arthritis

Anyone got any tips for keeping arthritis pain under control my gp does not want me to take brufen or anything like it incase my asthma does not agree. I wear tuby grips on my knees to see if that helps and got deep heat travistine and ibulieve gel but still very painfull anyting herbal has anyone used with succsess any tips please thanks in advance xxxx

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Hi Kerry-anne,

I am sorry to hear that you are having so much trouble with arthritis - sometimes it seems like it's one thing after another, doesn't it? I have joint problems, as a result of myopathy, so I can sympathise. I am not surprised that your doctor is reluctant for you to take Non-Steroidal Anti-Inflammatory Drugs (NSAIDs - ibuprofen, diclofenac, mefanamic acid and similar) - most severe and brittle asthmatics are advised to avoid these even if they don't have a documented reaction to them.

Of course, there are other painkillers you can take. You should not underestimate the value of simple paracetamol - when used regularly, especially in combination with other painkillers, it is a pretty effective drug. The maximum dose is 1g (two tablets, usually) every 4 - 6 hours, to a maximum of 8 tablets in 24 hours. It is important to stay within this maximum, and to remember that this also includes other paracetamol containing products such as cold and flu remedies, because taking more paracetamol than this can put you at risk of liver damage.

The weak opioids are another class of moderately strong painkillers that can be useful for arthritis. These include codeine, dihydrocodeine and tramadol. They are all much the same in terms of strength, although different ones may suit different people. Some caution is required in people with a history of breathing difficulties - whilst these drugs should not make most people's asthma worse, as such, they do depress the breathing slightly, so if someone has slightly borderline respiratory function and oxygen levels to begin with, they may cause problems. Having said that, I do know people who have very severe brittle asthma and who can take even stronger opioids without difficulties. It is really a case of knowing how you react, and your GP will be able to guide you as to whether these drugs are suitable for you. They may want to start them for the first time in a controlled environment such as in hospital or in your GPs surgery. You can buy weak cocodamol (paracetamol 500mg and codeine 8mg) over the counter in a chemist, but I would suggest you discuss it with your GP if you have not had this class of drugs before.

There are also stronger opioids available, such as morphine and oxycodone. These would usually be prescribed with a lot of caution in someone with breathing difficulties, and it would not be usual to prescribe strong opioids for arthritis. They are useful for other types of pain, though, and again, although some severe asthmatics can't take them, I know other people with severe breathing problems who take them without problems.

Another drug which your GP may consider prescribing is the atypical painkiller nefopam. This is a moderately strong painkiller which doesn't really fit into any of the usual classes of painkiller - it's not an opioid, and it's not an NSAID. It is not very commonly used these days - it's mainly used in people who used to have drug habits, who need treatment for pain and do not want to be given opioids because of their previous addiction. There is no reason why it can't be used in people who are not ex-drug addicts too though! It can be a very effective painkiller. The only potential problem with it is that the side effects may be similar to and interact with drugs that you are already on - they are mainly anticholinergic (ipratropium-like) and sympathomimetic (salbutamol-like). This means, on the plus side, that it is very unlikely to make your asthma worse - quite the reverse, if anything - but on the negative side, any side effects from your asthma drugs may be made worse. I think I am remembering correctly that you also suffer from SVT? It may be that your GP would be reluctant to prescribe nefopam for you for fear of making your SVT worse.

Gels like Deep Heat and ibuprofen gel can be helpful too, although it is worth noting that people who are sensitive to NSAIDs can still react to these gels, as a small amount is absorbed into the body. Deep Heat cream contains salicylates, so is not suitable for anyone with an aspirin allergy or sensitivity to salicylates. Capsaicin (chilli) cream can also be useful and works in a similar way to Deep Heat cream, by setting up a counter-irritation on the skin - it is only available on prescription.

If there is a specific one or two joints that are giving you problems, your GP may consider doing a joint injection. This could be done by your GP, or you may be referred to a GP with a specialist interest or a hospital clinic, depending on the joint involved. They will normally aspirate any fluid that is on the joint (inflammed joints often have fluid on them) and then inject local anaesthetic, which will numb the joint for a while, and possibly steroid, which will damp down any inflammation.

There are herbal remedies that are said to help with arthritis and joint pain, but the evidence is equivocal at best for a lot of them, and they may have severe side effects or have life-threatening interactions with prescription medication, so if you are considering trying any of them, do discuss it with your doctor first. There is a little bit of evidence that glucosamine sulfate can be useful in arthritis, and it appears to be safe in most people, although again you should consult your doctor first. It may not be safe in people with seafood allergy, as it is derived from the shells of shellfish. Acupuncture, hydrotherapy and massage therapy have also been shown to have some beneficial effect, and they are probably very safe.

