CD-ROM Today 1996 January

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$Unique_ID{BRK01751} $Pretitle{} $Title{Information for You about Arthritis, part II} $Subject{arthritis joints joint tendinitis bursitis stiffness rheumatoid gout bones elbow knuckle synovial membrane ligaments ligament tendons rheumatic ra immune system Swelling morning tenderness redness warmth fever weakness osteoarthritis rheumatoid systemic lupus erythematosus ankylosing spondylitis scleroderma psoriatic fibrositis autoimmune disease diseases knees knee hand hands feet uric acid probenecid sulfinpyrazone kidneys allopurinol aspirin acetylsalicylic acid gold salts penicillamine nonsteroidal anti-inflammatory drugs NSAIDs CORTICOSTEROIDS immunosuppressive hydroxychloroquine Quackery Ankylosing spondylitis Bursae Cartilage Flare flare-up Remission Synovectomy} $Volume{Y-0} $Log{ Osteoarthritis*0001702.scf Rheumatoid Arthritis*0001703.scf Tendons of the Wrist*0001705.scf Gout Affects the Elbow*0003801.scf Gout Affects the Kidneys*0003802.scf Gout Affects the Knee*0003803.scf Gout Affects the Ankle*0003804.scf Gout Affects the Toes*0003805.scf Gout Affects the Instep*0003806.scf Gout Affects the Hand*0003807.scf Gout Affects the Ear*0003808.scf Progressive Levels of Arthritis*0005601.scf Typical Rheumatoid Hand Deformities*0005602.scf Bursae of the Knee*0016401.scf Gout and the Kidney*0016701.scf} Copyright (c) 1991-92,1993 Health Update by Dr. Allan Bruckheim Information for You about Arthritis, part II ------------------------------------------------------------------------------ NONSTEROIDAL ANTI-INFLAMMATORY DRUGS Aspirin and salicylates are part of a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). As their name suggests, these drugs reduce inflammation but are not related to the drugs known as steroids. Researchers believe that NSAIDs relieve pain and inflammation by blocking the action of chemicals in the body called prostaglandins. NSAIDs are chemically related to aspirin. A person who cannot tolerate the side effects of aspirin often will be able to take an NSAID with no problem. If you are allergic to aspirin, however, you may also be allergic to NSAIDs, so your doctor must exercise care in prescribing them. A major benefit of NSAIDs is that you can take fewer tablets per day and achieve the same effects as with aspirin. However, NSAIDs are usually far more expensive than aspirin, and since arthritis is a chronic disease and you might need to take medication for years, the expense could be a drawback. Except for the 200 mg size of ibuprofen, all NSAIDs are prescription drugs. Advil, Nuprin, Medipren and various store brands of ibuprofen are available without a prescription. The prescription-strength brands of ibuprofen are Motrin and Rufen. Generic ibuprofen is also available. Other names for NSAIDs (brand names are in parentheses) are piroxicam (Feldene), sulindac (Clinoril), indomethacin (Indocin), naproxen (Naprosyn), tolmetin (Tolectin) and fenoprofen (Nalfon). Each drug is different and may have different side effects, although for the most part the side effects of all NSAIDs are similar to those for aspirin. If you do experience side effects to one drug, your doctor may switch to another. Because every person with arthritis reacts differently to medications, it may take some time to find out which drug at which dose level is right for you. CORTICOSTEROIDS Corticosteroids are drugs that are related to cortisone, a chemical the body makes in the adrenal glands. These drugs suppress the symptoms of inflammation and allergy. When they were first used in 1949, they were hailed as miracles, but the side effects of corticosteroids were later found to be severe. Over the years, the proper use and dosage sizes of corticosteroids have been found for treating arthritis. The effects of corticosteroids can be amazing in reducing swelling and pain. But these drugs are still used very cautiously because of their side effects and are reserved for very severe cases of arthritis or bad flare-ups of the condition. Corticosteroids can be given orally or by injection. In severe cases of osteoarthritis, a corticosteroid may be injected directly into the involved joint. This type of injection minimizes the side effects of the drug, but the procedure cannot be done more than a few times into the same joint without the possibility of causing damage. A direct injection would be reserved for a painful, immobilized joint, and would reduce swelling for a time. During the time the injection is effective, an exercise program can be started that will keep the joint mobile. Because of the generalized nature of severe rheumatoid arthritis, oral corticosteroids may be prescribed. The side effects may include weight gain due to water retention, increased blood