Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
"If I have minimal or no symptoms with early signs of osteoarthritis, what should I do?"
The ideal steps to take should lead to a proper diagnosis and an optimal long-term treatment plan. While many steps are described here, the plan must be customized for each person affected by osteoarthritis, depending on the joints affected and the severity of symptoms.
An opinion regarding the cause or the type of the arthritis can often be adequately obtained by consulting a general family doctor. It is often unnecessary to see an arthritis specialist (rheumatologist), like myself, for this purpose. However, if the diagnosis or treatment plan is unclear, a rheumatologist might be consulted.
When I determine that a patient has a classic node formation from osteoarthritis (Heberden's node), I may make the diagnosis solely based upon the examination, without the need for any additional tests, such as blood or X-ray testing. Sometimes, testing can be helpful to better understand the degree and character of the osteoarthritis affecting a certain joint. It can also be helpful for monitoring and to exclude other conditions.
Treatment may not be necessary for osteoarthritis of the
hands with minimal or no symptoms. When symptoms are troubling and persist,
however, treatment might include pain and anti-inflammatory medications, with or
without food supplements, such as glucosamine and/or chondroitin. Furthermore,
heat/cold applications and topical pain creams can be helpful.
As a first step, I recommend that patients go ahead and try the over-the-counter food supplements glucosamine and chondroitin. Each of these supplements has been shown by some studies to relieve the pain and stiffness of some (but not all) patients with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a two-month trial, I suggest that they discontinue these supplements. Of note, the manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.
For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammatory properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
Obesity has long been known to be a risk factor for
osteoarthritis of the knee. I recommend weight reduction for patients who are
overweight with early
signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. Foods to avoid include those that promote weight gain. As described above, even modest weight reduction can be helpful.
Pain medications that are available over the counter, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis. I recommend these as the first-line medication treatment. Studies have shown that acetaminophen, given in adequate doses, can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. If symptoms persist, then I recommend trials of over-the-counter anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, Nuprin), ketoprofen (Orudis), and
naproxen (Aleve). Many patients do best when they take these medications along with their glucosamine and chondroitin
supplements.
Some patients get significant relief of pain symptoms by dipping their hands in hot wax (paraffin) dips in the morning. Hot wax can often be obtained at local pharmacies or medical supply stores. It can be prepared in a
Crock-Pot and be reused after it hardens as a warm covering over the hands by peeling off and replacing it into the melted wax. Warm water soaks and nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms.
Performing gentle range of motion
exercises regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.
Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (ArthriCare, Zostrix), salycin (Aspercreme), methyl salicylate (Ben-Gay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.
Finally, when arthritis symptoms persist, it is best to seek the advice of a
doctor who can properly guide the optimal management for each individual
patient. Many other prescription medications are available for the treatment of
osteoarthritis for patients with chronic, annoying symptoms.
In addition to the steps described above, you should pay
attention to joint problems elsewhere in your body if you develop early signs and symptoms of osteoarthritis of the hands.
Osteoarthritis - Symptoms at Onset of DiseaseQuestion: The symptoms of osteoarthritis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
A torn meniscus (knee cartilage) may be caused by suddenly stopping, sharply twisting, or deep squatting or kneeling when lifting heavy weight. Symptoms of a meniscal tear include pain with running or walking long distances, popping when climbing stairs, a giving way sensation, locking, or swelling. Treatment depends upon the severity, location, and underlying disease of the knee joint.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
A Baker cyst, also called a popliteal cyst, is swelling caused by knee joint fluid protruding to the back of the knee (popliteal area of the knee). Not uncommon, baker cysts can be caused by virtually any type of joint swelling (arthritis). They are often resolved with removal of excess knee fluid in conjunction with cortisone injections.
The common bunion, an enlargement of the inner portion of the joint at the base of the big toe, primarily affects women. The signs and symptoms of bunions include inflammation, redness, tenderness, and pain of the first metatarsophalangeal joint. The little toe may also develop a bunion (tailor's bunion). Rest, walking shoes, stretching, cold packs, and antiinflammatory medications may alleviate pain. Surgery is also a treatment option.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis. It is characterized by calcification along the sides of the vertebrae of the spine. Symptoms include stiffness and pain in the upper and lower back. Anti-inflammatory medications are used to treat DISH.
A ganglion is a fluid-filled cyst that forms from the joint or tendon lining. Ganglia are most frequently found in the ankles and wrists and are usually painless. A ganglion often resolves on its own. Aspiration of the ganglion fluid or surgery may be necessary.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
Alkaptonuria is a condition that causes urine to turn black when exposed to air. Alkaptonuria is inherited, and usually appears after 30 years of age. Kidney stones, heart problems, arthritis, and prostate stones are also conditions associated with alkaptonuria.
Arthritis patients are sometimes vulnerable to quackery (the business of promoting unproven remedies). These "quick fix" treatments are promoted as cure-alls, but they really have no right to such claims. Consumers should be wary of products that have marketing claims like "will cure," "ancient remedy," "has no side effects," and "revolutionary new scientific breakthrough." Read about arthritis remedies and tests that have no scientific proof of benefits.
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