Optimal treatment

• Explanation. Provide patient education and reassurance that arthritis is not the crippling disease perceived by most patients.

• Rest. Rest during an active bout of inflammatory activity only; prolonged bed rest contraindicated.

• Exercise. A graduated exercise program is essential to maintain joint function. Aim for a good balance of relative rest with sensible exercise. It is necessary to stop or modify any exercise or activity that increases the pain.

• Heat. Recommended is a hot-water bottle, warm bath or electric blanket to soothe pain and stiffness. Advise against getting too cold.

• Diet. If overweight it is important to reduce weight to ideal level. Obesity increases the risk of osteoarthritis of the knee approximately fourfold and weight loss may slow progression; 10

otherwise, no specific diet has been proven to cause or improve OA. Some people claim that their arthritis is improved by having a nutritious balanced diet consisting of fish, rice and vegetables and avoiding meat, dairy produce, alcohol, pepper and spices.

• Correction of predisposing factors and aids. Apart from weight reduction the following may help:

o walking stick o heel raise for leg length disparity o back brace o elastic or hinged joint support, e.g. knee

• Physiotherapy. Referral should be made for specific purposes such as:

o correct posture and/or leg length disparity o supervision of a hydrotherapy program o heat therapy and advice on simple home heat measures o teaching and supervision of isometric strengthening o exercises, e.g. for the neck, back, quadriceps muscle

• Occupational therapy. Refer for advice on aids in the home, more efficient performance of daily living activities, protection of joints, and on the wide range of inexpensive equipment and tools.

• Simple analgesics (regularly for pain). Use paracetamol/acetaminophen (avoid codeine or dextroproproxyphene preparations, and aspirin if recent history of dyspepsia or peptic ulceration). Take before activity.

• NSAIDs and aspirin. These are the first-line drugs for more persistent pain or where there is evidence of inflammation, such as pain worse with resting and nocturnal pain. The risk versus benefit equation always has to be weighed carefully. As a rule, NSAIDs should be avoided if possible. Significant risks of NSAIDs:

o gastric erosion with bleeding o gastric ulceration o depression of renal function o hepatotoxicity

Note: Change to a suppository form will not necessarily render upper GI tract safe from irritation.

Intra-articular corticosteroids. As a rule IA corticosteroids are not recommended but occasionally can be very effective for an inflammatory episode of distressing pain and disability on a background of tolerant pain, e.g. a flare-up in an osteoarthritic knee. Viscosupplementation: intra-articular hylans especially for OA of knee. Contraindicated drugs. For OA these include the immunosuppressive and disease-modifying drugs such as oral corticosteroids, gold, antimalarials and cytotoxic agents.

Rheumatoid arthritis

RA is the commonest chronic inflammatory polyarthritis and affects about 3% of the population. The disease can vary from a mild to a most severe debilitating expression. About 10-20% of patients have a relentless progression and require more aggressive drug therapy. H

Dealing With Back Pain

Dealing With Back Pain

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