The People's Perspective on Medicine

Show 1140: How Can You Manage Arthritis Pain?

Are there effective ways to manage arthritis pain? What are the pros and cons, and which ones work better? Call in your questions 888-472-3366 on 10/27/18.
Beth L. Jonas, MD, Reeves Foundation Distinguished Professor of Medicine and Chief of the Division of Rheumatology, Allergy and Immunology at the Medical School of the University of North Carolina at Chapel Hill
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How Can You Manage Arthritis Pain?

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More than 50 million adult Americans have been diagnosed with arthritis. While osteoarthritis is the most common form, there are many others, including rheumatoid arthritis, gout, psoriatic arthritis and even fibromyalgia. What are the similarities and differences between these various inflammatory conditions? What are the best ways to manage arthritis pain?

How Does Arthritis Affect the Body?

We think of arthritis as affecting the joints, and most forms of arthritis do indeed produce joint pain. However, some consequences of inflammation reach well beyond arthritis pain in the joints. Occasionally, people with rheumatoid arthritis complain of brain fog, and doctors may also see the results of inflammation in tissues such as the lungs, eyes and heart. Certain other conditions may increase the risk for arthritis. How can you reduce that risk as much as possible?

How Will You Manage Arthritis Pain?

Doctors usually recommend pain relievers such as NSAIDs (nonsteroidal anti-inflammatory drugs). These may be prescription medicines such as diclofenac or meloxicam, or over-the-counter products such as ibuprofen or naproxen. What are the benefits and risks of such medications to manage arthritis pain?

Are there other approaches to reducing inflammation and joint pain? We’ll consider what an anti-inflammatory diet might look like and how well it could work. Do stress and sleep deprivation increase the likelihood that you might experience arthritis?

What Questions Do You Have About How to Manage Arthritis Pain?

On this live show, we welcome your questions about arthritis pain and how to manage it. You can reach us by email at radio@peoplespharmacy.com, or call between 7 and 8 am EDT on Saturday, October 27, 2018: 888-472-3366.

This Week’s Guest:

Beth Jonas, MD, is the Reeves Foundation Distinguished Professor of Medicine and Chief of the Division of Rheumatology, Allergy and Immunology at the Medical School of the University of North Carolina at Chapel Hill. She is also a rheumatologist with the UNC Thurston Arthritis Research Center and Director of the UNC Rheumatology Fellowship Training Program.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Yes, Sandy from Texas, please tell us where you got the CBD oil you used. If it’s from hemp, instead of marijuana, it should have zero THC, which is what I want for my painful arthritic knees (bone on bone). I’m 71, doing PT, and resistance exercises to prepare for a knee replacement, hopefully early 2019.

Thanks!

there is a steroid-that is longeracting than cortisone called zilretta(its a formof triamcinolone)gives some people releif for 6 to9 mos-Md says many people get relief from medical marijuana-ALso Md says peopleover 85 are greater risks than younger folk for knee replacement and recovery is longer

Despite providing much useful information, the podcast with Dr. Jonas was a let-down. I had expected the doctor to comment a lot more about her opinions of the various home remedies for arthritis, particularly those mentioned in the Graedon’s “Alternatives for Arthritis.” It is based on that Guide that I am currently taking a regimen of grape juice, Certo, gelatin and a tart cherry supplement. So far, everything is positive.

My knee arthritis is tolerable, not disabling. I sometimes use a CBD coolstick (legal in WA) and have a Rx for Meloxicam, for “moderate” pain but only take one occasionally. I get around the house OK but use a cane when shopping, and hiking poles when walking along the river. I also have a Rollator but have only used it once so far, at an outdoor wedding, but surely will again. I visited Victoria BC recently with my daughter; the Gardens and Museum provide wheelchairs. I’m not considering knee replacement because I’m 84, but am waiting to see results of stem-cell testing because that might be an option, altho very pricey and maybe not covered by Medicare. I tried Visco shots a couple of years ago but wasn’t impressed, so I didn’t again. But I plan to try some of the suggestions in the Graedons’ book.

For those of you who love turmeric, here is a recipe for Turmeric Latte.
1 cup nut milk
1/2 tsp turmeric
1/2 tsp ground ginger
1/4 tsp vanilla
pinch of salt
a sweetener of your choice
Drink it warm. mmmm…good!

I forgot: Just remembered that Dr Beth Jonas’s sister is a vet and has Rh Arthritis

MAP is a zoonosis

She should get tested for MAP.
https://humanpara.org/map-testing/

It is treatable with 3 or 4 specific anti MAP antibiotics

I sent a link in the previous email where one can get tested.
Also if you go to http://www.humanpara.org you can watch videos of speakers presenting at the 2015, 2017 and 2018 MAP conference

2015 conference:
https://humanpara.org/symposium-information/

especially this one:
MAP in Veterinary Medicine – Dr. Michael Collins
&

2017 conference:
https://humanpara.org/berkeley-conference-abstracts/

&
https://humanpara.org/2018-map-conference-presentations/

They discuss cases, diagnosis and treatment

Hope all this helps
Incidentally a friend of mine who has suffered severe psoriatic arthritis for 7 years got tested earlier this year at my urging and her test came back positive. She is now on 3 antibiotics.

