Ask the Doctors January 2008 Issue

Ask The Doctors: 01/08

Iím new to Arthritis Advisor. Iím sure Iíve already missed some good advice on treating osteoarthritis, which I have. Can you tell me the best treatment for OA?

There are a number of strategies for coping with osteoarthritis. Exercise is important in managing arthritis, especially exercises that donít place stress on the joints such as walking and swimming. Exercise also can improve your endurance and your ability to perform daily tasks.

The use of heat or ice can help relieve soreness and inflammation, as can some topical medications. Oral medications also can help relieve joint swelling and pain. All medications have potential side effects and should be taken only when necessary, but over-the-counter analgesics and anti-inflammatory medications can be very beneficial. Your physician also may prescribe stronger anti-inflammatories or other types of medication.

Some studies have indicated that chondroitin sulfate and glucosamine may be useful in the treatment of osteoarthritis. Keep in mind that dietary supplements such as glucosamine and chondroitin sulfate are not currently regulated by the U.S. Food and Drug Administration. As nutritional supplements, they are not subject to the same rigorous regulation as prescription and nonprescription drugs, which means the quality and amount of the ingredients can vary widely. Finally, injections of hyaluron or cortisone can provide pain relief and delay the need for surgery.

I have rheumatoid arthritis in my shoulder and my doctor has recommended I take methotrexate for relief. But Iíve heard that methotrexate can cause liver problems. How will I know if Iím developing liver problems?

Methotrexate remains a widely used and effective treatment for rheumatoid arthritis. The drugís effects on the liver are well known and well studied. As many as two-thirds of patients have mild and transient elevation of liver enzymes while taking methotrexate. These changes usually do not reflect serious liver damage and do not require cessation of treatment. Rarely, methotrexate may cause liver fibrosis (scarring). The risk of serious liver injury is increased by alcohol consumption. Regular monitoring of liver enzymes by blood test every two to three months is generally recommended for people taking methotrexate. Persistent significant elevations of liver enzymes may warrant a liver biopsy to evaluate for scar formation. Because this is such a rare complication of methotrexate treatment at doses used in the treatment of RA, routine liver biopsy is not recommended. As with any medication, careful monitoring by your physician is required, but most patients with RA are able to take methotrexate for years without liver injury.

Since the symptoms of arthritis and Lyme disease are similar, how can I tell if my joint pain may be due to Lyme disease? Is the treatment for arthritis any different than that for Lyme disease?

Lyme disease is an inflammatory disorder caused by a tick-borne bacteria. Early symptoms may include a flu-like syndrome of fever, fatigue, and joint pain. If recognized and treated with antibiotics, the disease is cured and further symptoms rarely develop. Untreated, about 10 percent of people with Lyme disease develop a more chronic arthritis usually affecting a single joint. Lyme arthritis can be confirmed by evidence of antibodies to the Lyme bacteria in the joint fluid. Finding antibodies in the blood is not useful in the diagnosis of Lyme arthritis, since these antibodies may persist even if the infection was treated correctly. In people with Lyme arthritis, antibiotic treatment is recommended if it was not previously administered.