pressure and a depressed immune system. Long-term use of corticosteroids will also cause osteoporosis, weakening of the bones. If your doctor prescribes a corticosteroid drug, take it exactly as he or she tells you. Do not take more than the prescribed amount and do not stop taking the drug suddenly. Corticosteroids suppress the natural output of the adrenal glands and to suddenly stop taking them can cause a reaction. Your doctor will instruct you on how to lower the dose slowly when you need to stop. SPECIAL DRUGS FOR RHEUMATOID ARTHRITIS Researchers have created several drugs for use in treating rheumatoid arthritis, including gold salts, penicillamine and immunosuppressive drugs. These are all considered remissive drugs, because they can cause rheumatoid arthritis to subside for a while. Drugs normally used to treat malaria and cancer have also been found to be effective against rheumatoid arthritis. All of these drugs take a long time to show effect, however, so you may be taking them for months before seeing any improvement. If aspirin, NSAIDs and corticosteroids do not control rheumatoid arthritis, your doctor may prescribe the antimalarial drugs chloroquine or hydroxychloroquine; they may be added to NSAID therapy. However, these antimalarial drugs can cause damage to the retinas of the eyes, so you may be asked to go to an ophthalmologist for screening. Your doctor may decide to prescribe either gold salt injections or tablets. Gold salts take a long time to work and are not always effective. It may be several months before you and your doctor know whether gold salts will have any effect, so you must be patient. If injections are used, you can expect to require a weekly shot for up to six months. If treatment is effective and continues, you may need a shot only once or twice a month. Your doctor will test your blood regularly and watch you carefully for side effects. Side effects of gold salts injections include skin rashes, sores in the mouth, kidney problems and low blood counts. If there is a skin rash, it may be aggravated by exposure to sunlight. Because gold salts can be toxic, your doctor may treat you with small doses of gold salts for a week or two to test for a reaction. Bear in mind that many people who are put on gold salt therapy must give it up because of side effects. There is an oral form of gold salts called Ridaura. Here again, it may be months before there are any signs of the drug taking effect, or it may not be effective for you at all. Ridaura has fewer side effects than injections, but can cause severe diarrhea. Penicillamine is another remissive drug used for rheumatoid arthritis. It commonly produces the same side effects and toxic reaction that gold salts do, but can be used in some people who cannot take gold salts. Here again, the drug will probably take some time to show an effect. Immunosuppressive drugs are also used in some cases. These drugs suppress the immune system, and since it's the immune system that causes rheumatoid arthritis, the drugs can make the disease go into remission. However, they have many side effects, and since the entire immune system is suppressed, little is left to fight off colds and infections. Rest and exercise You may not consider rest and exercise to be therapy for arthritis, but they are both very important parts of your treatment. The two go hand in hand. Too much exercise can cause soreness and more inflammation, but too much rest can cause joints to stiffen. The right amounts of rest and exercise for you will depend on the severity of your condition, and your needs may change as your arthritis does. Resting must be as regular as exercising. Rest allows your muscles to relax. You don't have to lie down or take a nap. Simply sitting down and relaxing at some time during the day will help your joints and muscles recover from your activities. Your doctor may suggest that you take short walks daily or attend an exercise class on a regular basis. He or she may also recommend that you swim regularly. Swimming is an excellent way to stay limber, since the buoyancy of water takes some weight off your joints. You can either swim or exercise in the water. Besides keeping your joints in condition, regular exercise helps keep the rest of you fit. Exercise can help control weight, which in turn will reduce the stress on arthritic joints. Regular walking or swimming is also good for your cardiovascular health. Your doctor may also suggest that you perform special exercises every day. These will help keep your joints limber, or help loosen joints that have become immobile. The purpose of the exercises is to keep your body functioning as much as possible, while at the same time preventing further damage. A physical therapist can teach you some of these procedures and determine