Ask the Doctors October 2004 Issue

Ask Dr. Marks: 10/04

I’ve seen a lot of ads for exotic herbs and special supplements that claim to rebuild worn cartilage. Do any of these treatments work? If not, are there any procedures or treatments that do work in rebuilding cartilage?

No herbs, dietary supplements, or home remedies have been proven to rebuild damaged cartilage—and you should be wary of any ads that claim their product does so. Surgical procedures can rebuild a type of cartilage, called fibrocartilage, but it is a poor substitute for articular cartilage. Fibrocartilage is produced by arthroscopically drilling small holes into the bone, but it does not hold up well against the stress of everyday walking or athletic activities. Cartilage can be transplanted from other areas to the area of deterioration. This procedure, which is called mosaicplasty, can be done for small areas of cartilage damage. Neither procedure can be performed for large areas of cartilage damage such as seen in osteoarthritis.

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I've been told that compounded medications—gels, creams, transdermal patches—can be applied to an area of joint pain for quick relief, and since the medication doesn’t travel throughout the body, there’s no risk of side effects. Are they really all that effective?

Compounded medications, such as ketoprofen gel, can be useful in the treatment of osteoarthritis of the thumb and other small joints of the hand. When multiple large joints are involved, however, oral medications are best. Compounded medications have fewer side effects, but they are generally less effective than oral medications. They play a limited but useful role in the overall treatment of osteoarthritis.

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If one painkiller helps a little to ease my arthritis discomfort, are there any benefits or dangers in doubling my dosage?

Increasing the dosage of a medication is a dangerous practice, and should never be done without first checking with your doctor. Doubling the dose may result in serious side effects. If your pain has increased to the point where you are thinking about doubling your dosage, then your doctor should be notified about the worsening of your condition. Most pain prescriptions are written in such a way that they give you some leeway in the amount that you take. Do not, however, go beyond the maximum dosage written by your doctor.

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I’m a woman and have been taking calcium supplements for years, but I’ve read that supplements alone won’t prevent me from getting osteoporosis. What else can I do?

Lifestyle issues—calcium intake, exercise, not smoking, not drinking to excess (less than two drinks per day), not being excessively thin with low body weight—can help maintain bone mass. Walking is the best exercise to prevent osteoporosis. It is better for you than swimming or bicycling for bone metabolism. However, some women have a genetic predisposition to osteoporosis. In this case, exercise and calcium intake are not enough, and your doctor may prescribe one of several medications—Evista, Fosamax, Actonel, Forteo, Miacalcin—to prevent the onset of osteoporosis.