You may want to show Dr Jonas these emails

Re the aetiology of rheumatoid arthritis:

Bacteria in milk and beef linked to rheumatoid arthritis
https://www.sciencedaily.com/releases/2018/01/180130123743.htm

More here:
Dr. Saleh Naser recently linked MAP to rheumatoid arthritis. As a Prof. of Microbiology, he has been researching MAP at the University of Central Florida for years. Today we celebrate Dr. Naser as our MAP Research of the Day! #WorldMAPday #MAP2CURE

https://www.frontiersin.org/articles/10.3389/fcimb.2018.00011/full

Info re MAP:

Mycobacterium avium subspecies paratuberculosis, known as MAP, a bacteria found in about half the cows in the United States. Its a form of bird TB that gets into milk when birds sit on cows or when cow pats contaminate fields or streams/rivers.

Pasteurization (For example, milk is pasteurized at 161°F (72°C) for 15 seconds) doesn’t kill this bug, but UHT treatment of milk does (Ultra-high temperature processing (UHT), ultra-heat treatment, or ultra-pasteurization is a food processing technology that sterilizes liquid food, chiefly milk, by heating it above 135 °C (275 °F) – the temperature required to kill spores in milk – for 1 to 2 seconds)

MAP is thought to be the cause of many diseases especially autoimmune diseases:
Crohn’s Disease
Ulcerative Colitis
Sarcoidosis
Type 1 Diabetes
Multiple Sclerosis
and
Other Conditions like Psoriasis,Blau Syndrome,Parkinson’s,Thyroiditis

Info for patients:
https://humanpara.org/educational-pack-for-patients/

Testing for MAP:
https://humanpara.org/map-testing/

More here: http://www.humanpara.org

and

Resolution of Crohn’s disease and complex regional pain syndrome following treatment of paratuberculosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385555/

I am 78. For 42 years, I walked back and forth from home to office, office to gym, gym to office and office to home 5-6 days a week. On top of that, I served 27 years as scoutmaster, hiking with the boys up and down mountain trails. My orthopedic doctor (one of my former students) looked at my knew X-rays and pronounced “bone on bone”. My Ph.D. physical therapist daughter agrees. My right knee now prevents me from the long walks that I used to enjoy. Advice: moderate exercise on natural surfaces is better than long walks on asphalt. If a little bit is good, a lot is not necessarily better.

Fred, I have the same condition, and decided to try PT before hip surgery. My PT suggested I wear flat shoes and flat sneakers. A good nearby running shop gives the percentage of elevation of the heel. When my sneakers changed to 4% from 8% incline, my leg pain reduced. I also gave up walking on the treadmill because a person’s gait can be different than it is while walking regularly. I can walk at a comfortable pace now for 1+ hours without the hip and shin pain I had before.
I am also taking Glucosamine/chondroitin daily. Who knows why, but it’s all working at the moment.

Am missing yoga stretching exercises, Boll exercise inversion table for 45 degree only also helpful, and acupuncture water exercises.

PRP (platelet rich plasma) injections are very helpful.

I would like to hear more of experiences with PRP. My pain management doctor is encouraging me to consider it.

I am 71 years old and was a long-distance runner (mainly marathons) until ten years ago. Thank goodness I do not have osteoarthritis or rheumatoid arthritis (yet!) but I have recently been diagnosed with gout. My symptom: very painful left foot which my GP diagnosed as gout. I do not think that the huge amounts of exercise for my marathons are a cause of my ailment. The causes could be my age (weak kidney function) and/or diet (indulgence in shellfish and red meats). My GP did recommend oral medication which I was reluctant to take; he also suggested tart cherry extract, hydration (plenty of water) and a list of food and beverage that I should avoid. I am keeping to his suggestions and so far my gout has not recurred. I only mention my gout as I note that it is related to your discussion on arthritis. A great ‘thank you’ for your The People’s Pharmacy radio programmes.

I was advised to have bilateral knee replacement 24 yrs. ago, at age 41. Early-onset osteoarthritis due to a congenital defect, with knee pain & swelling from age 3. On rare occasions I’ve needed to use a cane or walker.

I became unable to use oral NSAIDs due to GI bleeding. The past few decades I’ve managed pretty well with several grams/day of high-quality EPA concentrate fish oil, cetyl myristoleate topical & oral, and occasionally a topical Rx compounded NSAID called ketoprofen, along with an anti-inflammatory diet. I found that cheaper fish oils and solvent-based supplements made my OA pain worse. Keeping shoes in good repair & using professionally crafted orthotics have also been very important.

