Medicine Talk

Arthritis – Life Beyond Vioxx

By Dr. Terry Maresca
Tribal Connections

I've seen a higher than usual number of arthritis patients in the last month since the recall of the anti-inflammatory drug Vioxx from the market. Some are devastated, telling me "it was the only thing that worked for me." Others are glad they only used Vioxx (or one of its COX-2 anti-inflammatory cousins) periodically, since the major danger of increased heart attack and stroke risk in the scientific studies were for people who used the drug daily for over a year. Unfortunately, some of my patients were in a more worrisome category, having already had a heart attack or diabetes. They really want and need to change therapies. So the big question in my office lately is – what arthritis alternatives exist?

Before we get to this, I have two general reminders to share. First, be sure you know the type of arthritis you have. The diagnosis is key to determining the correct therapy. I am amazed by the high percentage of people who cannot name their arthritis and do not know the details of their family history of arthritis, even when many persons have been affected. As American Indian and Alaska Native people, we do have higher rates of inflammatory arthritis, like lupus, rheumatoid arthritis, and AS (ankylosing spondylitis). We, like other Americans, also have high rates of osteoarthritis ("wear and tear" of cartilage), the most common type in the world.

If you have undiagnosed joint symptoms, especially if they are associated with fever, fatigue, weight loss, joint swelling and warmth, and morning stiffness, do see a health professional for a diagnosis. These can be symptoms of inflammatory arthritis, which is often mis-diagnosed or under-diagnosed until late in the disease. Sadly, I have treated people who ate Tylenol or ibuprofen regularly for years for their pain while the disease did irreversible damage to their joints. Newer, potent disease-modifying medicines are available to stop this progression, and this field is changing rapidly. Yes, these medicines are expensive, but you are worth it. Insist on an early referral to a rheumatologist (arthritis specialist) if ever in doubt about the name of your condition, its treatment, or if your current therapy is not working.

On to arthritis alternatives. The second general principle is, adopt non-drug alternatives first, especially if you have osteoarthritis. Exercise and stretching, of the non-weight bearing or low impact kind, is best. Walking, yoga, swimming, biking, treadmill, tai chi, or bicycling helps keep joints limber and maintains full range of motion. This also increases our natural brain pain killer chemicals.