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ARTHRITIS
FOUNDATION OF VICTORIA Introduction Pain, stiffness and inflammation are hallmarks of arthritis, which is not a single disease but a range of 150 or more separate conditions. Two common forms are osteoarthritis (OA) and rheumatoid arthritis (RA). Osteoarthritis is essentially a degenerative process with symptoms including pain, stiffness, muscle weakness and cramps or muscle spasm around the affected joint. Rheumatoid arthritis is a complex, frequently progressive disease which is characterised by inflammation and joint deterioration. Some patients with osteoarthritis or rheumatoid arthritis find exercise, physiotherapy, occupational therapy and rest can help, but medication may often be required under a doctor's supervision. The types of medication used to treat arthritis range from analgesics such as paracetamol and aspirin (also an antiinflammatory) to prescription medications such as the nonsteroidal anti-inflammatory drugs (NSAIDs). Although cures are possible in some forms of arthritis, the basis of much therapy recommended by doctors is to control the disease and therefore the symptoms. Exercise is an important management strategy. Other helpful health professionals can include: Physiotherapy In spite of limited scientific evidence of effectiveness or precise mode of action, a broad range of treatments are successfully used by the physiotherapist to treat pain, stiffness, increase muscle strength and maintain joint mobility. These commonly include heat, cold, ultrasound and electrical treatments such as TENS and interferential. The treatments are often used in combination with an individual exercise programme, massage, joint mobilisation and postural assessment. Education about management of the disease is also a very important aspect of physiotherapy in rheumatic conditions. Chiropractic Good results can be achieved in some patients by well-trained, experienced chiropractors. Manipulation is a commonly used technique for the treatment of mechanical and degenerative spinal disorders. Acupuncture Properly Applied acupuncture has a role in the relief of pain, but it has not been established to be more effective than physiotherapy or anti-inflammatories. Osteopathy This treatment consists of a wide range of soft tissue stretching, massaging and relaxation techniques, as well as manipulative therapy for specific spinal joints and soft tissues. Its effectiveness has neither been proven nor disproves. "Unproven" RemediesMany patients are keen to try 'new" treatments that may be recommended by relatives and friends or have been featured in the media. When taking unproven remedies or other treatments purchased without a prescription, this should be discussed with your doctor. A great deal of money may be spent on some unproven remedies which may be of no benefit. Copper The use of copper has little scientific support. Copper bracelets are a popular alternative treatment for arthritis, but there have been no proper trials of copper bracelets in rheumatoid arthritis. Evening primrose oil Evening primrose oil supplements have been shown to decrease inflammation, but the benefits are still not confirmed. The safety of long term use has not been determined. Fish oil There have been a number of studies examining the relationship between treatment with fish oil and rheumatoid arthritis which found a modest improvement in morning stiffness, number of tender joints and onset of fatigue. There is research under way investigating the possibility of using fish oil in combination with anti-inflammatories. It may be beneficial to include several fish meals in the diet each week. Supplements Vitamin and mineral supplements, herbal and homeopathic remedies have been advocated for arthritis. The claims for these therapies are largely unproven and they may have adverse effects. In addition these supplements may be highly priced and they should not be a substitute for treatments that have been proven to be effective. Zinc has not been proven to have a significant anti-rheumatic effect and prolonged use may be harmful. Selenium supplements require further study to determine their role, if any, in the treatment of rheumatoid arthritis. Vitamins Although vitamin C levels may be reduced in rheumatoid arthritis patients, large doses have not been found to be effective. Serious toxic effects have been reported in patients taking large doses of water soluble vitamins such as vitamins B3, B6 and C and fat soluble vitamins (A, D, E, K). A large number of herbs have been advocated for use in arthritis, including celery, devil’s claw, willow bark and yucca. There is little information regarding their safety and some may have long term adverse effects. Some herbs such as devil’s claw and celery should be avoided in pregnancy. Large quantities of any one product taken over a long period of time may be dangerous. Scientific studies on the efficacy of herbal remedies are generally lacking. Patients should tell their doctor if they are taking herbal remedies. New Zealand Green-Lip Mussel Green-lipped mussel extract has not been proven to be beneficial in reducing inflammation in arthritic patients. Date Last Reviewed by NEVDGP: 20 August, 2006 |
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