Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
Two diseases. To understand those changes, it helps to know that rheumatoid arthritis (RA) and osteoarthritis (OA) affect joints in two different ways. RA is an autoimmune disease, in which the body turns on itself and attacks the tissues lining the ends of bones, causing serious inflammation. It's a bodywide ailment. OA, by contrast, is often confined to one joint and occurs when the cartilage breaks down, causing the bones to rub together. Disease seriousness is rated by degree of pain--using a 1-to-10 scale or similar measure--and loss of movement, as well as the impact on daily activities. X-rays can also determine the amount of deterioration in the joint.
For both conditions, treatment starts with the simplest and least risky interventions and progresses to more intense medicine that is specialized for each illness. "We use everything we can," says Joe Couri, a rheumatologist in Peoria, Ill.--an OA patient himself, currently recovering from shoulder surgery. "I did anti-inflammatory drugs for a while and then cortisone shots. The challenge is finding the right combination for the right person. Sometimes it takes months, or even years, but eventually we get there." The approaches Couri and other doctors call on fall into nine general categories.
1. TOPICAL TREATMENT
Some arthritis remedies go on the skin, not into the body. The most common include heat and cold. This can be as simple as a hot water bottle or a bag of frozen peas. Cold, says Klippel, keeps inflammation down, while heat increases blood flow and loosens up a stiff joint. Some rheumatologists feel that heat can actually increase inflammation, so if your knee is red and swollen, stay away from the heating pads and use ice or those pea bags. Ultimately, it's an individual choice.
A skin patch containing 5 percent lidocaine, a topical anesthetic, cut OA pain, according to a study published this year. Creams are also common remedies. Celecaine, a cream made of natural oils, improved pain and function better than a placebo did in several scientific trials.
Doctors are a lot more skeptical about two folk remedies: magnets and copper bracelets. While some studies have shown that magnets of certain strengths may relieve a little pain, Roy Altman, a rheumatologist at the medical school of the University of California-Los Angeles, concludes: "If you're going to try them, don't spend too much money." As for a copper bracelet, you're best not spending anything at all.
2. SUPPLEMENTS
One popular supplement, called glucosamine-chondroitin, really seems to work. A review in the Journal of the American Medical Association concluded that the compound has a modest beneficial effect and is safe. Glucosamine is supposed to help cartilage form, and chondroitin is supposed to prevent it from breaking down. There are lots of preparations on the market, however, and one lab analysis found that not all of them contain as much of these substances as they claim. Chondroitin was the ingredient most likely to come up short--in one case, only 18 percent of the claimed 500 mg. Some brands that did meet their label claims included CosaminDS and Puritan's Pride.
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