Full Issue PDF

There is no cure for osteoarthritis, which can worsen over time. Treatment is aimed at relieving symptoms. The most effective treatment is weight loss if you are above ideal weight, says Dr. Day. Physical therapy, exercise and knee braces can help. Other options are nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol), supplements, and injections of corticosteroids or hyaluronic acid.

While it might seem that restricting calories would make you very hungry, Kirkpatrick says that its the opposite. Hunger actually goes down. Your body adjusts and you are satisfied with smaller amounts of food. You see the chocolate chip cookie, but you dont have to have it. A patient of Kirkpatricks who just started a fasting plan noticed that she felt some hunger in the evening. She expected to be starving the next morning, but she actually had little appetite when she woke up.

When your back or neck aches, you may reach for pain relieving medications. While they can help, experts suggest trying nondrug treatments first. For both short-term and longstanding low back pain, for example, the recently updated guidelines by the American College of Physicians recommend starting with therapies such as heat, massage, exercise and spinal manipulation.

lasting less than 12 weeks the ACP recommends nondrug treatments, such as application of heat, massage, acupuncture or, possibly, spinal manipulation by a chiropractor or osteopathic physician. If this is not successful, you can add medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin) and naproxen (Aleve), or muscle relaxants, including cyclobenzaprine (Flexeril).

Youve probably seen the ads on television-a celebrity with osteoporosis talking about a drug thats protecting her bones. If you need an osteoporosis drug, should you take the one the celebrity ispromoting?There are several osteoporosis drugs on the market. They may be taken as a pill, a shot or an infusion. Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic, and associate editor of Arthritis Advisor, helps us sort out the variousoptions.

The key to treating gout is to lower the uric acid level in the blood until it is consistently less than 6 milli- grams (mg)/deciliter (dL). Chang- ing your diet can help, but even the strictest low-purine diet will only reduce uric acid levels by 1 mg/dL. If your level is 12 mg/dL, youll never get it low enough with diet alone, says Cleveland Clinic rheu- matologist Elisabeth Ray, MD.

Participants, who had heart disease or were at increased risk for it, were randomly assigned to celecoxib (100 mg twice a day), ibuprofen (600 mg three times a day) or naproxen (375 mg twice a day), which they took for at least 18 months. There was no significant difference in the occurrence of heart attack, stroke or death between the three groups. One limitation of the study was the high number of people who dropped out. However, the drop-out rate was similar for all three groups, so I dont think it affects the overall conclusions, says Dr. Husni.

It seems logical that injecting HA into the joint should help relieve arthritis symptoms. But its unclear whether the synthetic HA gets incorporated into cartilage. Evidence about the effectiveness of injections is mixed, which has resulted in some disagreement among medical specialty societies about the role of this therapy. The American Academy of Orthopaedic Surgeons says the evidence does not currently support its use.

If you have knee osteoarthritis and a meniscus tear, definitely try physical therapy. If youre getting progressively better, then stay with it for the complete course of sessions, says Dr. Spindler. People who dont make any progress should consider being evaluated for surgery. The surgery is called arthroscopic partial meniscectomy. With arthroscopic surgery, the surgeon makes small incisions through which a camera and surgical instruments are inserted.

While they can be very effective, biologics have some drawbacks. Most of them must be taken by injection or intravenous infusion, and there are potential side effects, some of which can be serious. In most cases, the benefits will outweigh the risks, says Dr. Bunyard. But it may take some trial and error to find the right drug or combination of drugs that leads to remission or low disease activity without any unacceptable side effects.If you are on a regimen of drugs for rheumatoid arthritis and are still experiencing pain or dysfunction, it may be time to make a change. But Dr. Bunyard notes that increased pain and dysfunction may also stem from a different cause.

Immobilizing the joint with a splint can help with pain and joint alignment. You can buy one in the drug store, but its better to have one custom made by an occupational therapist. If you buy a ready-made one, be sure it is specifically designed for the thumb (and not, for example, for the wrist). Some splints hold the joint in one position, while others allow for some movement. Your doctor or occupational therapist will help you determine which type of splint is most appropriate for you. Youll probably start by wearing the splint most of the time, and then gradually use it less frequently during the day but continue bracing while you sleep at night.

Hip resurfacing is an alternative that preserves more bone and may allow for greater mobility. With hip resurfacing, the socket part of the implant is the same as in the total joint replacement. But instead of inserting the stem and ball device into the femur, the surgeon reshapes the bone at the head of the femur and places a metal cap over it. A larger ball is used than in total joint replacement, which should make the joint more stable and less likely to dislocate. The neck of the thighbone and part of the head are preserved, which may make revision surgery or total hip replacement easier if needed later on.