Arthritis Archive

Anti-inflammatory medications applied to the skin as creams, gels, sprays, or patches work best for mild to moderate pain near the surface.

Do you have mild to moderate osteoarthritis, or perhaps a sore shoulder or throbbing elbow from yard work? If the source of the pain is close to the surface, you should know about topical analgesics.

It appears that people with rheumatoid arthritis are at a higher risk of developing a venous thromboembolism (VTE). To avoid developing a VTE, quit smoking, become more physically active, and avoid prolonged bed rest if possible.

The amount of total knee replacements in the United States has more than doubled since 1991. This may reflect an expanding pool of older adults and a desire to maintain a more active lifestyle that is possible only if arthritic knees are replaced.

Some topical nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve osteoarthritis pain as well as oral medicines, with less risk of gastrointestinal bleeding. The best evidence is for diclofenac solution or gel.

Despite theoretical reasons to worry that biologic response modifiers may raise cancer risk, it appears they don’t significantly raise the risk of malignancy. The drugs can dramatically improve inflammation in people with rheumatoid arthritis.

Most people don’t think twice about taking Motrin, Advil, Aleve, or similar over-the-counter painkillers. A new study suggests that heart attack survivors should use these drugs, known as nonsteroidal anti-inflammatory drugs (NSAIDs), as little as possible. A team of Danish researchers found that among heart attack survivors, those who used an NSAID were about 60% more likely to have died during each year of the five-year study than those who didn’t use an NSAID. Of all the NSAIDs, diclofenac (Cataflam, Voltaren, generic) was linked to the largest increases in death or heart attack rates, while naproxen (Naprosyn, Aleve, generic) appeared to carry the lowest risk. The lower risk with naproxen confirms what has been seen in older studies. If you have heart disease and need pain relief, try acetaminophen first. If you need an NSAID, naproxen is probably the best choice for your heart. But whatever you and your doctor decide is best for you, use the lowest dose possible for the shortest period of time.

A recent study in the Archives of Internal Medicine indicates that the risk of having a heart attack is up to 31 times higher immediately following joint replacement surgery. Those relative risk numbers could be terrifying for someone who needs to have a knee or hip replaced. The absolute risk numbers offer some reassurance. In the six weeks following surgery, one in 200 people in the study who got a new hip and one in 500 who had a knee replaced suffered a heart attack. One new point the study underscored is that the elevated risk may last longer than previously thought. Though earlier research had suggested a danger zone lasting four to five days after joint replacement—coincidentally, the period in which many people are discharged from the hospital—the elevated heart attack risk may persist for two to six weeks.

A new series of books is bringing readers the kind of inspirational stories that have made Chicken Soup for the Soul books international bestsellers plus with trusted health advice from Harvard Medical School. The combination of stories providing hope, inspiration, and great person-to-person advice plus straight talk and life-changing medical information from Harvard doctors will help readers live healthier, more satisfying lives. Each book focuses on a single topic. The first four will be available beginning May 22, 2012. They are Chicken Soup for the Soul: Boost Your Brain Power! by top neurologist Dr. Marie Pasinski; Chicken Soup for the Soul: Say Goodbye to Back Pain! by leading physical medicine expert Dr. Julie Silver; Chicken Soup for the Soul: Say Goodbye to Stress! by noted psychologist Dr. Jeff Brown; and Chicken Soup for the Soul: Say Hello to a Better Body! by respected internist Dr. Suzanne Koven.

There are many treatments short of surgical replacement.

If your knees have become painful, tender, or swollen, are stiff first thing in the morning, or are making crackling noises, the probable cause is osteoarthritis, which affects more than two-thirds of women over age 60. Osteoarthritis results from the breakdown of joint cartilage, the tough, slippery tissue that protects the ends of bones (see "Anatomy of knee osteoarthritis"). Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone. The goals of osteoarthritis treatment are to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.

About 5% of women in the United States over age 50 have had total knee replacement surgery, the recommended treatment when more conservative measures have failed and pain and disability are intolerable. The number of these procedures has more than doubled over the past decade, according to research presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). This is partly because knee replacement works—more than 80% of patients say they're satisfied with the results. But experts say it's also a sign that people aren't fully utilizing the many noninvasive strategies that evidence suggests should be tried first—above all, weight loss and exercise.

Q. I'm in my late 70s and have been getting about four cortisone shots a year for the past several years for the arthritis in my left knee. They really help with the pain, but I've heard that, long-term, there could be bad side effects. Should I be worried?

A. Cortisone is one of the many corticosteroid drugs. The corticosteroids are powerful anti-inflammatories that can do a lot to relieve pain, but the side effects are a drawback. As pills, they deplete bone and have other systemic effects. Injected cortisone, which is often combined with lidocaine, a short-acting pain reliever, sometimes clumps into crystals and may worsen pain rather than relieve it. Repeated shots can eventually damage skin and other tissues. Small amounts of cortisone that have been injected into a joint can get into the rest of the body and have hormone-like effects that make diabetes harder to control. There's also the slight risk of the shots leading to an infection of the joint.