Arthritis Treatment Update (cont.)

MEMBER QUESTION:
What is your opinion of the implantable modalities (either with medicine drip or electrical impulses) to control pain?

SMITH:
The implantable devices for pain are quite effective for people that aren't able to tolerate medications by mouth or who have such severe pain that these other medications aren't working for them. The electrical impulses can also help but these are probably less effective, but this depends on the exact cause of your pain and what area is affected. Your doctor would be able to address this more specifically since he or she knows more about your situation. But both treatments are reasonable when used appropriately.

MEMBER QUESTION:
Given the Celebrex warnings, which would you take: Celebrex or ibuprophen if I'm just taking 100 milligrams per day? If and when I go hiking, I do take 200 milligrams per day.

SMITH:
I can't tell you which one is best for you. However, unless you have had stomach problems, such as an ulcer, there really is no reason for you to need to take Celebrex. Celebrex doesn't relieve pain any better than ibuprofen or the other anti-inflammatory drugs. Recommendations now are that it should only be used when someone has had trouble with the other medications, such as stomach bleeding.

Ibuprofen is a tough drug to take because you have to take it several times a day to get full day relief. However there are many other drugs to choose from that you only have to take once or twice a day.

If you don't have a reason to need Celebrex, talk to your doctor about taking a drug that might be easier to take.

MEMBER QUESTION:
Is Aleve safe to take twice a day for my arthritis? I take 10 milligrams of prednisone, one Plaquenil per day.

SMITH:
Aleve is safe to take but still carries a risk of side effects.

I want to be clear that when we need arthritis drugs they are relatively safe to take. We don't have a lot of other good options so people shouldn't worry excessively about taking the arthritis drugs when they need them.

I'm assuming your doctor knows about the Aleve and that's fine. Your doctor will watch to see if you have any side effects such as stomach irritation and he or she should also follow you to evaluate your heart risks. The risk is low especially if you have no other heart disease risk factors. It sounds like you have RA and you need this arthritis drug or something similar so I wouldn't worry about it. Just take it as directed by your doctor and it should be fine.

MEMBER QUESTION:
I have nodules on the middle knuckles of my index and pinky fingers. Is this arthritis or are they from gout which I get occasionally? Will they go away? Is there any procedure that will help eliminate them? I think they are referred to as tophi.

SMITH:
Tophi are due to crystal accumulation in the joints related to gout but such nodules can also be caused by other types of arthritis. However, in those middle joints, my guess is that this is due to your gout and not another form of arthritis. Nodules in those joints can sometimes be caused by RA but you don't appear to have any symptoms to rheumatoid arthritis.

Tophi may get smaller with gout treatment but they don't usually go away. Surgery can get rid of them but this is often temporary, therefore we don't usually recommend it.

"There have actually been no studies to show that one arthritis drug works better than another, some people just seem to respond better for whatever reason."

MEMBER QUESTION:
I have been diagnosed with RA and fibromyalgia (FM) for about 12 years. Recently I have had pain on my right side in my rib cage. The urgent care doctor said it was RA in my ribs. Is this possible? It is very painful and hurts throughout the day regardless of what I am doing.

SMITH:
RA can cause pain and inflammation in the joints in the ribs. However it can also cause inflammation in the lining of the lungs; this is called pleuritis and you might want to look it up to see if your symptoms are consistent with this. The pain would occur when you breathe in and out, but the pain with arthritis in the ribs can also occur with breathing so it can be difficult to figure out which one it is.

Pleuritis can show up in a chest X-ray. If you had a chest X-ray in the emergency room the doctor may have ruled this out, but I would let your doctor know as well so he or she can keep an eye on it.

MEMBER QUESTION:
Does osteoarthritis follow from osteoporosis or vice versa?

SMITH:
The two conditions are not really related. Osteoarthritis is inflammation of the joints. Osteoporosis is a thinning of the bones. However, when someone has osteoporosis it can sometimes cause excess strain on a joint that can lead to osteoarthritis, but otherwise the two aren't really related. They do often occur together but that's more due to the fact that they often affect the same group of people. Both are very common in older women but can even occur in men.


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