Osteoarthritis Questions for your Physician
Many have asked how to prepare for the next meeting with a doctor, after having been diagnosed with osteoarthritis (or suspecting the diagnosis). There are a number of things to consider when walking into your next appointment.
Is this pain I am having Rheumatoid Arthritis?
No, osteoarthritis generally affects the large, weight–bearing joints, and is rarely associated with swelling, warmth and redness. People with osteoarthritis can have rheumatoid arthritis (and vice versa), but each condition is quite distinct.
Will I have to take medications for life?
Not necessarily. Frequently doctors will begin treatments with Tylenol or non-steroidals (ibuprofen and naprosyn as examples) in an effort to reduce pain, but these medications can be associated with compromised kidney function and gastrointestinal bleeding if taken continuously for greater than twelve weeks or so. In addition, other medical problems (certain heart arrhythmias, stroke, clot formation) may require daily anticoagulation with Coumadin, a drug which increases bleeding risk. Non-steroidals are not prescribed with coumadin. Many physicians will begin treatment with medication, while encouraging aggressive weight loss, muscle strengthening and exercise in order to strengthen the involved extremities. Eventually, joint injection and ultimate joint replacement may be required to eliminate pain.
What about weight loss?
What could possibly be wrong about losing pounds, increasing cardiovascular fitness, decreasing load-bearing and feeling better? Especially if weight loss alone could get you off medications! We encourage non-weight bearing exercise as much as possible, including swimming, bicycling and elliptical training. Remember that after the age of 30 for most of us, a slower metabolism requires adjustment of diet, with reduced quantities of fat and carbohydrates. For patients with weight concerns and osteoarthritis, we encourage nutrition consultation whenever possible, for diet planning and calorie counts.
Will my sex life be affected by OA?
Quite possibly, depending on the joints involved! People with advanced hip and knee osteoarthritis often experience significant pain with intercourse, depending upon the positions assumed. Pre-medication with non-steroidals may prove helpful, and an honest dialogue with your partner about modifying positions, use of pillows and altering expectations may prove useful between the sheets.
Do I have to take narcotics?
For the most part, no. There are some patients who cannot tolerate Tylenol or non-steroidal medications (those with ulcer disease or difficulty swallowing pills) who require either oral or transdermal opiates to achieve adequate pain relief. For this small population of osteoarthritis patients, careful monitoring (including random urine screening and pill counts) is required to prevent drug diversion, while insuring compliance with medication prescription. Opiates can be habit-forming, therefore alternative therapies are encouraged, including weight loss, non-steroidal use, topical therapies and even joint injection prior to considering their use.
Published On: February 16, 2007