The Do's and Don'ts of Arthritis Treatment
Here's how to safely ease joint pain without hurting the rest of your body
If you have osteoarthritis (OA), easing the pain is important, especially if it helps you move more. (Exercise, in turn, will reduce the pain and increase your range of motion.) But before you pop yet another ibuprofen or prescription anti-inflammatory, bone up on the do’s and don’ts of safely treating this condition.
Don't take ibuprofen and other NSAIDs forever. NSAIDs like ibuprofen, naproxen and the prescription drug celecoxib (Celebrex) are a good choice if you have severe joint pain. But you should take the lowest dose for the shortest period of time possible. Long-term use has been linked to stomach ulcers and an increased risk for heart attack and stroke.
Don't double up on your NSAIDs. Too-high doses of NSAIDs can cause ringing in the ears, blurred vision, stomach pain, confusion, drowsiness and difficult breathing. If you keep taking too much, over time you risk gastrointestinal bleeding. If the safe dose of your NSAID isn’t enough, "you can always add acetaminophen to the NSAID for additional relief, if needed," says Eric Matteson, MD, chair of the division of rheumatology at the Mayo Clinic. If you are taking more than the recommended dose of any NSAID, talk to your doctor about alternatives.
Don't use topical creams containing salicylates if you take aspirin, warfarin or other blood thinners. Salicylates are the chemicals in aspirin, and they thin the blood. You want to make sure you don't thin your blood too much.
Don’t use heat on a hot, swollen joint. Heat is a wonderful thing for stiff joints and tense muscles. However, "if you already have a hot swollen joint, then we would not recommend heating it more; ice would be a better choice," says Atlanta rheumatologist W. Hayes Wilson, MD. Cold packs or a bag of frozen veggies numbs pain and reduces swelling. Don't ice for more than 20 minutes. Doing so could damage the skin and even cause frostbite. Some people find switching between ice and heat helpful.
Don’t just assume your joint pain is due to osteoarthritis. "Always make sure you know what type of arthritis you have before self-medicating," says Donald Miller, PharmD, chair of the pharmacy practice department at North Dakota State University and member of the FDA Arthritis Advisory Committee. "Severe types, like rheumatoid arthritis, need to be treated promptly with prescription drugs. Lack of appropriate diagnosis and treatment could lead to long term joint damage."
Do try ointments and creams. Topical pain relievers are rubbed directly onto the skin over the painful joint. Over-the-counter creams that contain capsaicin (the ingredient that gives hot peppers their heat) can really help ease osteoarthritis joint pain. They can sting a bit at first, but the sting goes away over time. Other topicals commonly used for arthritis contain menthol, camphor or aspirin (salicylate). A prescription topical called Voltaren Gel helps with hand and knee osteoarthritis. It contains an NSAID called diclofenac.
If you are over age 75, the American College of Rheumatology (ACR) says you should opt for topicals instead of pills or tablets.
Do try acetaminophen (Tylenol) before ibuprofen. Ibuprofen and other NSAIDs can upset the stomach and cause ulcers. That's why the ACR recommends acetaminophen as the first-to-try med for patients with mild to moderate hip and knee OA. It is safe for the stomach. Don't take more than 3000 milligrams a day unless your doctor tells you to . It could cause liver failure.
Do check the ingredients in all the medicines you take. Ibuprofen and acetaminophen are found in many other OTC products, like cold and allergy meds and sleep aids. If you take your usual dose and then take one of these products on top, you could overdose. Always read the labels. Skip your usual dose if you’re getting the same drug from another product.
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Do consider supplements. One combo to consider is glucosamine sulfate and chondroitin. These are substances that occur naturally in and near the spongy tissue that cushions joints. Some studies suggest the supplements can ease knee joint pain or rebuild cartilage. Others say maybe not. Still, it may not hurt to try them. No serious side effects have been reported. "Some patients appear to obtain pain relief using these products," says Matteson. Another supplement to consider is curcumin (found in turmeric and curry powders). Many arthritis patients find it helpful, and research shows it eases inflammation.
Before buying any supplements, check the FDA Health Fraud site to make sure your supplement is not on the FDA's health fraud list. (The FDA doesn't check the safety of all supplements, but it does provide a list of products recalled, like supplements, for reasons such as dangerous claims or ingredients.) You can also search for a list of tainted supplements on this FDA site.
Talk to your doctor before taking any supplement. Glucosamine/chondroitin may not be recommended if you have diabetes or take the blood thinner warfarin (Coumadin), for instance. Turmeric can cause some belly troubles.
Do ask about joint injections. If you have a sore, swollen knee joint and need quick relief, a cortisone (steroid) injection may be helpful. You should feel better for about three or four months. If not, injections of hyaluronic acid may be recommended. This acid is found naturally in the joint fluid. People with OA often have a lower-than-normal amount. Hyaluronic injections (also called viscosupplementation) usually last for six months to a year.
Don't be surprised if you don't feel better right away after an injection. You might feel sore for a day and may even have some swelling. Cortisone shots often ease pain fast, but it can take several weeks for the benefits of hyaluronic injections to kick in.
Do talk to your pharmacist. He or she can help you steer clear of dangerous drug interactions. Ask questions like "Can I take this cold medicine with my current prescriptions?" Tell the pharmacist about all the medicines you take.