Ask the Doctors June 2011 Issue

Ask The Doctors: June 2011

Implant Longevity . . . Sjögren Syndrome . . . Breaking Glucosamine Capsules

I had a hip replacement recently and am now considering a knee replacement. How many pain-free years can I look forward to after undergoing a knee or hip replacement?

Total hip and knee replacement are two of the most successful orthopaedic procedures, relieving pain and restoring function in more than 95 percent of patients who undergo the procedures.

Although earlier implants could be expected to last about 10 years, newer implant materials and techniques have extended the longevity to 20 years or more.

Implants erode because of some of the same factors that caused your osteoarthritis; weight-bearing and joint motion place stress on the new joint and can, in time, cause it to wear out.

Some precautions will be necessary for the first few months after surgery, but then you will be able to maintain an active lifestyle, including such activities as walking, cycling, swimming, golfing, and dancing. High-impact activities, such as jogging or running, basketball, and sports that require twisting or pivoting, usually should be avoided. Your surgeon and physical therapist can provide information about which activities are appropriate during your rehabilitation.

I have rheumatoid arthritis in my hands. I’ve also lately been experiencing dryness in my eye and mouth. I’m told I may have Sjögren syndrome. What is it, and how is it treated? Is there any cure for it?

Sjögren syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands, especially those of the eyes and mouth, most commonly producing symptoms of dry, itchy eyes and dry mouth.

About 90 percent of people with Sjögren syndrome are women, and most are diagnosed in their late 40s, but it can occur in all age groups, including children, and in both sexes. Sjögren syndrome sometimes runs in families, and it’s common for people who have Sjögren syndrome to also have a rheumatic disease, such as rheumatoid arthritis or lupus.

There is no cure for Sjögren syndrome, and treatment focuses on relieving symptoms, which often subside with time. Prescription medicines for dry eyes and dry mouth are available. A number of over-the-counter products also can be used to alleviate different types of dryness.

Make sure your physician knows about all the prescription and OTC medications you are taking. Many drugs have side effects that can make Sjögren symptoms worse. It’s important for you to discuss all of your symptoms with your physician so that a multidisciplinary team, which might include your rheumatologist, ophthalmologist, and dentist, can coordinate your care.

Since I’m unable to swallow pills, I wonder about the effectiveness I can expect from glucosamine sulfate if I open a capsule and take the contents with food.

The effectiveness of glucosamine sulfate probably will not be markedly affected by the method in which it is ingested. Several manufacturers now produce glucosamine-fortified foods or drinks, and it is available as a powder, but there is limited research on the use of glucosamine in these forms.

You should be aware, however, that two recent studies found that patients with chronic pain experienced no benefit from taking 1,500 mg/day of glucosamine. Although no study so far has found any serious side effects from taking glucosamine, you should discuss its use and effectiveness with your doctor.