The Cleveland Clinic Arthritis Advisor

Volume 7
Number 9
September 2008

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

September 2008

Injections May Help OA Knee Pain
Viscosupplementation—the injection of a gel-like substance called hyaluronic acid into a joint to supplement the viscous properties of the synovial fluid which lubricates the joint—has become an increasingly effective treatment option for knee osteoarthritis (OA)—even if your pain is mild or moderate. "Many people look at viscosupplementation as an alternative," says A. J. Cianflocco, MD, a staff physician at Cleveland Clinic, "when other treatments, such as medication, physical therapy, bracing, or orthotics, have failed—or as an option only in cases of severe OA for those who want to avoid or delay total knee replacement. "But the ideal candidate is the patient with mild or moderate arthritis," he adds. "Viscosupplementa-tion should be considered a first-line treatment of osteoarthritis of the knee for these individuals." Others who might benefit are those who have not responded to pain or anti-inflammatory medications, such as aspirin, ibuprofen, or naproxen.

Vitamin D: What You Need to Reduce Your Fracture Risk
The "Got Milk?" campaign may have convinced us to drink more milk. But if you’re drinking enough milk—and therefore getting enough calcium—does that mean you’re getting enough vitamin D? Not necessarily; even three daily servings of milk won’t deliver the daily 400 international units (IU) of vitamin D now recommended by the U.S. Institute of Medicine for people ages 51 to 70, or even half the 600 IU recommended for people 71 and older. It’s important to pay attention to how much vitamin D you’re getting every day, because it’s essential for much of your body’s health, including bone strength. "Vitamin D promotes bone mineralization through calcium absorption. It strengthens the immune system and protects against osteomalacia (bone softening) and hip fractures," says Carolyn Snyder, MPH, RD, LD, a member of the staff at Cleveland Clinic’s Nutrition Therapy Department. "New research shows vitamin D may play a role in protection from hypertension, psoriasis, multiple sclerosis, rheumatoid arthritis and up to 18 different types of cancers."

New Strategies to Fight Fibromyalgia
Fibromyalgia syndrome (FMS), a mysterious condition characterized by chronic, widespread joint and muscle pain, headache, sleep disturbance, fatigue, and depression, afflicts an estimated three to six million Americans. The disorder overwhelmingly affects more females than males. In the elderly, the condition is frequently masked by symptoms that are often misdiagnosed as arthritis or rheumatism. A diagnosis of FMS is based on two criteria: existing pain in all four quadrants of the body, and the occurrence of pain in at least 11 of 18 so-called "tender points" on the front and back of the body. Until recently, the thinking was that the stronger the pain medication, the more relief it seemed to give those who have the condition. But powerful, opioid-based narcotic drugs, such as hydrocodone and oxycodone, have not provided effective relief for FMS sufferers. There is hope that the newest crop of treatments, including anti-convulsant and antidepressant medications, can bring relief. However, the answer to treating FMS lies not just in medication but also in developing an understanding of why the pain occurs in the first place.

Gout: Prevention More Than Meds
The first symptom of gout—a condition that most often affects older adults—is an excruciatingly painful attack, usually in the joint at the base of the big toe, which often occurs at night. The pain can be so severe that even the touch of a sheet is unbearable. Given this sequence, it would seem that gout strikes without warning. But to the contrary, gout develops over time, the result of an abnormal buildup of uric acid in the blood. Doctors have identified risk factors and claim that the disease can be controlled—in some cases prevented—through diet, exercise, and medication.