Exercise treatment for arthritis only applies to osteoarthritis

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 slow-release Tylenol, but I heard of a study that says tart cherry pills help. — B.L.

Dear B.L.: 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, to my knowledge, 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 and one which is often not recommended strongly enough. Many people worry that exercising on their arthritic joints will worsen the problem. We even used to call osteoarthritis wear-and-tear arthritis, leading people to think they will wear out their joints by exercising. 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. This medicine gets into the superficial joints (it can’t penetrate into deep joints like the hip) and can relieve pain for many. It is very safe and worth a try.

If topical anti-inflammatories don’t help, I usually prescribe an anti-inflammatory 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 stomach upset and even ulcers, especially in large and sustained doses and especially in older adults (women are a bit more susceptible). They can also cause kidney damage, too, so a discussion with your doctor is wise, even with these relatively safe medicines taken for a prolonged period. The prescription medications offer convenient dosing and work better in some people. It often takes several tries to find the right one.

Tylenol has long been used, but many people get inadequate benefit. And it, too, can cause damage after long-term use, especially to the liver and kidneys. I have had some success with anti-depressants, especially duloxetine, as it has some pain benefits.

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.

Dear Dr Roach: I “toot” a lot. I eat healthy — veggies, beans, grains, etc. — and don’t want to give those up. Can I take an anti-gas overthe-counter medicine after every meal? My spouse is anxious for your reply. Truthfully, my dog would appreciate it, too. — Q.T.

Dear Q.T.: You can take the over-the-counter medicines, but I don’t think they work particularly well. We inevitably pass gas as part of the intestinal bacteria working on undigestible parts of what we eat. The average person passes gas 10-20 times a day. Beans, cabbage, onions, broccoli, Brussels sprouts, wheat and potatoes commonly cause increased gas production, but as you say, these are a part of a healthy diet.

A food diary, combined with keeping track of your gas, might help identify the worst foods for you, but your spouse and dog should know this is also a part of being human.