Do I Have Arthur-itis?

Ahh, arthritis. A common lament.

Actually, arthritis is not a specific diagnosis. It is a symptom that describes pain in your joints.

Any initial evaluation of arthritis should consider uncommon but potentially disabling forms of arthritis in which your immune system is actually attacking your own joints. Yes this can happen, often runs in families and can be treated very well by a rheumatologist with medications that can alleviate pain and prevent crippling deformity. Examples of these kinds of arthritis include rheumatoid arthritis and systemic lupus erythematosus (lupus).

By far, the most common kind of arthritis is simply related to day-to-day, year-to-year wear and tear on the cartilage that lines your joints. Most folks call this age-related or wear-and-tear arthritis. It is technically called degenerative joint disease or osteoarthritis.

This will affect load-bearing joints such as shoulders, back, hips and knees and also frequently used joints such as the fingers. It differs from the nastier ones described earlier by typically being worse as the day goes on, and not being at its worst first thing in the morning.

What to do for it?

First, stay active. Avoiding absolutely everything that hurts can be worse in the long run because you can gain weight which will increase the load on joints, and lose muscle strength that supports your joints.

Exercise that is non-weight bearing is best: swimming, water aerobics, aqua running. If this is not practical, exercise that does not involve impact against the ground is good. This is referred to as closed-kinetic chain exercise and includes bicycling, stationary bike, elliptical trainer, Stair Master, etc.

Applying ice or a warm water bottle several times a day is also helpful.

Tylenol would be the best medication to use first. It relieves pain as well as any other over-the-counter or prescription medicine and has fewer side-effects. Kidney injury is rare, it cannot cause bleeding or stomach problems and it cannot hurt your liver (if you have hepatitis or drink over 2 drinks a day, cut the following doses by half or bring it up with your doctor).

The correct dose of Tylenol (or generic acetaminophen) is 1,000 mg at a time, 3-4 times a day. Yes, that's 8 extra-strength Tylenols a day.

If you take an aspirin a day for your heart or are on "blood thinners", it is okay to take Tylenol. It does not interfere with the aspirin's ability to prevent heart attacks and strokes, and cannot cause bleeding, and does not interfere with Coumadin/warfarin.

If that isn't enough, try adding topical capseicin (such as Zostrix). This is a topical ointment containing an oil-based extract of cayenne pepper. You apply it to your arthritic joints 3-4 times every day. It burns a bit for the first week or two, but after this it relieves arthritis pain by depleting a chemical that your nerves use to send pain signals to your brain. Native Americans in the Southwest have eaten cayenne for centuries as a treatment for pain. Applying it as an ointment works very well to relieve pain, though you should wash your hands thoroughly after rubbing it on!

If Tylenol and Zostrix are not adequate, then you may want to try anti-inflammatory pain relievers (NSAID's) such as Advil or Aleve instead. Tylenol is usually worth trying first since wear-and-tear arthritis doesn't cause joint inflammation.

Prescription level doses on these are double those on the label: 4 Advils 3 times a day, OR 2 Aleves 2 times a day.

• Do not take NSAID's along with Tylenol. You should only use them if Tylenol isn't working well enough, therefore you should then stop the Tylenol.
• Do not play mix-and-match. Use on or the other, not both.
• It's okay to take them with food or on an empty stomach.
  
• You cannot use NSAID's with Coumadin/warfarin or Plavix/clopidogrel which are prescription "blood thinners". Taking NSAID's along with these can cause fatal bleeding problems.
• If you have had a heart attack or have congestive heart failure, you should consider use of NSAID's with caution. They can keep aspirin from protecting your heart, and can cause fluid retention which could worsen your heart disease.
  
• If you take an aspirin a day to prevent heart attacks or strokes, you may as well stop taking it since the NSAID keeps the aspirin from doing its job. Yes, that does mean you are losing your heart attack and stroke protection!
• You can prevent these medicines from causing an ulcer, which is definitely worth doing, especially since 85% of these ulcers are totally painless.
• Take one 20-mg Prilosec OTC a day, and this will reduce the chance of an ulcer to nearly zero.
• Ignore the labeling on the package about not taking it for over 14 days. Or rather, do not suppose that this means it's not safe to use. The label is intended to keep folks from using it for stomach pain for over two weeks without seeing a doctor about it.

Narcotic pain pills may be appropriate for treating arthritis since the disease can really impact your quality of life. However, they have numerous side-effects and can be addictive so should be used with caution.