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THE
Graedons' Guide to
PEOPLE'S
PHARMACY
www.peopiespharmacy.org
Double bind: n.
According to the Arthritis Foundation, or prednisone for prolonged periods of
70 millionAmericans (one in three adults) time. It took quite a while before they
1. A psychological im
passe created when con
tradictory demands are
suffer from arthritis. Most have to take
made of an individual
so that no matter which
directive is followed,
the response will be
construed as incorrect.
2. Asituation in which
a person must choose
between equally unsat
isfactory alternatives; a
punishing and inescap
some kind of pain reliever for their stiff,
realized they were playing with fire.
Side effects of long-term, high-dose
aching joints. But the history of treat corticosteroid use include weight gain,
ments for arthritis has not provided a cataracts, glaucoma, increased sus
c l e a r w i n n e r.
ceptibility to infections, elevated blood
V i o x x w a s t a k e n o f f t h e m a r k e t i n pressure, fluid retention, potassium
2 0 0 4 a f t e r a s c a n d a l , b u t C e l e b r e x loss, stomach ulcers, blood clots, ir
remains. Drugs of this general type, regular heart rhythms, osteoporosis,
including even OTC ibuprofen, have headache, thin skin, impaired wound
come under scrutiny for increasing the healing, menstrual disturbances, moon
risk of heart attacks or strokes.
face, diabetes, muscle weakness and
a hard place I On the one
hand they must cope
loss, bone deterioration, spontaneous
Problems with arthritis drugs are fractures, insomnia, irritability, fatigue,
nothing new. If you turned back the and "steroid psychosis."
clock to the 1950s, you would hear N S A I D S
about a wonder drug called cortisone.
Once physicians and patients real
It was used widely to relieve joint pain, ized how dangerous corticosteroids
especially for people suffering from could be, they became more cautious.
r h e u m a t o i d a r t h r i t i s . P a t i e n t s l o v e d Although aspirin is a type of nonsteroi
"corticosteroids" because such drugs dal anti-inflammatory drug (NSAID), it
reduced inflammation and made it pos wasn't until prescription medicines like
sible to function. People who couldn't indomethacin (Indocin) were devel
get out of bed without pain were able oped (1965) that NSAIDs were seen
to reclaim their lives.
as a potentially safer alternative for
Many doctors loved cortisone-type arthritis patients. Doctors hailed each
drugs too. When they prescribed pred new NSAID as it became available,
with sometimes debili
nisone in the 1950s and 1960s they then lost enthusiasm when the next one
tating aches and pains.
Ontheother, manyofthe
drugs doctors prescribe
felt like heroes because patients were
so grateful. Corticosteroids worked like
magic to relieve a host of hard-to-treat
conditions, from arthritis and allergies
to asthma and atopic dermatitis. That's
because they have profound effects on
a broad range of immunological and
inflammatory actions in the body. There
are few other drugs that can dampen
inflammation and immune response so
able dilemma.
T h i s d e fi n i t i o n f r o m
the American Heritage
Dictionary of the English
Language describes
the quandary arthritis
patients face with pain
relievers.
Put another way, they
are between a rock and
can have serious side
effects.
12010 Graedon Enterprises, Inc.
CORTICOSTEROIDS
effectively.
Early on, many physicians prescribed
high doses of corticosteroids like corti
sone, dexamethasone, prednisolone
came along. Drugs like Clinoril (sulindac), Feldene (piroxicam), Motrin
(ibuprofen), Naprosyn (naproxen)
or Voltaren (diclofenac) were hugely
popular in their day. Such drugs are
still widely prescribed for chronic pain.
And millions of people take the overthe-counter NSAIDs ibuprofen (Advil,
Motrin IB, etc) and naproxen (Aleve).
Nonsteroidal anti-inflammatory
drugs work by blocking the synthe
sis of chemical messengers called
prostaglandins. These hormone-like
compounds are responsible for the
NSAID Benefits?
Despite the fact that
NSAIDs have been
around for decades
and have been pre
scribed to tens of
millions of people to
relieve arthritis pain,
there is not much
evidence that they
really help for the
long term. A review
(meta-analysis) of
23 studies involv
ing over 10,000 pa
tients concluded:
"NSAIDs can reduce
short-term pain in
osteoarthritis of the
knee slightly better
than placebo, but the
current analysis does
not support long
term use of NSAIDs
for this condition.
