The Cleveland Clinic Arthritis Advisor

Volume 8
Number 7
July 2009

Many of the charts & tables found on this site are PDFs.

July 2009

Experimental Therapies May Hold Key to Future Pain Treatment
Because there is no cure for arthritis, the goals of controlling pain, minimizing joint damage, and improving or maintaining function have long been the main goals of treatment. But as researchers continue to seek the "holy grail" of therapy—a disease-modifying medication or surgery—they are gaining a better understanding of how arthritis develops, how to target therapies based on an individual’s genes, and how to grow new cartilage in ways that may one day slow, if not reverse, the course of the disease. "We’re taking strides and moving in the right direction," says Richard Parker, MD, chairman of the Department of Orthopaedic Surgery at Cleveland Clinic. For example, viscosupplementation, which involves injecting a thick fluid (hyaluronate) into the knee to help lubricate the joint, "may have the attributes of being disease-modifying," he says. Its effectiveness in treating activity-related knee pain in studies lasting six months has been found to be comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs). But it would take a study lasting at least 20 years to determine whether the intervention could actually reverse underlying disease, he explains

Good Habits Can Save Your Back
Misery loves company, as the saying goes, and if you find yourself immobilized by excruciating pain in your back, you might derive a bit of comfort in knowing that you are not alone. Cleveland Clinic rheumatologist Daniel Mazanec, MD, says he and his colleagues at Cleveland Clinic treat more than 600 patients each week for back pain. "The back is the number one source of pain that people in the U.S. report to their primary-care physicians," says Dr. Mazanec, director of the Cleveland Clinic Spine Center. "It is well documented that between 80 and 90 percent of Americans will have episodes of back pain lasting between two and four days at some point during their adult lives. So it is a universal problem." According to Dr. Mazanec, older men and women with arthritis joint degeneration are particularly susceptible to back pain. But all individuals are vulnerable, he declares, regardless of age, gender, occupation, or activity level. On a brighter note, Dr. Mazanec contends that the incidence of back pain could be significantly reduced if people better understood the anatomy of their backs and the forces that these complex arrays of bone and soft tissues must typically withstand. Most important, he advises, all adults should be aware of the simple measures they can take on a daily basis to protect the health and structural integrity of their backs.

Arthritis and Exercise: Rules of Engagement
There is a fine line between exercises that strengthen the joints of the body and increases flexibility and those that could make the symptoms of osteoarthritis (OA) worse. Even the results of research can send conflicting messages. Some studies show an association between mechanical strain and knee arthritis, while others have proven that strengthening joint-supporting muscles can reduce pain and enhance both flexibility and mobility. A.J. Cianflocco, MD, Program Director for Cleveland Clinic’s Primary Sports Medicine Fellowship, and physical therapist George Sibel, DPT, provide some direction on which exercises to avoid and suggest the types of activities that can help you diminish or prevent some of the symptoms that accompany OA. "Activities to avoid are the ones that hurt, particularly while you’re engaged in the activity," says Dr. Cianflocco. "Pain is a red flag that tells you to stop what you’re doing and perhaps eliminate it from your exercise routine altogether. If the discomfort develops only after an activity, you may be able to get back to doing it with either less intensity, fewer repetitions, or for a shorter period of time."

The Benefits–and Hidden Dangers-of Prednisone
Many people with rheumatoid arthritis (RA) suffer flare-ups that their regular medications aren’t strong enough to help. Others find that medicines typically prescribed to ease RA symptoms aren’t enough at all. Prednisone can bring relief in both cases. "We know that prednisone can improve swelling, pain, and function. So most rheumatologists will prescribe it for someone who is flaring or suffering with increased pain, joint stiffness and swelling ," says Matthew Bunyard, MD, Director of Clinic Operations for the Department of Rheumatic and Immunologic Diseases at Cleveland Clinic. Research has shown that prednisone can be very effective in relieving RA pain. But the drug, even in low doses, also can have serious side effects, including cataracts, infection, muscle weakness, weight gain, elevated blood sugar, hypertension, and osteoporosis. And while patients taking prednisone over longer periods for chronic pain and swelling are at greater risk for developing these conditions, even patients taking prednisone briefly can suffer from serious side effects.