Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
If you're just starting an exercise routine, don't hesitate to talk with a physical therapist or doctor about any new aches and pains. "One of the first things we do is differentiate between normal pain at the beginning of an exercise program and arthritis," says Greene. If the pain is in the muscles and fades in 24 to 48 hours, it's probably old-fashioned muscle soreness. If the joint is inflamed--swollen and feels warm to the touch--and stays that way for a long time, it's most likely linked to arthritis.
5. ANTI-INFLAMMATORY DRUGS
Drugstore shelves are filled with different brands of aspirin, ibuprofen (such as Motrin or Advil), and naproxen (such as Aleve). And behind the prescription counter, there used to be a host of more specialized drugs like Vioxx, Bextra, and Celebrex. They not only killed pain but blocked inflammation, a special boon for arthritis patients. Then, last fall, the roof caved in. Vioxx, it turned out, was raising the risk of heart attacks. The manufacturer, with nudging from the Food and Drug Administration, pulled it. This February, Bextra also got the hook, leaving only Celebrex and the over-the-counter drugs--and a lot of scared arthritis patients. Susan Silbiger, a retired schoolteacher from Aurora, Ohio, who has OA, says: "I was on Vioxx for a while, but my blood pressure went up. So then I switched to Bextra. Then all the news reports came out about those heart problems. It was all a little scary. I just stopped as soon as I heard." Now she gets by with a few over-the-counter pills. "I'm a lot more cautious now. My big problem is in my thumb, probably from playing too much golf. I still play. But I take an Aleve, I don't grip the club quite so tightly, and I'm ready to go."
This spring the FDA, after reviewing many studies of these nonsteroidal anti-inflammatory drugs, or NSAID s, as these drugs are collectively known, came to two basic conclusions. First, all of these drugs raised the risk of heart trouble. But, second, it remained unclear just how much that risk was increased. Some studies implied a little rise or even none at all, while other studies pointed to a big jump. So rather than banning ibuprofen, naproxen, and Celebrex, the agency opted for big warning labels and left it up to doctors and patients to sort things out.
The latest news is that lower doses of these drugs appear to be safer. That's according to a massive study of some 650,000 arthritis patients just announced at the Annual European Congress of Rheumatology in Vienna. Gurkirpal Singh, a gastroenterologist from Stanford University who conducted the study, says even at higher doses the increased risk was "modest." Basically, this means arthritis patients with high blood pressure or other heart disease risk factors should be watched carefully if they use these drugs for pain on a daily basis. Occasional use doesn't seem to be a problem.
The heart isn't the only concern with these drugs. There are well-documented worries about stomach ulcers, even with Celebrex, which is supposed to be easier on the stomach. So one thing that patients can do is add a drug called a proton-pump inhibitor, which protects the stomach. "You can use Nexium, or better yet the generic version of Prilosec, which is a lot cheaper and you get the same protection," says Moskowitz. "If I had to use naproxen, I'd feel a lot more comfortable adding one of these."
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