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Tips For Dealing With The Chronic Pain Of Osteoarthritis

Severe osteoarthritis of the hands

One of my patients came to see me today with severe right knee pain.  This is not a new problem, and in fact, we have been dealing with flare ups of her osteoarthritis for years.  It mainly affects her knees and hands and today her right knee was swollen and felt like the “bone was rubbing together” with each step. She could hardly walk because of the pain.

Osteoarthritis is also known as degenerative arthritis and it is one of the most common maladies of aging joints, affecting millions of people.  The cartilage in joints wears down and inflammation causes the bones to build up spurs and small micro tears.  It affects women more than men and  the cause is unknown.  There are likely genetic factors as it tends to run in families.  Arthritis can occur in any joint but the most common are the fingers, wrists, hips, neck and spine and knees.  Stiffness (especially in the morning) and pain are the main symptoms that limit mobility.

You can see the bony changes that have occurred over time in my patient’s hands. (click on the photo for a better view). Note the swelling at the wrists and the way the thumbs angle inward.  She cannot stretch those thumbs out and there is wasting of the intrinsic muscles in her hands.  Surprisingly, she was not experiencing any pain in her hands or wrists today, although in the past it has been a problem.  Today it was the knee.

Because arthritis is chronic and affects millions of people, there are many purported “cures” and treatments.  Many of them are a big waste of money.  Here is what has worked for many patients:

  • Stay active and keep weight down.  Work on flexibility and range of motion.  For severe arthritis pain, aquatic exercise helps without causing more pain.
  • Yoga
  • Heat on the painful area alternating with ice as anti-inflammatory.
  • There is no proof for the “anti-inflammatory” diet, but eliminating sugar, glycemic white flour and processed foods increases energy levels and helps with weight control.  If you aren’t exercising you probably need very few calories and they should be mainly fruits, veggies, grains and protein.
  • Trial of gluten free diet
  • Pain relievers like Nsaids, tylenol and aspirin can help
  • The evidence is still not clear for glucosamine or other supplements.
  • Cortisone injections
  • Hot tubs/hot baths
  • Joint replacement

A cortisone shot will hopefully help this patient and quite down the flare up in the knee.  Osteoarthritis is truly a pain and it requires a lot of attention.

*This blog post was originally published at EverythingHealth*


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5 Responses to “Tips For Dealing With The Chronic Pain Of Osteoarthritis”

  1. Tom Hennessy says:

    Over a decade ago children with JRA were shown to deposit iron in their joints which caused damage and the researchers failed to pursue the findings. Child criminal neglect in my opinion. I wonder what it is called when doctors refuse to address the same problem in adults ? Criminal neglect or sheer stupidity . Which one ?

    “We examined the iron deposition in the synovia of 25 patients with rheumatoid arthritis, 25 patients with osteoarthritis, and 20 controls without joint disorders. Both osteoarthritis and rheumatoid synovia contained iron, but in the latter greater quantities were present. None of the controls with normal synovia had iron deposition.”

  2. Toni Bayer,MD says:

    Tom Hennesey: I’m not sure what your point is, nor the quote without a source. Never heard of it. Quackery is alive and well in Medicine and it is sheer stupidity if a Physician believes a non resourced “study” of 70 people.

  3. Tom Hennessy says:

    “it is sheer stupidity if a Physician believes a non resourced “study” of 70 people”

    ANY study which is conducted must be taken as they are. A study took alot of people , fairly intelligent people , for the most part , to conduct. It had to be ‘agreed upon’ and peer ‘reviewed’ and funded. It , according to you and others, cannot be “believed” BECAUSE of the ‘small number of people’. Any ‘quotes’ I use can be placed in Google as is IN quotes and up will pop THAT particular study. As to the study of JRA .. Baylor conducted the study and found the iron to be building in their joints at a HIGH level and they said a study NEEDED to be conducted to see if regular dietary iron did the SAME , build in the joints. They never did the study. THAT , imho , would be construed as child criminal neglect , in that they FOUND something harming children and NEVER ‘took it to the cops’, so to speak. THAT is criminal neglect , in that if you see something HARMING someone and FAIL to take REASONABLE steps to intervene then you are guilty of criminal neglect. The osteoarthritis is the same in that they have ‘age-related iron accumulation’.
    In the case of most doctors it would be stupidity , or criminal neglect , or more like ignorance I suppose in that they are not UP on the cause or ‘symptom’ or secondary to the disease. Stupidity might be a bit harsh.

