Ask The Doctors: August 2010
Prednisone and Disc Disease. . .Oral vs. Injectable Steroids. . .Rebuilding Cartilage
I have degenerative disc disease—osteoarthritis of the spine—and I’ve read about using prednisone in a controlled manner (called microdose therapy) to relieve the pain. Does this treatment work?
There is little evidence to support this treatment method for osteoarthritis. Studies of its use for fibromyalgia and rheumatoid arthritis report mixed results. Concerns over the use of this therapy include suppression of the immune system (which could make you vulnerable to infection) and loss of bone density. However, one study found that bone mineral density (BMD) was not significantly reduced by low-dose prednisone in a group of patients with rheumatoid arthritis, although hip BMD was reduced in postmenopausal women. Talk with your physician about other, more reliable, and less costly treatment options.
I’ve heard that corticosteroids are effective for easing the inflammation of arthritis, but when taken orally they can cause some nasty side effects. Are injections better—and what kind of side effects am I likely to experience?
Corticosteroids taken orally are effective for inflammation in patients with inflammatory types of arthritis, such as rheumatoid arthritis, but are not recommended for the treatment of osteoarthritis. Steroid injections, on the other hand, are used for both types of arthritis and can be effective although temporary, usually lasting one to six months. Oral steroids have numerous side effects that limit their long-term use, including osteoporosis, muscle weakness, diabetes, and cataracts, among other problems.
I have a rotator cuff tear in my right arm. I also have chronic Lyme disease and cannot count on it being inactive or in remission for any period of time. Is it a mistake to have surgery on my shoulder while I have Lyme disease?
Before you consider surgery of any kind, you should consult with your primary-care physician and perhaps an infectious-disease specialist. Heart problems can be caused by Lyme disease, and a cardiovascular evaluation may be necessary before surgery.
If you are otherwise healthy and your Lyme disease is under control, rotator cuff surgery should be possible without any unusual complications. I’ve noticed several ads for exotic herbs and special supplements that claim to rebuild worn cartilage. Do any of these treatments work? If not, are there any treatments that do work in rebuilding cartilage?No herbs, dietary supplements, or home remedies have been proven to rebuild damaged cartilage, and you should be wary of any ads that claim their product does so. Surgical procedures can rebuild a type of cartilage, call fibrocartilage, but it is a poor substitute for articular cartilage. Fibrocartilage is produced by arthroscopically drilling small holes into the bone, but it does not hold up well against the stress of everyday walking or athletic activities. Cartilage can be transplanted from other areas to the area of joint deterioration. This procdure, which is called mosaicplasty, can be performed for small areas of cartilage damage. Neither procedure can be performed for large areas of cartilage damage, such as seen in osteoarthritis.