I’m moderately active: I walk almost every day, up to 5 miles, and do resistance training a couple times a week. Although my ability to run, jump, & kneel is limited, I’ve been satisfied with my decision to skip the surgery — especially when I meet the occasional person whose surgery has gone wrong. People have lived with osteoarthritis for millenia before the advent of joint replacement surgery. One of my biggest challenges has been finding doctors who support self-care & minimally invasive options, rather than surgical remedies.

87 yr old with crippling arthritis 10 years. 13 months on CBa2D oil, no THC in Wisconsin. 5 yrs on 40mg opiate daily. Down to 2 1/2 mg. off soon. Progressed from sitting between opiate dosage waiting for next one to pushing my lawn mower, shoveling snow, even if a tablespoon at a time. Family and friends call me the Miracle Lady. Kept a log for my Dr. She is on my side. Mayo gave me a choice. I chose hemp oil. Just came in from an hour of blowing leaves. Couldn’t do that for 5 years. The benefits are life-changing. Have listened to you and have your home remedy book and used many ideas from it during withdrawal. Many helped.

I STRONGLY feel that from personal experience that taking gluten, sugar, dairy out of the diet is most beneficial. Along with this is Vitamin D. I also take Turmeric.

I rotate between using Tylenol(500mg) one night and Ibuprofen (200mg the next for arthritic feet. My silly logic is that I’m doing less damage this way to internal organs. Your thoughts? I also use a topical pain killer.
Thanks, Kate

Your listeners should know that there is a semi-intelligent way of getting answers to their questions about arthritis (and many other medical subjects) such as:

What diet helps relieve the pain of rheumatoid arthritis?

put that into http://www.yippy.com, a little known but very, very useful public domain version of IBM’s Watson.

When one does this kind of search one gets answers to your questions filtered through Watson’s “artificial intelligence” that can come from the lay press, individual commentary and from peer reviewed literature article. One caveat: One can also, of course, get “Fake News” in the form, for example, of a statement that vaccines cause Rheumatoid Arthritis.

One can limit the search scope by preceding the question with a preface as:

From http://www.pubmed.com what literature articles discuss the relationship between DIET and Rheumatoid arthritis?

One can also ask very specific questions such as:

Is a gluten free diet helpful in the treatment of rheumatoid arthritis?

AND of course one can ask even more specific questions:

Using http://www.pubmed.com as a source of literature articles is there evidence that a gluten free diet is useful in the treatment of rheumatoid arthritis?

AND of course one can do a classical Boolean Logic PubMed search such as:

gluten free diet AND rheumatoid arthritis

The first article in the above search is a “bio-biggie”:

Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study.

Elkan AC, Sjöberg B, Kolsrud B, Ringertz B, Hafström I, Frostegård J.

Arthritis Res Ther. 2008;10(2):R34. doi: 10.1186/ar2388. Epub 2008 Mar 18.

PMID: 18348715

We should be teaching students pathophysiology starting in the ninth grade by encouraging them to ask questions via http://www.yippy.com, read the results and compose both a summary of the answers to the questions AND form a model (hypothesis) pertinent to how key conclusions could be tested for their accuracy, validity and predictive value.

This could be done using a “literature club” approach that could include both team approaches and individual team presentations. That could be an excellent way to teach the scientific method of posing and answering questions. We would then all benefit from a more “evidence-based” approach to problem solving expertise that would result.

Thank you! We agree, this is an excellent idea.

My arthritis is in my knees and fairly mild so far. The only thing that keeps it at bay is physical therapy and walking a couple of miles every few days. As long as I do my physical therapy exercises and go on regular walks, I have no problems with ordinary walking around. If I neglect the physical therapy, my knees start to hurt quite a bit.

I asked surgeon to prescribe an unloader knee brace since my surgery can’t be done until mid-March, but he doesn’t recommend it. What are your thoughts on this? He says a walker or cane and over the counter pain meds

Is full knee replacement the only way to cure arthritis in the knee joints…is it safe for a going on 85 year old?

Questions concerning Proleo shots and diclofenac?
Where can I listen, from my computer or?

Prolozone injections.

My father was able to tell me when it would rain. I put him on 1 teaspoon of cod liver oil before going to bed. After that he was no longer my weather man. My friend had ankle pain and I had him try the cod liver oil. No further pain in either ankle plus the swelling went down in one of them. He was pain-free in two weeks.

Topical balm/salve of CBD oil w/THC works better than anything on joint pain. I am a 21 year RA pt .. also w/ sciatica.. and I have tried every single med/ drug/ treatment on the market. I have also tried herbs and teas.. and naturopathic treatments. I now use the CBD w/ THC, tylenol and 5% Lidocaine prescriptive patches……and a back brace… When finally CBD w/ THC is prescribed medically by physicians we will see better results for severe chronic joint pain.

I am very interested in what Sandy from Texas wrote. Sandy, would you please be kind enough to let me know the name, dosage, and where you bought the CBD oil w/THC? Also, how do you use it? I’m an 83 year old female with painful arthritic knees and am quite anxious to try CBD.
Thank you so much.

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