Age not sole cause of osteoarthritis

Wed., Sept. 15, 2004

Paul G. Donohue, M.D. King Features Syndicate

DEAR DR. DONOHUE: I have osteoarthritis, which, I’m told, comes from aging. If that is so, why don’t all my friends have it? I am 77. What’s the best medicine for it? How about joint injections? — C.C.

ANSWER: Osteoarthritis — also called degenerative arthritis — is the No. 1 kind of arthritis. Age is a factor in its onset, but it is far from the sole factor. Something not yet clearly evident changes the composition of the cushioning cartilage within joints, and that something brings on arthritis.

A joint is the juncture where the ends of two bones meet. Cartilage covers the bone ends to allow them to bend and twist against each other smoothly and painlessly. With osteoarthritis, the cushioning cartilage frays and flakes, and cells within the cartilage produce enzymes that can fill the joint with fluid.

Medicines are not the only focus of treatment. Exercise is most important. It keeps involved joints limber, and it strengthens adjacent muscles. Strong muscles stabilize joints and protect them from further damage. An exercise program for osteoarthritis is one that is best learned from a professional — a physical therapist. Occupational therapists can teach arthritis patients what devices are available to facilitate joint motion and how patients can use those devices.

Medicines abound. A simple pain reliever such as acetaminophen (Tylenol) might be the only drug needed. If stronger medicine is called for, anti-inflammatory, painkilling drugs like Aleve, Indocin, Voltaren and Motrin can often bring relief. These drugs have the potential to irritate the stomach. If they do, anti-inflammatory drugs without such stomach irritation can come to the rescue. Celebrex, Vioxx and Bextra are the names of those medicines.

Joint injections with cortisone can be given every three months. Such injections are valuable when drugs are not dulling the pain and when the joints are filled with fluid.

DEAR DR. DONOHUE: Should you take a multivitamin before, during or after you eat? I have conflicting information. Some say if you take it with food, the vitamin is not absorbed. Others say if you take it on an empty stomach, the vitamin passes through your digestive tract too fast. Who is right? — A.H.

ANSWER: I’m not sure that it makes a great deal of difference when you take it.

I’ll give you what I believe is the majority opinion. It says to take a multivitamin after eating, because food in the stomach delays the vitamin’s passage through the intestinal tract. That gives it a chance for complete dissolution and absorption.

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