Exercise can’t aid all arthritis types

Dear Dr. Roach: You recently had a column on arthritis that recommended more activity. So, what medications can help? You didn’t say in your article. I take a slowrelease Tylenol, but I heard of a study that says tart cherry pills help.

B.L.

Answer: Tart cherry juice has been shown to reduce the risk of gout, a type of arthritis caused by uric acid crystals in the joint, by about 35%.

This is specific to gout, however, and has not been shown to be effective in the most common type of arthritis: osteoarthritis.

When I mentioned exercise treatment for arthritis, I meant specifically for osteoarthritis. Because exercise improves both function and reduces pain, it’s a critically important treatment.

Many people worry that exercising on their arthritic joints will worsen the problem.

However, most people find that the more they exercise, the less pain they feel when exercising.

Unfortunately, some people have such severe arthritis that it is very painful to move the joints, or exercise alone is inadequate for pain relief. For superficial joints, such as the hands and knees, I often recommend topical anti-inflammatories, especially diclofenac (Voltaren) gel, two or three times a day.

If topical anti-inflammatories don’t help, I usually prescribe an antiinflammatory by mouth.

The over-the-counter medicines like ibuprofen and naproxen are very good for many people and pretty safe for most.

However, they can cause kidney damage, too, so a discussion with your doctor is wise. The prescription medications offer convenient dosing and work better in some people.

Tylenol has long been used, but many people get inadequate benefit.

And it, too, can cause damage after long-term use. I have had some success with anti-depressants, especially duloxetine.

There are many newer treatments, such as knee injections, TENS units, and knee embolization, that may offer some value before considering an aggressive surgery such as joint replacement.