  4. Tom Hennessy says:

    The studies are very old. Indomethacin and many anti-biotics are iron ‘binders’.

    EXPERIMENTAL BIOLOGY UPDATE: Arthritic kids’ iron supplements may hasten joint
    deterioration

    By Diana Swift

    WWASHINGTON, D.C. – The iron supplements that many arthritic children take to
    combat concomitant anemia may be hastening the deterioration of their joints,
    Houston researchers say.

    Led by biologist Roman Shypailo of the Children’s Nutrition Research Centre at
    Baylor College of Medicine, a Texas team looked at eight children being treated
    for juvenile rheumatoid arthritis. The patients, aged five to 15 years,
    received an intravenous radioactive tracer dose of iron (0.03 microsievert).
    Iron activity in affected joints was monitored on a position/energy-sensitive
    gamma counter, while a second machine monitored whole-body iron retention. Iron
    deposition was measured two hours post-infusion and again at days seven, 14, 28
    and 56.

    Anemic
    “We found that iron excessively accumulates in arthritic joints and probably
    contributes to the chronic damage,” said Shypailo. “That puts you between a
    rock and a hard place because many of these arthritic kids are anemic and need
    iron supplements, which may worsen the disease.”
    The study found a high level of agreement between the joint data and the
    whole-body data, with a greater than 90% retention rate of the infused iron
    both in joints and systemically. Furthermore, six of eight patients showed
    increased uptake at the affected joints: 165% over the first 30 days compared
    with initial uptake at two hours.
    The next step, he says, is to see if there is excessive deposition of dietary
    iron in arthritic joints.

    Clin Sci (Lond). 1984 Jun;66(6):691-5.
    Lipid peroxidation in rheumatoid arthritis: thiobarbituric acid-reactive material and catalytic iron salts in synovial fluid from rheumatoid patients.
    Rowley D, Gutteridge JM, Blake D, Farr M, Halliwell B.
    Abstract
    Thiobarbituric acid (TBA)-reactive material is present in serum and knee joint synovial fluid from rheumatoid patients, consistent with lipid peroxidation occurring in vivo. The amount of TBA-reactive material in synovial fluid correlates with the concentration of iron salts present as determined by the bleomycin method, presumably because iron is an important catalyst of radical reactions in vivo. There appear to be significant correlations between the contents of TBA-reactive material and bleomycin-detectable iron in synovial fluid and the activity of rheumatoid arthritis as assessed with a clinical index of local inflammation and with various laboratory parameters.

    PMID:6723205

  5. Tom Hennessy says:

    THESE guys seem to have covered the ‘criminal neglect’ end of the deal by actually ‘putting it in writing’ that they are advocating BECAUSE of the damage / harm they OBVIOUSLY see.

    “We therefore **advocate** routine sampling of ferritin levels in patients with unexplained joint complaints”

    Neth J Med. 2006 Sep;64(8):307-9. Links
    Sporadic porphyria cutanea tarda due to haemochromatosis.de Geus HR,
    Dees A.
    Department of Intensive Care, Erasmus Medical Centre, Rotterdam, the
    Netherlands.

    Haemochromatosis is a hereditary iron-overload syndrome caused by
    increased intestinal iron absorption and characterised by
    accumulation of potentially toxic iron in the tissues. Sometimes this disease
    presents as a cutanea porphyria. We describe a patient with joint
    complaints and blistering skin lesions on sun-exposed skin. After
    identifying the porphyria cutanea tarda by urine analysis we found
    that the serum activity of uroporphyrinogen decarboxylase (UROD) was
    normal, meaning a partial inactivation of UROD in liver tissue due to
    external factors. Further investigation showed the homozygous Cys282Tyr
    missense mutation and high levels of serum ferritin. It is important to
    recognise the symptoms of iron overloading at an early stage because
    hereditary haemochromatosis needs to be treated immediately. We
    therefore advocate routine sampling of ferritin levels in patients
    with unexplained joint complaints.

    PMID: 16990695

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