whether you're doing them correctly. If you have very severe arthritis, regular physical therapy sessions may be required, where the therapist helps you move your limbs to help keep them supple. SUGGESTED EXERCISES One easy but helpful exercise for the hands and ringers is to simply bend your wrist back and forth slowly several times, then make an "O" with your thumb and index finger. Make an "O" using the next finger, and touch each finger to your thumb five times. Repeat this with the other hand. Your doctor can recommend other hand and finger exercises as well. For your knees, sit comfortably in a straight-backed chair with your bare feet on the ground. Slowly raise your lower leg so that your whole leg is straight, then slowly lower it again. Do this with each leg several times a day. For the ankles, do the same exercise with one extra movement. Raise your lower leg until your leg is straight. Now bend your ankle until your foot points back at you and curl your toes back and forth. Point your foot away from you and curl your toes back and forth. Lower your leg slowly. Repeat this using the other foot and leg. (Always make sure you exercise both legs equally.) You may feel very stiff the first few times you do any exercises, but it's important to keep doing them. After a few weeks you will probably notice some improvement. If any exercise is painful or makes you feel uncomfortable, consult your doctor or physical therapist. Heat and cold treatments Your doctor may recommend that you use heat and cold to treat your arthritis. You may already know that a warm bath or shower helps ease your stiffness and aching for a while; it is a good way to relax your muscles. And because your body floats in water, a bath also takes some weight off your joints for a while. Hot packs, heating pads and hot-water bottles can also be helpful in easing pain. Be careful not to use too hot a setting and never sleep with a heating pad or rest on top of one. If you have a metal replacement joint, talk to your doctor before using any heating devices, because the metal within you may heat up. You may think cold would make arthritis worse, but cold treatments can sometimes case arthritis stiffness and pain. The cold seems to numb the joints and give some people a few pain-free hours. One method for cold treatment is to simply dip affected hands or feet into a pail of cold water. The water should not be so cold that it is a shock. Another arthritis therapy consists of combining the two treatments as a contrast bath. This is easiest done with the hands or feet. Just prepare two pails of water, one hot and one cold. Soak the pained joint in the hot water and then switch to the cold water. Surgery Surgery can be an option for someone suffering from arthritis that's so severe it has completely damaged a joint. Surgery used to be reserved for only the most severe cases, but now, with better techniques and materials, joint surgery is done earlier in the course of a disease and on younger individuals. Synovectomy is a procedure whereby some of the synovial fluid and membrane are removed. Another procedure involves opening up the joint and removing the diseased cartilage and bits of overgrown bone; this can reduce pain in the joint, but the relief may not be permanent. There are also procedures to fuse a joint to relieve pain, but unfortunately these also result in loss of motion of the joint. There are now surgical procedures for replacing hips, knuckles and knees. In some cases, joints can be repaired rather than replaced, using either new bone cements or pieces of bone from elsewhere in the body. Joint replacement has become a relatively common operation, but it is not without risk and may be more useful for certain forms of arthritis, such as osteoarthritis and rheumatoid arthritis. Bear in mind that a replacement joint does not last forever, and may need to be replaced after a number of years. Life expectancy for a replacement joint is now about 10 years. Replacement joints are made of metal or plastic pieces that are cemented into the natural bone when the diseased joint is removed. It is possible for the new joint to come loose, especially in an active person. This is why joint replacement is usually done in less active elderly people. A younger person might have to go through two or three replacements on the same joint over his or her lifetime. Infection is another risk of joint replacement. An infected replacement joint would have to be removed. Remember that no surgical procedure is risk-free. If surgery is being considered, you should sit down with your physician and the orthopedic surgeon who will perform the operation, and have them explain all of the pros and cons of the procedure. Joint protection If you have arthritis, your joints are your weak