Ellen Campbell Grizzle - Pharmacy Today THE WORD "arthritis" describes more than 100 different conditions involving the body's joints and connective tissues. However, osteoarthritis (OA) is a progressive degeneration of the synovial joints due to the loss of cartilage.
Your doctor will differentiate this from other conditions, notably rheumatoid arthritis (RA). Jamaican seniors often complain about a 'little arthritis pain' which they believe is a natural part of the ageing process. Rubbings are very popular treatments with this group. Their home remedies are concoctions of camphorated oil, menthol, camphor blocks with various herbs steeped in the mixtures.
Experts suggest that OA is due to 'wear and tear' on the joints over time coupled with inadequate regeneration of cartilage leads to deterioration. The cartilage becomes a less efficient shock absorber and the joint may lose its shape. This puts additional strain on surrounding ligaments, muscles and tendons and weakens them. Eventually, bone rubs on bone causing pain and later inflammation to develop. Age, obesity, race, ethnicity, gender, diseases that damage cartilage and previous trauma, predispose persons to the development of OA and the body part affected.
Signs and symptoms appear within 40-50 years due to joint changes that take several years to occur. The joints affected to varying degrees in different persons are the knee, hip, hand, feet and spine. Symptoms may appear in cycles and spontaneously subside. These include joint stiffness for 30 minutes after waking or joint pain that worsens with inactivity; dry crackling sound with joint movement; joint enlargement and localised tenderness; muscle spasm around the joint and swelling. In advanced stages, some persons complain about sleep interruption due to pain.
Topical applications such as liniments, ointments, creams and gels give off heat that increases the blood flow to the area and reduces pain. They should be applied with gentle massage and should never be used with any type of heating pad. Capsaicin, an ingredient found in hot peppers, also relieves pain. It must be applied regularly three to four times per day to work effectively. Cooling has a numbing effect and reduces muscle spasms.
PARACETAMOL USE
Several medicines are prescribed to manage pain and inflammation. Paracetamol (acetaminophen) is widely used. However, when there is severe inflammation, your doctor may choose to add on a specific non-steroidal anti-inflammatory drug (NSAID). An NSAID may take at least two weeks of continuous use to be effective. You should:-
Take the product with a full glass of water, after meals or with food to avoid stomach upset (unless it is enteric coated).
Avoid lying down 15 to 30 minutes after taking.
Avoid caffeine, tea, coffee, cola, chocolate, alcohol or nicotine.
Check for darkened stool due to bleeding in the intestines.
Glucosamine and chondroitin are now frequently added on to therapy. Both are building blocks of cartilage and should help to slow down its deterioration. Calcium supplementation is advised and many products are available that combine calcium, chondroitin with glucosamine. Injections of hyaluronan, corticosteroids, glucosamine and chondroitin have also been used.
Surgery is a final resort in persons who are not responding to treatment. All therapies require monthly monitoring to assess the progression of OA against patient satisfaction with the effectiveness of the drugs being used. There is no known prevention or cure for OA. However, there are useful therapies that moderate its debilitating effects, reduce associated pain and improve joint mobility. If you want to know more about getting the best results from your treatment programme for OA, ask your pharmacist, you have the right to know!
Ellen Campbell Grizzle, President of the Caribbean Association of Pharmacists (CAP), Director, Information & Research, National Council on Drug Abuse (NCDA).
