Ask the Doctors July 2013 Issue

Ask The Doctors: July 2013

Pain medication combinations . . . Stillís disease . . . Strontium ranelate

Q. I take ibuprofen (Advil, 200 mg) after exercising during the day, and acetaminophen (Tylenol, 135 mg) at night for my back pain. Do I need to wait before switching from ibuprofen to acetaminophen?

A. Over-the-counter (OTC) pain medications are effective, inexpensive and different. Before you take another dose of acetaminophen or ibuprofen, itís important to understand the differences between the two medications. If reducing pain is your only goal, acetaminophen (Tylenol) is the place to start. If youíre trying to reduce pain and inflammation, consider first taking a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (including Advil, Motrin, Nuprin and Medipren). Acetaminophen is usually effective for mild OA pain, but ibuprofen may be a better choice if the pain becomes more severe. About half the people who take over-the-counter medications either take too great a dosage or take them too often. For the safest and most effective pain relief, you should take them exactly as directed. The dosage for acetaminophen is 325 to 650 mg every four to six hours, with a maximum dosage of 3,000 mg per day. A dosage of 4,000 mg of acetaminophen can be taken daily for short periods time. Ibuprofen should be taken with food every four to six hours, with a dosage of 300 to 800 mg. Both acetaminophen and ibuprofen can be taken at the same time if needed.

Q. I was diagnosed with rheumatoid arthritis (RA) over 30 years ago, but have recently been told I also have Stillís disease. What is Stillís disease and is it a result of my RA?

A. Adult Stillís disease, more commonly called adult-onset Stillís disease (AOSD) is a rare illness that causes high fevers, rash and joint pain. It may lead to long-term (chronic) arthritis. Stillís disease is a severe version of juvenile idiopathic arthritis (JIA), which occurs in children. A condition that affects women more often than men, Stillís disease is diagnosed in fewer than one out of 100,000 people each year. The cause of AOSD is unknown, but because its symptoms are similar to those of arthritis the condition is treated similarly with aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Prednisone may be used for more severe cases. If the disease persists (becomes chronic), medicines that suppress the immune system might be needed; such as, anakinra (Kineret), methotrexate, or tumor necrosis factor (TNF) antagonists like etanercept (Enbrel).

Q. I was recently diagnosed with osteoarthritis (OA) in my knee. Is it true that the medication strontium ranelate (Protelos or Protos) could the slow the course of OA and help ease my knee pain in the future?

A. There is a lot of interest in the use of strontium ranelate for the treatment of osteoarthritis (OA) of the knee due to evidence suggesting the drug can slow the course of the disease, according to a study published in Osteoporosis International (March 2012). The† trial involved 1,683 people with OA of the knee using strontium ranelate. The researchers concluded that both 1g/day and 2g/day doses of strontium ranelate had a beneficial effect on joint structure in patients with knee osteoarthritis. The 2 g per-day dose significantly improved overall symptoms as well as the pain sub-score and the ďtrendĒ for improved physical function sub-score.

These findings are encouraging, yet the future of strontium ranelate in the United States remains unclear because it is not currently an approved medication by the U.S. Food and Drug Administration (FDA).