William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
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
Melissa Conrad Stöppler, MD
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.
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"If I have minimal or no symptoms with early signs of osteoarthritis, what should I do?"
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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.
Reviewed by Melissa Conrad Stöppler, MD on 11/18/2011
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