‘Tis the season of stress and colder weather. What’s an arthritis sufferer to do? Practicing moderation and common sense (beware of those icy patches when you’re rushing in and out of retail stores!) goes a long way.
But we also thought it was prudent to check in with orthopaedist Dr. Randy Rosier, who’s been treating people with osteoarthritis for nearly 30 years. Below, he offers tips on weather-related flare-ups, supplements, and stem-cell therapy. It’s important to note there are many types of arthritis (inflammation of the joints); in this post, we’re focusing on arthritis resulting from simple wear-and-tear, rather than from autoimmune disease or infection.
Q: Many people believe their symptoms worsen in cold weather, but we’ve also heard that’s just a myth.
Rosier: I’ve got to say that I believe there’s some truth to it. Over and over, patients report that changes in the weather makes arthritis symptoms worse. This also applies to joint injuries and bone fractures. When it’s cold, our joints do get stiffer. Humidity and other dramatic swings in weather patterns seem to affect joints and mobility as well. My snow-bird patients tell me that when they go to the Southwest or Florida in the winter their symptoms get better. Although no one knows exactly how this works, I think it makes sense that milder climates ease arthritis.
Q: So, other than moving to the South, what other lifestyle changes can Rochesterians make, particularly if pain and stiffness is a daily struggle?
Rosier: Winter is still a great time to exercise. You need to keep moving and keep your weight under control, to keep arthritis symptoms in check. Regular activity also helps lubricate arthritic joints and diminish stiffness.
If you go outside, avoid spending prolonged periods in the cold. And don’t ignore your legs and hips when you’re dressing in layers! So often we think of wearing layers above the waist, but long underwear, socks, and heavier pants that protect your hips, knees, and ankles is equally important.
In terms of types of exercise, make sure it’s low-impact. Swimming is the best thing you can do if you suffer from arthritis. However, I realize that’s not always convenient for many people, so the next best thing is an indoor exercise bike or elliptical machine. You can work up a good sweat with either one, and they’re gentler on the joints than a treadmill. I urge people with arthritis to avoid running, jumping jacks, squats and lunges. I’ve seen a recent trend where people with mild arthritis or joint discomfort are doing squats and lunges at exercise or zumba classes – and suddenly they’ve got damage to the knees.
Q: What about taking supplements for arthritis? Does science support certain over-the-counter remedies more than others?
Rosier: In general, the evidence supporting supplements for arthritis is weak and controversial. That said, however, I have patients who take glucosamine or fatty acids (omega 3s) and firmly believe it helps. Neither of those supplements will harm you, so I don’t discourage it. Keep in mind, though, that the science is not very strong in this area. The NIH did a large clinical trial testing glucosamine, and the results showed no significant benefit. See, the tricky thing about arthritis is that it’s such a variable disease. I have patients who experience mild symptoms over the course of 40 years and others who progress from almost nothing to severe joint destruction in a short period of time. Symptoms also come and go, from agonizing pain to almost no pain, so it’s difficult to decide whether supplements actually help.
Q: What about other medical interventions, short of surgery? Does anything really help?
Rosier: Yes, we can make several recommendations. Cortisone injections can help in some acute situations, as does ice or cold packs. Heating pads are better for chronic pain. Massage can alleviate symptoms by lessening stiffness. You can’t really massage the hip joints, but for knees, ankles, and shoulders, it can bring some relief. Acupuncture is a pain treatment, and it’s relatively harmless, but I haven’t had any rave reviews from my patients. Finally, a procedure called viscosupplementation, which is an injection of a lubricant similar to the native hyaluronic acid that is in joint fluid, may give relief of symptoms for several months.
Q: Since we’re in the middle of the holiday season, we wondered about some information that popped up on the Internet – that alcohol and caffeine tended to have a damaging or drying impact on cartilage. Is that true? Should we avoid peppermint lattes and the open bar at the office party?
A: Interesting topic, but there’s no convincing evidence to avoid alcohol or caffeine entirely. It’s okay in moderation, and obviously, with alcohol it’s important to limit your intake. But, having said that, consider the flip side: A compound called resveratrol found in grapes and wine is an anti-inflammatory. I’m not advocating drinking for those who don’t, but having some red wine with dinner or hors d’oevres won’t hurt and, who knows, it could help.
Q: Finally, what’s the latest news on the horizon in terms of treatment for arthritis?
Rosier: First, it’s important to emphasize that we’re talking about osteoarthritis – which stems from wear on the joints – and not other forms (e.g., rheumatoid, psoriatic, etc.). In that context, we’re writing grants to seeking funding for a clinical trial to test a known drug, Forteo, which has been shown in mice to prevent or retard deterioration of joint cartilage. Other things on the horizon involve stem-cell treatments. But I have to add a big dose of caution here: Patients should beware of clinics that claim to be able to cure arthritis by injecting stem cells into the joints, or enriching plasma with platelet injections. A lot of charlatans exist out there, and none of this is covered by insurers. At this point we don’t have any solid, peer-reviewed, stem-cell therapies to offer. With further scientific research, however, these directions may hold some future promise.
One last note of caution: Many patients like to take over-the-counter pain relievers for arthritis. In the past we worried about the effects of anti-inflammatory medications on the stomach, but more recent concerns focus on their ability to raise blood pressure and harm the kidneys. We tell patients to limit the use of these medications to a week or two, when they’re experiencing a severe flare-up.
The URMC offers the most advanced arthritis care in the Rochester area, at Clinton Crossings, 4901 Lac de Ville Boulevard, Building D, Rochester, N.Y., 14618. To schedule an appointment call (585) 275-6321. Two new faculty members – Dr. Jennifer Paul and Dr. John Ginetti – are accepting patients.