As serious adverse
effects are associated
with oral NSAIDs,
only limited use can
be recommended."
(British Med. J. Nov.
23, 2004)
Vioxx may have been somewhat easier
redness, warmth, swelling and pain as
sociated with inflammation. But they are on the stomach, but it increased the risk
also important for other functions in the of heart attacks and strokes enough to
body. For example, one prostaglandin outweigh its benefits.The problem is that
called prostacyclin keeps the sticky part blocking COX-2 prevents the production
of blood called platelets from clumping of prostacyclin, and prostacyclin prevents
together to form clots. It also dilates blood unwanted blood clots. In 2000, a large
vessels. Prostaglandins also protect the study of Vioxx showed an increased risk
of heart attacks and other cardiovascular
stomach lining from damage.
NSAIDS like ibuprofen and aspirin are problems. Later, when Vioxx was taken
not very selective. They block two en off the market and warnings were issued
zymes, COX-1 and COX-2, that produce on Bextra and Celebrex, the popularity of
prostaglandins. That helps explain why these COX-2 inhibitors was compared to
these drugs can be helpful, but it also ex a "house of cards" based on wishful think
plains the downsides of NSAIDs. Irritation ing {JAMA 2005; 293:366-368).
of the digestive tract is common. As many
Soon after Vioxx was taken off the mar
as half of the patients taking such drugs ket, a safety expert for the FDA, Dr. David
regularly experience heartburn, nausea, Graham, estimated that up to 139, 000
abdominal pain or ulceration. Many people Americans might have suffered a heart
end up with sores in their digestive tracts attack or stroke as a side effect of Vioxx.
without any obvious warning symptoms. Although a similar drug, Bextra, has also
These lesions can become bleeding or been removed from the market, Celebrex
perforated ulcers, which can be life threat is still available and remains quite popular.
ening. Experts estimate that more than
100,000 people are hospitalized each year
because of such complications, and more
than 16,000 die (A/. Engl. J. Med. 1999;
340:1888-1899). In addition, many of these
medicines can raise blood pressure, alter
heart rhythm, cause fluid retention, dizzi
ness, tinnitus, visual problems, headache,
depression, trigger skin reactions, or put
a strain on the kidneys. NSAIDS can also
interact with many other medicines.
ASPIRIN
One of the earliest arthritis drugs, aspi
rin, might still be one of the best choices.
Unlike the newer, pricey prescription
drugs, it costs just pennies a pill. No other
arthritis drug has been shown to relieve
arthritis pain more effectively than aspirin.
Aspirin has another benefit in addition to
pain relief. Unlike Vioxx and other COX-2
inhibitors, aspirin actually lowers the risk of
heart attacks and thrombotic strokes. One
COX-2 INHIBITORS
large, long-term study the Physicians'
Health Study, demonstrated that aspirin
developed compounds to block COX-2 reduced the risk of a heart attack by 44%
more selectively. By allowing COX-1 to in apparently healthy middle-aged men.
produce protective prostaglandins, they (There were 22,000 of them in this trial.)
anticipated that patients would get pain Those who were at high risk for heart at
r e l i e f w i t h o u t G l u l c e r a t i o n f r o m m e d i tack actually got even more benefit.
cines like Bextra, Celebrex or Vioxx. The
Men are not the only ones to benefit.
commercials for this new class of pain T h e W o m e n ' s H e a l t h I n i t i a t i v e O b s e r v a
r e l i e v e r s m a d e t h e m s e e m l i k e w o n d e r tional Study found that women who took
drugs. People with arthritis were dancing, aspirin lowered their risk of dying from
ice skating, and doing martial arts. The their heart disease by about 25 % {Circula
evidence that Celebrex actually protected tion. Cardiovascular Quality & Outcomes,
the digestive tract from serious damage March, 2009). As a bonus, aspirin has
was not strong enough for the FDA to b e e n a s s o c i a t e d w i t h a r e d u c e d r i s k o f
Doctors were excited when researchers
allow the manufacturer to promote it as many types of cancer.
substantially safer than other NSAIDs.
