected into the knee for the relief of osteoarthritis? A friend told me about this and did not know the name, but said it begins with the letter H.

Answer: News to me-try to get some more information.

Golfing & Arthritis
Question: I started playing golf seriously several months ago and notice that I cannot get my ring over my finger. I talked to some other golfers and they have the same problem. Could this be arthritis related or is it something to worry about?? It seems to be just my wedding ring finger that is swollen just around the knuckle.

Answer: Clearly arthritis compounded with trauma to the joints. Ensure that your grip is correct. Also, taking a NSAID like motrin, Aleve etc. prior to playing may help.

Golfing & Arthritis
Question: Can you please tell me the side effects of naproxen sodium when taken as a prescription drug for arthritis? My mother takes this regularly and I was wondering if it is good to take over long periods of time.

Answer: This belongs to a class of drugs called non-steroidal anti-inflammatory drugs. There are many prescription and non-prescription drugs in this class. They essentially have the same side effects. That is GI trouble(ulcers, gastritis, diarrhea) occasional rashes, occasional hypersensitivity(causing wheezing, asthma) etc. Long term if used on a regular basis(10 years or so) they can decrease renal function and cause premature renal failure.

New Medication
Question: On today's noon news show for NBC, they covered what they described as a new drug for arthritis, but didn't show the spelling of the name. They pronounced it like: sellacoxo, or selacoxo, or cellacoxa. There are three of us in this family, aged 63, 65, and 92. We all suffer from various degrees of arthritis. Can you send any information about this drug to us? I have used your web site, and find it very helpful. Thank you for your presentations and for any help you can give us on this drug.

Answer: I'd check with your local NBC affiliate and get the correct spelling. I can't guess offhand what this is.

Methotrexate Shots
Question: My Mother has been taking methotrexate shots for arthritis for 4 years. She is experiencing shortness of breath. Could this drug be causing her problems?

Answer: Methotrexate can be a cause of pulmonary fibrosis. Generally, regular pulmonary functions are done with this medication.

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