points and you must protect them. They are already under a certain amount of stress and there are ways that you can avoid adding more. As a general rule, use a stronger joint to protect a weaker one. If your hands are weak, don't carry things in them for long periods of time. For example, a woman might substitute a shoulder purse for a clutch purse. Push a door open with your shoulder or the side of your body rather than with your hands. Try not to sit or stand in one position for too long to avoid stiffening. Get into the habit of changing your body position every 15 to 20 minutes. Make your work areas work for you. Organize the kitchen or office so that most items you need are within easy reach. Make sure your work surfaces are at a comfortable height. Sit whenever you can, including while ironing or doing office work. Even better, sit in an office chair with wheels and move around your work space in that. If you must push with your hands, do it right. Don't compress your fingers under your hand, because this puts pressure on your knuckles. If you are pushing up from a chair, for example, let your ringers hang over the edge and push up with your palm. Devices to make life easier There are many aids and devices you can use to make life a little easier. Some can be bought and some can easily be made to help you do your work and live independently. Attach straps to drawers so you can put an arm through and pull with your forearm rather than using your hands. Use a button hook to help with buttons. Put a paper clip into a zipper-pull to make it larger and easier to handle. Doorknobs can be replaced with levers. Faucets and toilet handles can be replaced with larger ones or built up so that they are easier to use. Put a handle or grip bar on the edge of the bathtub to make it easier to get in and out. Black foam padding that is adhesive on one side (normally used as pipe insulation) can be added to pencils and toothbrushes to make them larger and easier to handle. A regular clip clothespin can be attached to the controls of small appliances to make them easier to turn. The Arthritis Foundation publishes a list of helpful devices and hints for people with arthritis; the address of the Arthritis Foundation is at the end of this booklet. Sex and arthritis Any long-term ailment will have an effect on a person's sex life, and arthritis is no exception. Arthritis can cause pain and discomfort, can limit movement, and can change the way you feel about your body. All of these changes may interfere with sexual enjoyment, but that doesn't mean that your sex life is over. People with arthritis can have an enjoyable, satisfying life, that includes sex. One of the oldest myths around is that somehow older people, especially those with arthritis, either should not have or will not enjoy sex. This simply is not so. Sex can be a wonderful way to release tension and frustration while communicating with your loved one. Communicating is a key word. Talk with your loved one about your needs and how you feel. Part of communicating will include the two of you accepting the changes that have happened in your body. If you feel resentful and angry over your illness and how it has changed you, do not assume that your partner feels the same way or has rejected you. Be aware that your loved one may fear that hugging you or holding you too tightly may hurt you. Make sure he or she knows how you feel. In order to keep sex a vital part of your relationship, try planning ahead. Plan to make love at a time of day when you are less tired or sore and take a pain reliever earlier to ensure that it will provide greatest relief at the right time. If a hot shower or bath loosens up your joints and helps you relax, take one before you retire to the bedroom. Quackery Arthritis is a disease that has no cure. People with arthritis spend a lot of money for medical care, and, unfortunately, a lot of money is spent on unproven and worthless remedies as wen. The Arthritis Foundation estimates that almost $2 billion is spent yearly on quack medicines and therapies. Sadly, people with arthritis are easy to exploit. Too many people who have aching joints doctor themselves. Because arthritis tends to come and go naturally, a person who puts on a copper bracelet and feels better, thinks the bracelet had something to do with it. The only benefit you can get from wearing copper jewelry is if it looks nice on your wrist. Often, dishonest merchants look for ways to make a buck by selling an arthritis cure. They may sell herbal remedies by mail that contain nothing more than a little aspirin, and they may back up their claims with "testimonials" from people who have been cured. The pills you receive won't help you, and will definitely hurt you in the wallet. Remember, if a remedy or therapy