Rheumatoid arthritis (RA) can be
Despite the good news about Diclofenac lotion was shown to
aspirin, it is not without risk. Many be more effective than placebo
people develop ulcers, includ- in a randomized trial {Archives of
ing life-threatening bleeding ul- /nterA7a/Med/c/ne, Oct. 11, 2004).
cers. This results in an estimated In a 12-week head-to-head trial,
100,000 hospitalizations and far Pennsaid was just as good as oral
too many deaths each year. Older diclofenac, but less likely to cause
peoples may be especially vulner- side effects like nausea, stomach
able to this complication. ache, indigestion or liver problems
Some people are allergic to as- {Journal of Rheumatology, Oct.
pirin or take drugs that are incom- 2004). Pennsaid is interesting bepatible with it. No one should take cause it uses DMSO to penetrate
aspirin regularly without medical the skin and carry the NSAID into
A LT E R N AT I V E S
TO ASPIRIN
Q. What can you tell me about
the pain reliever salsalate? My
doctor says that it will not only
help ease my arthritis pain but
might help control my blood
sugar. Diet has not controlled
my borderline diabetes.
supervision. There are, however, the joint.
some relatively old drugs that The FDA eventually approved
A. Salsalate has been used for
can provide pain relief like aspirin topical diclofenac. It is availdoes, without the digestive dan- able as Voltaren Gel as well as
g e r s . ( S e e b o x . ) P e n n s a i d . Vo l t a r e n G e l c o n t a i n s
TOPICAL NSAIDS diclofenac as its active ingredient
arthritis pain. It is related to
salicylic acid, which is similar
to aspirin (acetylsalicyhc acid).
Like aspirin, salsalate is effec
tive against inflammation and
For many years, people in Eu- although it does not have DMSO.
rope and Latin America have been Studies show these prescription
using NSAID medications in gels gels ease arthritis pain in hands
or creams applied directly to the {Journal of Rheumatology, Sept.
painful joints. Americans had no 2009) as well as knees and other
access to such medications, oth- joints {Expert Opinion on Pharer than certain aspirin-like drugs macotherapy, Nov. 2008). Side
(salicylates) found in products effects are uncommon except for
like BenGay. When diclofenac gel skin reactions, but it may be best
more than century to relieve
pain, but it does not irritate the
digestive tract as aspirin does.
Preliminary research suggests
that salsalate may help control
blood sugar levels in people
with type 2 diabetes {Diabe
tes Care, Feb. 2008). Two other
became available in Canada, we for relatively short-term relief-
studies are now underway to
determine how well this drug
urged people seeking relief to get comparable to an oral NSAID. Ask
works for diabetes.
a prescription for Pennsaid. your doctor about pros and cons
DRUGS OTHER THAN ASPIRIN
There are two little known aspirin-like drugs that
have been around for years. Both are less likely to
in-itate the stomach than aspirin. Salsalate (salicylic
acid) is only absorbed from the small intestine which
accounts for less tummy trouble, but it is about as
good as aspirin when it comes to relieving joint pain
or morning stiffness. It may be more likely to cause
hearing problems or dizziness, though. Salsalate is
available only by prescription as Amigesic, Artha-G,
Disalcid, Mono-Gesic and Salflex. It is unlikely to
prevent blood clots the way aspirin does.
Choline magnesium trisalicylate (Trilasate, Tricosal, Trisalicylate) may also be a little less likey
to upset the stomach than aspirin. Like salsalate,
this pain reliever won't protect against heart attacks
or strokes the way aspirin does. It also requires a
prescription.
Acetaminophen (Tylenol) is the other non-aspirin
analgesic people rely on to relieve pain. Traditionally
it has not been thought of as an arthritis drug because
it does not have the anti-inflammatory properties of
aspirin or other NSAI Ds. Nevertheless, many people
turn to acetaminophen to relieve osteoarthritis of
the knee, hip or fingers. Some physicians even
recommend acetaminophen as a first-line treatment
because it does not cause digestive tract upset the
way NSAIDs can. A review of arthritis research,
however, suggests that NSAIDs are better than
acetaminophen at improving symptoms {Arthritis
Rheum. Oct. 15, 2004). Despite the fact that most
people believe acetaminophen is totally safe, one
study suggested that regular use of this drug for
long periods of time may increase the risk of kidney
damage {Arch. Intern. Med. July 26, 2004).
