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March 2003 Issue
Osteoarthritis: a very complex equal opportunity problem crippling millions of us.
by Michael Fick
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Are you developing OA? Maybe, if you’re experiencing joint pain without obvious sprain, joint stiffness or pain after a good rest, joint swelling or tenderness, or joint crunching you can feel or hear. X-rays may reveal it before any symptoms show, giving you time to lose excess weight, change your work or exercise, or start medicines which may slow its progression.

Oral estrogen lowers the risk of hip OA, and foods high in vitamins C, D and E and beta carotene may help slow the progression of knee OA. Another dietary consideration worth pursuing is your balance of omega 3 and omega 6 essential fatty acids, discussed here last August. Acupuncture seems to help some patients.

If rigorous, proper exercise and an occasional Tylenol don’t help enough, drug therapy may. It may also let the cartilage degrade faster if it masks abuse. Unlike exercise, drugs do just one or two things to help, but often have side effects, some serious, some even life-threatening (see our October 2002 issue). While exercise is a low-risk, straightforward, and clearly beneficial mitigator of OA, drugs can be almost the opposite. They include OTC and prescription pain killers and anti-inflammatories, various types of injections, and both valid and snake-oil supplements. Study the drug options, and if you didn’t go back and re-read the October ’02 column referenced above, do it now. Aspirin and similar OTC “pain candy” are most definitely not candy; both they and prescription drugs have strong potential for both benefit and harm. NSAIDS are the drug of choice, but their prolonged or intensive use should be monitored for the side effects discussed last October. Concern is rising from veterinary studies and some human indications that NSAIDS, commonly used for OA, may inhibit cartilage self-repair.

In addition to NSAIDS, your doctor may discuss topical analgesic lotions, mild narcotics, corticosteroids, and hyaluronic acid. If your doctor doesn’t explain those options at great length, ask for some reliable websites that do, and/or start with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) search engine. They lead the nation in osteoarthritis research, and their reports include medical data for your doctor and plain-talk patient reports anyone reading this basic column can follow. Some readers may benefit in the future from NIAMS research in cartilage cell replacement, stem cell transplantation, and gene therapy.

Be wary of OTC supplements; many are useless or harmful. Two well worth considering, however, are the widely touted glucosamine/chondroitin tablets. They often relieve the pain as much as prescription meds, may slow the pathology progression, and may possibly even slightly heal cartilage damage. Very extensive testing is expected to address those issues by next year. The current bottom line is that they are safe and may help OA.

Research shows that self-care -- including education, participation, and informed treatment selection -- results in claims of decreased pain, fewer doctor visits, and better quality of life. You’ll find a lengthy patient-oriented tutorial at, and many more highly informative links at When surfing the net for information on your OA, though, skip the countless web sites pitching supplements. Treat them as the unregulated paid commercials they are. You’ll quickly see that this column covers but a flea on a pinfeather on a penguin on the tip of the OA iceberg.

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