looks too good to be true, it probably is. Never believe anyone who says a drug is completely safe. Nothing is completely risk-free. If you ever have any questions about remedies or therapies that you read about in magazines, talk to your doctor. It is a talk that will probably save you some time and money. Always consult your doctor Arthritis, a chronic disease that affects many people and causes much suffering, is the constant focus of research and investigations. New therapies and new medicines to deal with arthritis are being developed even as I write this booklet. Every effort has been made to give you the very latest information about this disease and to offer ideas and suggestions of a practical nature that can help arthritis patients deal with their affliction. Nonetheless, it is possible, even probable that new developments will occur as the weeks progress. It is therefore essential that you continue to consult your private physician, so that you may benefit from the latest therapies or discoveries and receive the personalized treatment that is most effective in your case and deals with your special problems and needs. More help is available The Arthritis Foundation can provide more information about osteoarthritis, as well as self-help guides and publications that tell you where to buy devices to help you perform daily tasks when stiff joints make bending difficult. The foundation can also put you in touch with other people with similar problems. Support groups offer a sympathetic ear when you're feeling depressed or frustrated, as well as encouragement to stick with your treatment program. Look in the phone book for your local chapter of the Arthritis Foundation, or contact the national organization at 1314 Spring St., NW, Atlanta, Ga. 30309. Telephone: (404) 872-7100. The National Rehabilitation Information Center (NARIC) is government funded and provides broad-based information and referral services, as well as computer searches, for a nominal charge. Telephone: 1-800-34-NARIC. The Arthritis Information Service of Alabama is a community program jointly sponsored by The Multipurpose Arthritis Center of the University of Alabama and the National Institutes of Health. Call toll-free: 1-800-345-6780 Glossary Ankylosing spondylitis--a form of arthritis of the joints of the spine that can cause these joints to fuse or grow together Arthritis--inflammation of a joint Autoimmune disease--a disease in which the body's immune system is out of control and attacking healthy tissue Bursae--small sacs of fluid that keep muscles, bones, ligaments and tendons from rubbing and that help absorb shocks Bursitis--inflammation of a bursa Cartilage--rubbery or plastic-like material that covers the ends of bones and prevents them from rubbing and absorbs shock Chronic disease--one that lasts for years and has no cure Flare or flare-up--an episode in which symptoms either reappear or become worse Gout--a disease in which the body produces too much uric acid, which forms into crystals and collects in joints. This leads to attacks of painful arthritis Immune system--the natural defense system of the body against disease or injury Inflammation--a normal reaction of the body to injury or disease, in which swelling, pain, redness and warmth occurs in the area affected Joint--a point in the body where two bones meet Juvenile arthritis--any of several forms of arthritis that occur in children Ligament--a strong cord-like material that connects bones to each other Osteoarthritis--the chronic breakdown of cartilage in certain joints; it is the most common form of arthritis and may be due to wear and tear Remission--a period in which symptoms of a disease are reduced or disappear for a time Rheumatic disease--diseases that affect muscles, ligaments, tendons, joints and sometimes other organs Rheumatoid arthritis--an autoimmune form of arthritis that causes inflammation in the joints and may cause systems problems as well Systemic disease--one that can affect the entire body rather than just one area Systemic lupus erythematosus--a disease that affects the joints as well as skin, muscles and other parts of the body Tendinitis--an inflammation of a tendon Tendon--a strong cord-like material that connects muscles to bones Uric acid--a chemical naturally formed in the body that, in gout, forms into crystals that collect in the joints and cause pain and damage ------------------------------------------------------------------------------ ACKNOWLEDGMENT: Research by Valerie DeBenedette; technical review by Dr. Gabriel Zatlin. For additional copies of Arthritis, send $2.75 to Arthritis, P.O. Box 4406, Orlando, Fla. 32802-4406. Make checks payable to Newspaperbooks. Multiple copy discounts are available. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.