HOME REMEDIES
Although NSAIDs are the most com
mon treatments for arthritis pain, you
Cherries
have learned that these medications
"I am a 62-year-old
professional piano play
er. The last few years I've
been getting pain in my
thumb and some finger
Cherries have a reputation for fight
ing inflammation, and studies support
have serious risks. Americans were
i t . C e r t a i n m a r k e r s o f i n fl a m m a t i o n
shocked to learn that the pills they
relied on to relieve aches and pains
could cause potentially life-threatening
knuckles. I attributed it
strokes.
dropped significantly after volunteers
consumed 10 ounces of Bing cherries
daily for a month {Journal of Nutrition,
April, 2006). Tart cherries are also
popular with readers like this one:
more to mousing at the
computer than to arthri
tis catching up with me.
I took aspirin and Aleve
with no results. Then I
started drinking eight
ounces of tart cherry
juice a day and the pain
was gone within 10
days. I had some pain in
my right knee and it has
gone away as well."
perforated ulcers or heart attacks and
Yo u h a v e a l s o r e a d t h a t N S A I D s a r e
not all that effective. When investigators
reviewed 23 studies involving more than
10,000 patients they concluded that;
"The advantage of oral NSAIDs over
placebo for short term pain relief is small
and probably clinically insignificant.
Evidence of long term effects from oral
NSAIDs is still lacking." {British Medi
cal Journal, Nov. 23, 2004. They go on
to say that, "This may in turn explain
non-compliance with prescribed drug
therapy in 29% of patients and the use
of non-conventional drug therapy by
one in four patients with osteoarthritis."
That makes sense to us, and it is why
we pay attention when our readers report
benefit from home remedies. As long as
it is inexpensive and not harmful, why
not give it a try? It just might help. Keep
more than two years.
When I forget to eat my
raisins for a few days or
(especially) a week or
more, my arthritis gets
so much worse I can't
believe how much better
I feel when taking them.
Since I do not tolerate
m e d i c a t i o n f o r i n fl a m
mation at all, the raisins
are my only relief. I am
so grateful."
two very expensive injections into my
hip. They only gave me relief for a
few days. Nothing was helping me.
"I was unable to exercise and was
in mind that there are no scientific stud
ies for many remedies, just anecdotes.
cold water. IT WORKS GREAT! I can
"I'm a nurse in a rural hospital. Some
have worked for me for
my right hip for almost ten years.
Last fall, the arthritis in my hip got
so bad that I could hardly walk. Over
the years, I have tried a lot of supple
ments for joint health and I have had
having a very difficult time doing my
job. My x-rays looked horrible. The
surgeon who will do my hip replace
ment next year wondered how I was
even walking.
I don't remember exactly when I
heard about cherries and cherry juice,
but I started eating a lot of Bing cher
ries last spring. I also started drinking
tart cherry juice concentrate mixed in
of the mountain folk I care for tell me
"Gin-soaked raisins
"I have suffered from arthritis in
that a bee sting every two years or so
will significantly decrease arthritis
inflamation and pain. They attribute
this remedy to the Chinese who came
climb stairs, exercise, mow the grass,
work without a lot of pain, and do
a lot of other things that I have not
been able to do for a few years. I
am still getting the hip surgery next
summer, but until then, tart cherry
juice is the best."
to this area to work on the railroads and
logging industry."
Apitherapy, the deliberate use of
bee stings for medicinal purposes, is
popular in the traditional folk medicine
of Europe as well as China. Research
in rats suggests that there may be a
scientific basis forthese reports {In Vivo,
July-Aug. 2005). We haven't seen any
clinical studies published in the medical
literature yet. People with bee-sting al
lergies MUST avoid this remedy!
Joint pain due to gout may also be
reduced with regular cherry intake.
One study found that women had
lower uric acid levels after eating
10 ounces of Bing chen-ies {Journal
of Nutrition, June, 2003). Tart cher
ries have also been shown to speed
muscle recovery after exertion such
as a marathon {Scandinavian Journal
of Medicine & Science in Sports, Oct.
21, 2009; British Journal of Sports
Medicine, Aug. 2006).
Gin-Soaked Raisins
Gin-soaked raisins are a perenially
"Empty one box of
golden light raisins into
a large shallow con
tainer. Pour enough gin
to completely cover the
soaked raisins offer relief, even when
How long does it take for the gin
to evaporate?