Non-drug strategies are really important in managing arthritis pain, especially in folks like us who are already on a lot of medication. A full multidisciplinary assessment is important - this could include a physiotherapist, an Occupational Therapist, and even people like a psychologist or a dietician if appropriate.

A Transcutaneous Electrical Nerve Stimulator (TENS) machine is a small battery powered machine with sticky pads which can be stuck over the affected area or the nerves supplying it. It can be very helpful for all sorts of chronic pain. You may be able to borrow one from your GP or Pain Clinic to see if it helps, or they can be purchased fairly cheaply from Boots and similar. They don't help everyone, but when they do help, they can be very useful.

Heat can be helpful, whether from a heat pad from the chemist, a wheat bag or a hot water bottle or even a hot bath. Icing the joints when they are particularly sore or stiff can also be helpful, and keeping the joint elevated when you are resting is important to help reduce the swelling.

It's important to keep moving and exercising if you can. I know it's really difficult with painful joints and brittle asthma, but almost anyone can do some form of gentle exercise. You should consult your doctor before starting any exercise programme. Low impact exercises are particularly good for joint problems - swimming is especially good if you can tolerate the chlorine fumes from a chest point of view. Walking, biking and yoga are also good ones to consider. You may be able to get a referral to a physiotherapist who can suggest a supervised programme of exercise specifically for your joint problems - do talk to your GP about this if you are not already under a physio.

If you are above optimum weight, losing weight is an important part of treating arthritis, although again I know this is really hard if you have brittle asthma and are on steroids, and so on. You could ask if your GP will refer you to a dietitian for advice if you are struggling - it's important, of course, to lose weight in a sensible way with a regimen that is not going to put your body under more strain.

Eating a balanced healthy diet with good levels of vitamins and minerals is important, as it is for everyone. Taking a vitamin or mineral supplement should not be necessary if you have a reasonable diet. Some people feel that certain foods trigger their arthritis - tomatoes, potatoes and peppers are common culprits. Please don't cut out whole food groups from your diet without consulting your GP or dietitian, though, as this can leave you vulnerable to deficiency diseases.

Extra joint support can be useful to reduce the movement around the joint on a day-to-day basis and help the joint inflammation to settle. It should be done under the supervision of a physiotherapist to get the balance between resting the joint and keeping active and keeping it moving. Many people find that wrist splints, for example, do allow them to have greater function of the joint with less pain. Tubi grips are not generally felt to be supportive enough to have any real benefit, but they will not do any harm if you think that they are helping. Other foot orthotics such as arch supports can also be useful, and again a physio or OT can assess to decide whether they would help.

An OT can also advise on whether you would benefit on aids and adaptations around your house, such as enlarged cutlery which is easier to hold, and tools to make opening jars and so on easier. There are loads of different things available, so if you are having problems with day-to-day tasks, do ask for an OT referral to sort this out.

I don't think there are any easy answers, but hopefully some of this should be useful. The website arthritiscare.org.uk/ is one that has been recommended to me in the past by patients, although I've not really looked at it myself.

Hope some of this helps and you get some improvement soon.

Take care

Em H

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Hi Emily

many thanks for your reply. I do have svt like you remembered I also am over weight not much when I went to see asthma con I was 11st 4lbs 2 weeks later I went to see cardiologist and I was 12st 6lbs Im having a few problems at moment so am also seeing a endrocronlogist I asked him about weight gain he said due to my medication and he wants me taken off alot which scared me alot. but my asthma con disagrees with him I got told I had arthritis by a bone dr I see (i know its alot off cons im seeing five at he moment for different things) he did not want to give me anthing for the pain just gel.

I am currently on kapake prn which does not seem to help I only went to drs on monday and she gave me ibulieve scared to go back so soon incase i make them angry im back already so going to wait a couple of weeks. Now i know how my clients feel from when i as a team leader for 15 years. also do exercises even when its really panful as I know this is good for me You have really helped so thankyou

K-A

xx

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Hi Kerry Anne

I also have arthritis and asthma - although thankfully, not brittle asthma. I can't take brufen as it does affect my asthma, but after some deliberation last year, the rheumatologist prescribed Celebrex, I had to take the first dose when I was with someone, just in case it affected by asthma, but it didn't. In fact, it has helped an awful lot. It may not be suitable for you, but then again, it might be.

Em's right, the arthritis website is also very good.

Kathyx