by S. Todd Stolp MD
©January 2009
Pharmacies often devote one of their larger shelves to remedies, palliative treatments, and salves for arthritis. This fact alone suggests that there is a significant prevalence of the condition. However, the packaging of such treatments can pose a confusing array of questions to the consumer trying to understand the difference between “Extra Strength,” “Maximum Strength,” “Super Strength,” “Long Acting,” and “Doctor-recommended.” Could there be any reason a doctor would not want to recommend something that provided “maximum” benefit to his/her patients? Understanding the strategy behind the treatment of arthritis is important to selecting the right product before you head to the cashier.
Arthritis means inflammation of a joint or joints. Note that joints are usually easily recognizable because they represent the hinges of our bones, where limbs bend and flex. Health providers prefer the word “articulation” instead of “joint,” because it has more syllables.
Some joints, such as where our ribs join the spine or meet the cartilage next to the breastbone, are not as obvious but are nevertheless true joints. One of the most helpful signs of arthritis is pain at the site of movement when there is motion in a joint. When pain occurs in muscles and soft tissues away from where there is flexion, the problem is often due to an injury to a muscle, tendon or other soft tissue rather than to the joint structure itself. On the other hand, there are occasionally times when pain arising from a joint may be felt at a location different from the actual site of movement, a phenomenon called “referred pain”.
Any joint can become inflamed, but there are different reasons for the inflammation. Inflammation of a joint can occur because one has just been tackled by a defensive lineman. Such an injury results from trauma to the joint. The injury may be to the soft tissues that support the joint (ligaments, lubricating machinery etc…), to the cartilaginous surface of the joint itself, or less frequently to the bone.
Joint inflammation in a grandparent often is due to the accumulation of birthday candles. Consider the tires on your car. It is absolutely predictable that the rubber on your tires will slowly be shed as the miles you drive accumulate. Similarly, the cartilage that helps to decrease friction in your joints will eventually show signs of wear. Whether this occurs at 50, 60 or 70 years of age (or thousands of miles) has to do with the joint owner’s occupation, family history and activity level. This is so-called “osteoarthritis,” or degenerative joint disease. We will all get it if we live long enough.
Another type of arthritis is inflammatory joint disease. In this situation the joint inflammation is secondary to an underlying inflammatory condition. Rheumatoid arthritis, caused by the traitorous activity of one’s immune system, is in this category. The result is an activation of the white blood cells, causing them to attack the tissues of the joint. Gout is another type of inflammatory joint disease caused by the formation of crystals within the joint space. In gout, the crystals act as an irritant, often affecting the joint at the base of the big toe. While treatment for degenerative arthritis can be addressed with over-the-counter medications and common sense, treatment for inflammatory joint disease should be coordinated with your health care provider at an early point.
Swelling and pain occurs in all these kinds of arthritis. Therefore, anti-inflammatory medications are the standard for treatment in most cases. Remember that aspirin, AKA acetylsalicylic acid, will diminish blood clotting and should not be used in children. Otherwise, the different over-the-counter anti-inflammatory medications – ibuprofen and naproxen – are very similar in effectiveness when taken at recommended dosages. One should be aware that these medications can be irritating to the stomach lining, so they should not be taken without advice from health care providers for people with a history of ulcer disease or stomach disturbances.
While acetaminophen does not provide an anti-inflammatory benefit, it can be helpful to reduce the pain of arthritis. If this allows a person to remain active, it is probably worth consideration as a part of the treatment plan.
The oral supplements chondroitin and glucosamine were popular treatments in the past for arthritis. Recent evidence, though, has indicated that these supplements are no more effective than placebo for treatment of pain or joint damage due to arthritis.
Certain over-the-counter salves are actually quite beneficial for some patients. You may recognize the active ingredient in salicylate creams (see aspirin above) which are available over-the-counter for arthritis. Smelling like a breath mint is a primary side effect.
It should be remembered that the treatment of arthritis should include proper physical care of the involved joint, such as an ice pack during the first 24 hours after a knee injury, rest for osteoarthritis of a thumb, or slow strengthening for a rheumatoid arthritis victim. Specific recommendations can be obtained from your physical therapist, orthopedist, rheumatologist, chiropractor, or primary care provider.