Ask the Doctors March 2013 Issue

Ask The Doctors: March 2013

Gout and RA Ö Reducing future fracture risk Ö Supervised knee strength training

Q. I was told that because I have rheumatoid arthritis I donít have to worry about developing gout. Is it true that having RA eliminates my risk for gout?

A. Having rheumatoid arthritis (RA) does not prevent a person from having gout; the two conditions can, and often do, exist simultaneously.† This misconception probably came about because the high levels of aspirin once used to treat rheumatoid arthritis also helped the kidneys expel uric acid, which causes gout when levels are too high. Newer medications for the treatment of RA have replaced the high-dose aspirin regimen.
Losing weight can help lower the level of uric acid in your body and reduce your risk of gout. Traditionally, avoiding foods such as animal products with high levels of purines (a naturally-occurring substance that is metabolized into uric acid) has been recommended, but the effectiveness of such a diet in lowering blood uric acid levels is actually quite low. A much more effective approach is a diet that replaces refined carbohydrates such as sugar and white flour with more complex carbohydrates; limits meat, fish, and poultry to four to six ounces a day; and increases vegetables and fruit. Consumption of coffee, vitamin C, and low-fat dairy products also appears to lower the risk of gout. Avoiding alcohol, especially beer, also decreases your risk of a gout attack; studies have suggested that drinking even two beers a day can double the risk. Maintaining a healthy lifestyle is the best way to avoid painful gout attacks and help in the management of RA.

Q. Iíve had RA since my early 30s, and have developed several bone fractures throughout the last 10 years. How can I strengthen my bones and reduce the risk of future fractures?

A It has long been known that rheumatoid arthritis (RA) increases the risk of fractures, and recent research has shown that women under 50 with RA have a five times greater risk of fractures than women of the same age without RA. Men with RA also have a greater fracture risk, but that risk seems to surface later in life.

Several factors may contribute to this increased fracture risk in people with RA, including a lack of physical activity related to difficulties with ambulation, which can cause falls. Even treatment of RA with corticosteroids can affect the bones. It is especially important for women with RA to take steps to strengthen their bones, including a diet high in calcium, appropriate exercise and quitting smoking. A number of medications currently are used for the treatment of osteoporosis, including vitamin D, protein, and calcium supplements; bisphosphonates; and hormone replacements. Bone density testing can help determine the severity of your osteoporosis, as well as its response to treatment.

Q. My doctor suggested strength training as a way to help my knee osteoarthritis. Do I have to see a physical therapist first, or are there ways I can do this on my own?

A. By strengthening the muscles around the joints, strength training helps to take some of the load off the arthritic joints and relieves pain. Areas to focus on are weight-bearing cardiovascular activities, flexibility and range of motion exercises, and strengthening exercises. Certainly, there are a number of exercise options that you can do on your own, such as walking, swimming, cycling, tai chi, and yoga. If you are performing specific strengthening exercises for the muscles around the knee, itís probably a good idea to have at least one visit with a physical therapist to ensure that you are doing them properly to avoid injury and obtain maximum benefit.