The symptoms are common: your knees rebel when you climb stairs; a long drive is murder on your hip; your joints feel like they need oiling in the morning; and pain is always there like an annoying background static. For the 70 million Americans who suffer from arthritis or joint pain the signs are all too familiar.

There’s no magic cure for arthritis, but there are plenty of strategies based on recent research that can help counter the pain and disability. Because arthritis is a condition many adults live with for decades, it’s important to be assertive and informed about self-care options as well as the latest drug therapies.

Arthritis literally means inflammation of the joint. Osteoarthritis, by far the most common form, develops when the cartilage that cushions joints breaks down, allowing bones to rub against each other. Rheumatoid arthritis, which is less common, creates chronic inflammation of the linings of the joints and connective tissues.

The treatment of rheumatoid arthritis has focused not just on addressing pain but on trying to halt the progression of the disease with powerful disease-modifying anti-arthritis drugs, known as DMARDs. These drugs include Enbrel (etanercept) Remicade (infliximab) and methotrexate. All slow the destruction seen in rheumatoid arthritis, although they have potentially serious side effects that must be closely monitored by a physician.

A new concept in arthritis treatment is DMOADs, disease-modifying osteoarthritis drugs. Also known as chondroprotective agents, these drugs may inhibit the progression of osteoarthritis by slowing the breakdown of cartilage. Limited studies of glucosamine sulfate given at high doses (500 milligrams two to three times daily) may slow the progression of cartilage destruction. Other drugs such as the antibiotic doxycyline and antimalarial antibiotics such as Plaquenil may have similar benefits. Further studies of these drugs are in progress.

Both glucosamine and chondroitin, supplements reviewed by a medical panel writing for Consumer Reports, seem to be effective in relieving arthritis pain. Neither is known to have any serious side effects.

The COX-2 Controversy
The introduction of two new drugs, the COX-2 inhibitors celecoxib (Celebrex) and rofecoxib (Vioxx) a couple of years ago offered hope of drugs that could be taken daily to relieve arthritis pain without the side effects of the older nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil) and naproxen sodium (Aleve). These older non-prescription NSAIDs were effective against pain but can cause nausea or stomach upset, and they increase the risk of bleeding ulcers in some patients.

The early enthusiasm for the more expensive COX-2 drugs has been tempered by the fact that although they do appear to cut the risk of bleeding ulcers in the two to four percent of patients likely to develop them, they don’t eliminate the stomach upset and nausea that some users experience. Of greater concern are some reports that COX-2 inhibitors are associated with an increased risk of heart attack. This issue is hotly debated and is the subject of further studies.

A number of new COX-2 drugs are currently being studied. One, Prexige, is the focus of a worldwide study of 18,000 patients, the largest arthritis clinical trial to date. The trial known as TARGET (Therapeutic Arthritis Research and Gastrointestinal Event Trial) will compare the effectiveness of Prexige with the NSAIDs ibuprofen and naproxen over 12 months. Cardiovascular safety will be evaluated as part of the study.

A new drug developed in Germany, licofelone, blocks both COX-1 and COX-2 as well as 5-lox, another enzyme involved in pain and inflammation. Licofelone was tested on 710 patients with arthritic knees for a year. The drug worked as well as the older drugs in treating pain and was gentle on the stomach with no signs of heart-related side effects. Licofelone is not approved for use in the United States.

Diet News
There are numerous unproven claims for dietary arthritis cures. There is also a lot of information about beneficial foods that is backed by reliable studies. Researchers at Tufts University have analyzed diet-related studies and devised an arthritis diet that emphasizes fruits, vegetables, fish, healthy oils and vitamin D.
The key elements of the plan include:

• Antioxidants, vitamin C and beta-carotene. The Framingham Heart Study showed that arthritis progression was reduced by more than half in those who took in an average of at least 152 milligrams of Vitamin C per day. Persons with arthritis of the knee who ate more than 9000 IU of beta-carotene daily were less likely to have symptoms grow worse than those who consumed 5000 IU or less daily.
• Vitamin D. Among persons with arthritis of the knee low levels of vitamin D (fewer than 350 IU daily) were associated with up to a fourfold greater risk of disease progression compared with those who got at least 400 IU daily.
• Omega-3 fatty acids found in cold-water fish such as halibut, salmon and sardines, help suppress inflammatory prostaglandins. Flaxseed oil, pecans, walnuts and tofu also contain some omega-3s, but they’re not as powerful. A number of oils, including safflower, corn, sunflower and cottonseed oil contain omega-6 fatty acids that promote inflammation and should be avoided. They’re often used in processed foods such as cakes, cookies and crackers.
• Persons who are overweight should strive to lose weight. Studies show that losing even 10 or 15 pounds can help ease the strain arthritis puts on joints.
• Researchers advise eating six servings of fruits and vegetables per day (three of each), four servings of fish per week (a three-ounce serving about every other day), and having at least one serving of fish, nuts or legumes each day. Milk has 100 units of vitamin D per cup, so if you drink the equivalent of two cups of low fat milk per day, a multivitamin supplement could help you reach 400 IU.

When pain and joint destruction are severe, joint replacement can restore mobility and eliminate pain. Replacement joints have a limited life expectancy, however–an average of about 15 years–so physicians encourage patients to wait as long as possible before opting for joint replacement surgery. Some patients have been able to delay knee surgery for a year or more with injections of hyaluronic acid into the knee.

Arthritis is a chronic condition and as such requires patience and perseverance. Weight loss, following a sensible diet plan; regular, gentle exercise, and working with your physician to ensure you are taking the safest and most effective drugs will help keep you moving and enjoying life.

REFERENCES:
“Arthritis–Hip Replacement,” Harvard Health Letter, February 2002.
“Arthritis–Should You Be Taking a COX-2 Inhibitor?” Harvard Health Letter, November 2001.
“Beating Arthritis With the Right Food Choices,” Tufts University Health and Nutrition Letter, May 2002.
Heidi Belden, “Arthritis Pain Guidelines Raising Some Eyebrows,” Drug Topics, May 6, 2002.
“CDC: One in Three Adults Has Arthritis,” Medical Letter on the CDC and FDA, December 8, 2002.
“Hip Replacement Surgery Viable Option for Younger Patients, Thanks to New Prostheses,” Medical Devices and Surgical Technology Week, March 17, 2002.
Elizabeth Mechcatie, “Enbrel,” Internal Medicine News, February 15, 2002.
Richard Misischia and Kenneth Saag, “Glucocorticoid Therapy for Arthritis: Overcoming the Problems,” Journal of Musculoskeletal Medicine, March 2002.
“Popular Arthritis Aids May Really Work,” American Medical News, January 7, 2002.
“Prevalence of Self-Reported Arthritis or Chronic Joint Symptoms Among Adults – United States, 2001,” JAMA, December 25, 2002
Linda Shookster, “Pharmaceutical Developments Expand Arthritis Care Options -- The Concept of Disease-Modifying Antirheumatic Drugs Is Now Being Applied to Osteoarthritis Management,” Biomechanics, June 1, 2002.
“TARGET: A Worldwide Arthritis Clinical Trial Launched,” Pain and Central Nervous System Week, July 8, 2002..
Anne D. Walling, “COX-2 Inhibitors vs. NSAIDs in Treatment of Arthritis,” American Family Physician, January 15, 2003.
Nancy Walsh, “Hold Off on a Knee Replacement in Middle-aged Arthritis Patients,” Family Practice News, June 15m 2002.
Michael Zoler and Damian McNamara, “Drug Update: Pain Management for Arthritis,” Family Practice News, November 1, 2002.