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Guide Health: The aches and pains of arthritis

There are two types of arthritis. If you have the condition, which one are you and how is it best treated?

It can seem inevitable that if you live long enough, of course you’ll be affected by arthritis, but it isn’t always so.

Arthritis is an inflammatory condition of the joints which makes movement painful and difficult, but it occurs in two types; rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis involves the immune system, with about one per cent of Canadians being affected, usually between 25 and 50 years of age. The most effective treatments for rheumatoid arthritis target the immune system in order to reduce inflammation and pain.

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Osteoarthritis, by contrast, is much more common, affecting 10 times more Canadians. It is a degenerative disease of the joints, commonly known as a “wear and tear” condition, which is why older people are more often affected. Athletes who use their joints continually and excessively can be affected at much younger ages.

The recommended treatment for osteoarthritis is considered to be acetaminophen, with two extra strength (500-mg) tablets four times daily for a maximum of four grams (eight 500-mg tablets = 4,000 mg or four grams). However, recent research has brought about some changes in this recommendation.

Acetaminophen still is a good starting point for mild to moderate pain, not severe, but in lower doses of two regular strength (325-mg) tablets four times daily for a maximum of 2,600 mg or 2.6 grams.

There is no proof that higher doses of acetaminophen are more effective for osteoarthritis pain, and American recommendations actually limit the maximum daily dose of acetaminophen to four grams for adults and 3.2 grams for seniors for any type of pain relief.

The key is taking acetaminophen on a regular basis to prevent and control the pain rather than waiting to experience the pain before taking the acetaminophen to counteract it. Ideally, you want to take the pain reliever every six hours, which can sometimes be inconvenient!

Acetaminophen is considered to be less risky than narcotic pain relievers because it is not linked to drowsiness, constipation, and dependency. Non-steroidal anti-inflammatory drugs like naproxen or ibuprofen will relieve osteoarthritis pain, but can cause problems for you if you have certain kidney conditions, if you are prone to stomach irritations, or even if you have heart disease. That said, a topical non-steroidal anti-inflammatory product like Voltaren Emulge will reduce pain without adverse effects, and can be used along with acetaminophen.

For more severe pain, a non-steroidal anti-inflammatory drug combined with acetaminophen is often recommended. If you have a heart disease risk, naproxen seems to be the best option, and if you have a gastrointestinal risk then celecoxib or low doses of ibuprofen are the best options.

Because you can buy some of these drugs without a prescription, check with your pharmacist to make sure you are not harming your health.

Narcotic pain relievers are for people who still have pain after such treatments, but these medications need to be taken in the lowest effective dose for the shortest possible period of time. Luckily, when it comes to osteoarthritis pain, there are numerous options, but you may need to try several before you find the right combination for you.

Non-prescription remedies are often advertised, but vary widely in their effectiveness. Glucosamine may have a modest benefit. That may be all you need, but be aware it can take up to three months to work. Capsaicin Rub helps some people who can tolerate it. Capsaicin is derived from the cayenne pepper plant, and thus can cause burning and irritation. Other rubs are not considered effective, although the massaging action may help.

With osteoarthritis you may limit your activities because you find movement difficult and painful. Pain relievers will help improve your mobility, but also remember that weight loss, keeping active, physical therapy, ice or heat applications, and even supports for your joints can also help.

Marie Berry is a lawyer/pharmacist interested in health and education.

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Marie Berry is a lawyer/pharmacist interested in health and education.

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