Should I take turmeric pills for my arthritis?
ITAKE warfarin due to atrial fibrillation and therefore cannot take conventional anti-inflammatory drugs for arthritic pain.
A Daily Mail article covered the advantages of turmeric, but did not mention the risks that I gather exist if used with warfarin.
How severe are those risks when taking 4mg a day of warfarin? Are there other options? I am 80. Derek Darwent, T Cuddington, Cheshire. HIS is a fascinating question, relevant to the many people who are on anticoagulant medication — given to those at high risk of blood clots — who, like you, also suffer from arthritic pain.
If you’re on anticoagulants, you can’t take anti-inflammatories — which include diclofenac, ibuprofen, naproxen, and even aspirin, because the latter carry a risk of bleeding from the stomach and duodenum, the first part of the small intestine.
As an anticoagulant stops the blood from clotting properly, when these two types of drugs are taken together there could be serious consequences — namely, uncontrollable bleeding.
This applies to older anticoagulants, such as warfarin and heparin and newer blood-thinning drugs: apixaban, dabigatran and rivaroxaban. Known as novel oral anti-coagulants (NOACs), these are simpler to take because unlike warfarin, patients do not need regular blood tests to check they’re getting the correct dose, which can vary according to what you’ve been eating.
While there have been suggestions that regular testing might effectively improve the safety of the novel anticogulants, the real issue with them was that they could not easily be reversed — which could be dangerous in an emergency.
But antidotes are now becoming available. For example, dabigatran (also known by the brand name Pradaxa) can be reversed by idarucizumab (Praxbind), which takes these modern anticoagulants into a new era.
However, as with warfarin, the new anticoagulants still carry an increased risk of bleeding, and therefore cannot be taken alongside certain drugs.
As you know, there has been some research into turmeric as a treatment for arthritic pain. The active component of this spice is curcumin, which in animal studies has been shown to have antiinflammatory effects.
I have seen a simple study where it was compared with ibuprofen in two groups of patients who took one or the other for six weeks, and in both groups their pain levels improved.
However, there aren’t enough welldesigned studies to reach any firm conclusions about the benefit in humans. And while turmeric is generally safe and rarely causes side- effects, unfortunately it has been proven to interact with warfarin and the novel anticoagulants.
This is because curcumin reduces the ability of platelets (cells which help blood to clot) to clump together — so the risk of dangerous bleeding is greatly increased in patients taking blood-thinning medication.
For that reason you must not selfmedicate with turmeric.
As for other ways to treat arthritic pain, there is ‘no one- size-fits-all’ option. If a patient is particularly affected by painful osteoarthritis of the knee, there is some evidence that acupuncture may help, as may the supplement glucosamine, though the best that can be expected from either is modest pain reduction.
Another option for knee osteoarthritis pain is AposTherapy, a biomechanical device worn on the feet which corrects the way you walk, taking pressure off the knee. This has been shown to be effective for some patients.
In terms of other aches and pains — such as osteoarthritis of the hands or hips — there is very little to offer. Even paracetamol, long relied upon by many taking anticoagulants, has recently been subject to questions over effectiveness. But there is nothing to stop you trying it.
However, talk to your doctor about the dosage. As well as never exceeding the recommended dose, you must avoid taking it with other remedies that include it, such as cold and flu remedies, to avoid any risk of overdose. MY WIFE has Bell’s palsy. She cannot close her right eye, eat on that side of her mouth or smile. When the symptoms appeared, she was told it was caused by pressure on the facial nerves — possibly from a virus — and given antiviral tablets.
They also said it would last three months — that was more than three years ago. If it is a nerve problem, should she be referred to a neurologist?
Eric Dodd, Walton-on-Thames. I AM sorry to hear about your wife’s experience. For the sake of other readers, I should explain the nature of Bell’s palsy, which should also help you understand what happened.
The condition is named after Sir Charles Bell, a Scottish surgeon and neurologist who first described it in 1821. Bell’s palsy causes the muscles of one side of the face to become weak or paralysed, leaving the patient unable to close the eye or mouth properly.
It occurs as a result of inflammation — causing swelling — in the facial nerve, which controls these muscles. This nerve passes through a tunnel in the temporal bone, which is part of the middle ear.
When the nerve swells, the nerve itself and the blood vessels around it become compressed in this tunnel, impairing its function.
We don’t know exactly why this inflammation happens. Some cases are thought to be due to the herpes simplex virus (which causes cold sores) or the herpes zoster virus (chicken pox and shingles), but viral infection may not always be the underlying cause.
Treatment usually involves steroids, such as prednisolone, to reduce the nerve swelling, which may improve the chances of full recovery. Anti-viral medicines such as valacyclovir may also be used, as in your wife’s case.
Most affected patients recover completely — studies show 85 per cent of patients show signs of recovery by three weeks, and 71 per cent ultimately have full recovery. But 16 per cent of patients have obvious continuing weakness that’s likely to be permanent (the remainder have minimal symptoms). AS YOUR wife suffered the symptoms three years ago, I fear this is likely to be the case with her. That’s why, as you tell me in your longer letter, she had surgery to have a gold weight inserted in her eyelid to help it close properly (otherwise the eye can become too dry, which can lead to damage).
unfortunately, you tell me the weight had to be removed, as she could no longer open her eye.
your question about referral to a neurologist is relevant because a nerve is involved in the condition. But at this stage I regret to inform you there is no treatment that can be offered — treatment only helps in the first few days of the illness.
Any improvement after that is down to natural recovery. At this stage, all efforts must be directed at further eye care and psychological support for you both.