October 24, 2014

Health

I have a friend who swears she can predict the weather—without ever opening the curtains or stepping foot outside. If her back and fingers start to hurt, she says a rainstorm or cold snap is coming.

I invited her on a walk one glorious day in January, but she declined, complaining that her whole body ached because "the weather must be changing." Sure enough, the next morning I could actually see my breath in the frigid air.

There is a wealth of anecdotal evidence suggesting that a decrease in temperature leads to an increase in joint pain, particularly for those with arthritis. The culprit is actually a drop in barometric pressure, says Naples rheumatologist Dr. Catherine Kowal.

"When the weather is steady, it’s not so bad [for my patients]," Kowal says. "When it changes is when they seem to get more pain and stiffness."

Curiously, most medical studies have failed to find any meaningful correlation between weather and joint pain. However, a 1960s study of rheumatoid arthritis patients, who were sealed in a chamber with changing atmospheric conditions, found that patients experienced some swelling and stiffness with a rise in humidity and a drop in barometric pressure.

With the rainy season in sight, you may be among those who experience an increase in joint pain. Find out what Naples rheumatologists recommend for these flare-ups—and what new treatments may be on the horizon.

The Right Diagnosis
Arthritis is an umbrella term for more than 100 conditions marked by joint pain and affects some 46 million Americans, according to the Centers for Disease Control and Prevention. The most common form is osteoarthritis, which is caused by wear and tear on the joints from age or injury.

"Essentially, everybody gets osteoarthritis if they live long enough," says Dr. Eric Hochman, a rheumatologist with Anchor Health Centers in Naples.

The second most common form is rheumatoid arthritis, a condition in which the body’s immune system mistakenly attacks healthy tissue, causing inflammation that damages the joints.

Misdiagnosing rheumatoid, an inflammatory condition, for osteoarthritis, a noninflammatory condition, can be dangerous.

"You don’t necessarily need to be treated for noninflammatory arthritis," Hochman says. "[But] rheumatoid, if left untreated, can lead to significant disabilities, and life expectancy decreases. Early diagnosis and early treatment are very important."

In general, rheumatoid arthritis is worse in the morning, symmetric and comes on suddenly, while osteoarthritis is worse as the day goes on, asymmetric and chronic. Eighty to 90 percent of the time, Hochman says, a physical exam and family history provide sufficient information for a correct diagnosis.

Conventional Medicine
Common treatments for the pain and stiffness associated with osteoarthritis include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil and Aleve. "My patients who have had arthritis for a while know how to manage their pain on their own with these," Hochman says. In more advanced cases of osteoarthritis, he has recommended joint injections of strong anti-inflammatories called corticosteroids to ease discomfort.

Rheumatoid arthritis patients’ primary treatment targets the disease itself, not just its symptoms. Often-prescribed methotrexate, for example, is a disease-modifying drug that decreases pain and swelling, and can also reduce damage to joints and the risks of long-term disability, according to the American College of Rheumatology.

Not Just for Wrinkles
A little Botox can smooth away those "worry lines." Someday it might give arthritis patients one less reason to worry. A recent study at the University of Minnesota found that when botulinum toxin type A, commonly known as Botox, was injected into arthritic joints, the subjects’ pain decreased. The relief lasted from three to 12 months, and no adverse side effects were reported.

While the results of this small study were promising, larger trials are needed to determine if Botox is a viable treatment for arthritis pain. The toxin, which is also being explored for treatments of other painful conditions, including fibromyalgia, is currently being administered to treat certain eye conditions, muscle spasms and severe sweating of the armpits, according to the Mayo Clinic Web site.

Value in Gold
Gold therapy: It’s more than a shopping spree. Physicians have been injecting patients with gold salts since the early 1900s. The shots ease pain and swelling associated with arthritis, particularly rheumatoid arthritis, but the treatment has been largely replaced by others with fewer negative side effects.

"Gold hasn’t been a mainstay treatment for maybe 15 years," Hochman says. "It is still used, but rarely, and as a very last resort."

A new study at Duke University in Durham, N.C., points to gold salts making a comeback. Researchers discovered how gold salts target a particular molecule that provokes inflammation, a key process of rheumatoid arthritis. Having identified at least one way that gold can help arthritis sufferers, there is new hope that safer, gold-based treatments can be developed.

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