Ask the Doctors July 2007 Issue

Ask The Doctors: 07/07

I have hypothyroidism and have been experiencing arthritis-like pain in my hips. Can hypothyroidism cause joint pain?

Some patients with hypothyroidism can experience symptoms that mimic the symptoms of rheumatoid arthritis with pain in multiple joints, stiffness, and swelling. However, this occurs in patients with low thyroid levels and high TSH (thyroid-stimulating hormone, also known as thyrotropin).

Once you have used thyroid medication and your TSH is normal, your arthritis-like symptoms should resolve. Some forms of hypothyroidism are considered "autoimmune," where thyroid antibodies can be seen in connective tissue. Patients with autoimmune hypothyroidism may also have other connective tissue diseases that can cause arthritis.

Iíve had OA in my hands and ankles for nearly 15 years. My doctor has recommended I take ibuprofen daily to keep the pain in check, but Iím not big on taking pills. Iím wondering if I can take ibuprofen only when the pain becomes bothersome, rather than use it daily.

Yes, you can. Just be sure that you take your ibuprofen with food. Since ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) do not have disease-preventing effects, starting and stopping these medications can always be done without causing harm.

Limiting the dose of NSAIDs you take may also reduce the potential side effects of gastrointestinal irritation and ulcers. Some patients hurt to an extent that they have no choice but to take the medication every day. All NSAIDS work best if taken regularly and a blood level (the amount of medication in your blood) is built up.

Iíve read that fish oil is effective as a pain relief for rheumatoid arthritis, and I know several people who suffer from RA and have found fish-oil supplements effective. But Iíve been taking them for three months to relieve RA pain in my hands and have noticed no difference. Do fish-oil supplements really work for people with RA?

Some studies have shown that eicosapentaenoic acid (EPA) can reduce RA inflammation. EPA, an polyunsaturated omega-3 fatty acid, is obtained in the human diet by eating oily fish or fish oilócod liver, herring, mackerel, salmon, menhaden, and sardines. It appears that EPA alters human cell membranes so that fewer inflammatory products are produced. However, the doses required for noticeable pain relief are quite large and are equal to taking 12-16 fish-oil capsules per day.

My daughter, who has had RA for several years, swears by the relief she gets from soaking in a hot tub at a local spa. I also suffer from RA and am considering installing a hot tub in my home. Before I make the investment, Iíd like to know if there has been any research on hot tubs and pain relief for RA. Also, would my health insurance company cover the cost?

There has been no research on hot tubs and their effectiveness for RA. But if it makes you and your daughter feel better, it is a reasonable measure to investigate.

People with RA often use heat (paraffin baths are a good example) to alleviate stiffness. You could ask your doctor to write a prescription for a hot tub and use it as a deduction if your medical expenses are a significant part of your income. It is doubtful that your health insurance company would consent to pay for this.