Get moving and fight arthritis Posted on Monday, April 30, 2007
Control the disease; don’t let it control you By Wendy J. Meyeroff THE ERICKSON TRIBUNE “About half the people who have osteoarthritis don’t know they have it. They just assume, ‘I am getting older, so aches and pains are natural,’” says Patience White, M.D., chief public health officer of the Arthritis Foundation. You and your doctor have to be vigilant in recognizing and fighting arthritis. This is especially true for older adults; 48% of people over age 65 have arthritis. That number is expected to double by the year 2030. Two major forms There are over 100 different forms of arthritis, but the two most common are rheumatoid arthritis (RA) and osteoarthritis (OA). RA affects 2.1 million people, the majority of whom are women, especially women over age 50. It is not only crippling, it kills. If left untreated, a 50-year-old woman with RA can expect to live four years less than the average female. “RA is an auto-immune disease. The body makes antibodies that misread their target and attack the person’s system,” says Leslie Brandwin, M.D., a rheumatologist and medical director of Greenspring, an Erickson- built and -managed community in Virginia. “RA spreads throughout the body. Joints are the major target, but it also attacks your heart, lungs, and other organs.” Affecting nearly 21 million adults, osteoarthritis is the most common form of the disease, the one generally dismissed as natural aches and pains. It is a breakdown of joint cartilage. That breakdown can result from general wear and tear, from injuries, and from the stress of carrying excess weight. There is also thought that, like RA, immunity issues may increase OA development. Getting diagnosed Proper diagnosis of OA versus RA is key to effective treatment. The earlier the better to stave off, or at least minimize, crippling effects. X-rays, blood tests, and tests checking joint fluid are among the ways doctors diagnose arthritis. Rheumatologists are the arthritis experts. To find one, either ask your primary physician or check the American College of Rheumatology website: www.rheumatology.org.
Extensive RA medications There are two opposing camps regarding RA treatment, which includes some highly potent drugs. “The newer thinking is jump right in with some of the more powerful drugs from day one and cut back as needed,” Brandwin says. He ascribes to the more traditional approach. “You build a pyramid. In medical school, we called it ‘go low and go slow,” he says. This process allows the doctor to evaluate how well each step is working and also gives patients a better chance to adjust to each medication. “You start with non-steroidal anti-inflammatories (NSAIDs)—first OTC (over-thecounter) drugs (e.g., aspirin, Motrin), then maybe a prescription (Celebrex). Next, maybe add a tiny dose (2.5 to 5 mg) of a steroid called prednisone. Finally, add the more potent drugs,” Brandwin says. The latter include DMARDs, disease modifying and remitting drugs, which “don’t just treat the symptoms (i.e., pain), they treat the disease,” Brandwin says, then antiTNF (tumor necrosis factor) drugs. Of course, all of these drugs have a downside, so choosing a treatment depends on patient and doctor. Some people simply want immediate relief— whatever the cost. “With an 80-year-old, it may be more important to maximize their quality of life now and not worry, as you would with a 30-year-old, about osteoporosis developing in ten years,” he says. What about OA? For OA, analgesics such as acetaminophen (Tylenol) are the first course of action, steroids are the main drug treatments. For people with severe pain, some doctors add painkillers, many of which carry addiction dangers. There is a new warning about long-term use of any of the OTC anti-inflammatories increasing your risk of high blood pressure (HBP). Of 1,968 men, the ones who took any NSAID for six or seven days a week had a 38% increased risk of HBP. Aspirin showed the lowest increase, with a 26% higher risk. Exercise, exercise Most people with arthritis don’t get enough exercise, and a third don’t exercise at all. “People with arthritis pain tend to get sedentary,” says Miriam Nelson, Ph.D., associate professor at the Friedman School of Nutrition Science and Policy, Tufts University. But exercise is critical for possibly preventing arthritis (at least OA). Women who lose as little as 11 pounds reduce their risk of developing OA by up to 50%. “Every ten pounds you put on increases your risk of developing OA,” White says. “Every five pounds is like 15 pounds at the knee,” Nelson adds. Exercise also increases your chances of enhancing your overall health and lifestyle. “Strengthening exercises, like lifting weights or using exercise bands, are very good for fighting pain, improving mobility, and improving overall quality of life in people with either OA or RA,” Nelson says. “After strengthening exercises, do something
aerobic—walking, gardening, or using a stationary bike.” Aerobics is beneficial to your overall health, lowering cholesterol and improving circulation. Ways to stay motivated It isn’t easy to keep moving when you are hurting, but Nelson suggests using the desire to fight pain as your motivator. It is also important to find what works for your personality and arthritis type. “Rest with an ice pack might be called for in some cases. Maybe you need a more active approach, like planning rest breaks throughout the day,” says Francis Keefe, Ph.D., associate director of research for Duke University’s Pain and Palliative Care program. If it’s hard to motivate yourself, seek help. A spouse, friend, or support group (like a walking club) are some options. “A mental health provider can become an important part of your support team. Have your doctor prescribe ten minutes of walking daily or refer you to a physical therapist. Be active; don’t let the disease control you,” Nelson says.
Debate on supplement still waging Last November, the American College of Rheumatology brought together a panel to discuss the pros and cons of taking a supplement combining two chemicals, glucosamine and chondroitin, to fight osteoarthritis (OA). There have been very positive reports from various European studies versus more cautious reports from the U.S.’s four-year government Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). The GAIT outcome GAIT divided 1,500 participants with knee arthritis into several groups, including people taking placebos, glucosamine alone, and glucosamine/chondroitin combos. “The combination drug showed virtually no difference in relieving pain for people with mild to moderate OA,” says Arthur Weinstein, M.D., director of rheumatology at Washington Hospital Center in Washington, D.C. “But for a smaller subgroup of people with moderate to severe OA, there was a benefit,” he says. Specifically 79% of these people who took glucosamine/chondroitin experienced pain relief, compared to 66% who took glucosamine alone, and 54% on a placebo. What does it mean? To many experts, the fact that there was no major pain relief in the majority of the GAIT means glucosamine/ chondroitin has no value. Weinstein is more cautious. “More than half the population of the subgroup—the people with more severe arthritis—reported an effect. How can you dismiss that result? Also, when the supplement is effective, it takes at least six weeks to kick in. That makes it more believable to me that something is actually working in your system,” he says. “These combinations have virtually no side effects or interactions with other
medications, which means older people can take them safely. I have no problem recommending them,” Weinstein says. He gives this advice “The recommendation is 1,500 mg of glucosamine and 1,200 mg of chondroitin daily. Since these supplements aren’t government regulated, buy a drug store’s brand name. The chains have a lot to lose if they don’t provide a decent product. Only buy two months’ worth. If you have not noticed an improvement in that time, it isn't going to work."