It depends a bit on the humidity in the
air. It may take just a day or two, or it
can take up to 10 days. The raisins
will not be dry, but there will be no gin
puddled in the dish.
Once the raisins are ready, should
they be refrigerated?
They should be kept in a tightly
covered container. Refrigeration will
other approaches have fallen short:
extend the shelf life.
popular home remedy for arthritis, but
there are no clinical trials of their ef
raisins. Let stand, un
fectiveness. Nonetheless, grapes have
some compounds that are related to
those in cherries (proanthocyanidins),
and these compounds have anti-inflam
covered, for about seven
matory potential {Acta Pharmacologica
days until all of the liq
uid evaporates. Stirring
occasionally will help
the evaporation process.
After the gin has evapo
rated, place the raisins
Sinica, Dec. 2001).
Many readers have found that gin-
in a closed container ...
dismayed with increasing arthritis to the
point of pain when I attempted simple
activities. Aspirin and exercise helped a
bit. I tried deleting the 'reds' (meat, to
matoes, eggplant) from my diet, taking
'guaranteed' OTC arthritis remedies (I
got my money backbecause they didn't
Eat nine raisins a day.
If you don't like raisins,
put them on your cereal
or in a salad."
Howmuch alcohol is in the raisins?
"As an active senior I was more than
Attributed to "The Acts of
work) and capsules with Boswellin/
Saint Lucas," the newslet
Turmeric/Bromelain mix.
ter of St. Lucas Lutheran
"Then I tried the gin-soaked raisins
and I am pain-free and flexible once
more. I am so very grateful to you for
Church, Toledo, OH.
your advice! My horses thank you, my
grandkids thank you and my garden
also thanks you."
Some people speculate that the gin
is responsible for the effects of gin-
"I suffered arthritis pain
in my lower back and
hip joints for more than
15 years. Prescriptions
from my doctor did
nothing for me. Then
I tried golden raisins
and gin and am living
pain free again after
so many years. What a
godsend!"
Frequently Aslced Questions:
d r e n c h e d r a i s i n s . G i n i s fl a v o r e d w i t h
juniper berries, which was used histori
cally for treating stomach problems, as
an inhalant for bronchitis, and even for
arthritis. But hard as we tried, we could
find no research confirming that juniper
is helpful for arthritis. The medical litera
ture is silent on gin-soaked raisins. On
the other hand, the formu la doesn't seem
likely to do much damage, especially
once the gin has evaporated.
People often snicker about this recipe
and suggest that it would be just as effec
tive to skip the raisins and go straight to
the gin. Although people with an alcohol
problem should choose another remedy,
once the gin has evaporated there is just
one drop of alcohol in all nine raisins.
There is approximately one drop in
the daily dose of nine raisins.
Does it matter what type of gin?
You don't need to buy the most expen
sive gin, since you will let it evaporate.
Don't buy the cheapest one, either.
Ask the clerk to help you find a gin
that is flavored with real juniper ber
ries rather than artificial flavorings.
Some people report using sloe gin.
Sloe gin is flavored with blackthorn
berries ratherthan juniper. Blackthorn
berries were traditionally used for
digestive problems but might have
some anti-inflammatory properties.
Can you use dark raisins?
Some people do. Most people prefer
the golden raisins. Others report using
dried apricots. One variant, soaking
dark raisins in sloe gin, results in a
very dark purplish concoction. But if
it helps ease aches, color should not
be a problem.
Are there any side effects?
People who are sensitive to sulfites
must avoid golden raisins, since they
are treated with sulfites. Sticking to
nine raisins daily should reduce any
digestive tract issues such as gas.
Will I flunk a Breathalyzer testafter
eating the raisins?
Don't keep the raisins in your vehicle.
Take them at least half an hour before
you might be tested. A Breathalyzer
might be able to pick up traces of
alcohol within a few minutes of eating
the raisins.
Grape Juice and
Other Remedies
Perhaps the grapes are just as impor
tant as the gin in gin-soaked raisins.
Remedies utilizing grape juice as one
ingredient are numerous and popular.
We have heard from a great many
people that Certo, a liquid pectin product
used in home canning to make jams and
Q. My wife and I tried
your golden raisins and
gin for arthritis and we
were unimpressed. We
have discovered some
thing else, though. Take
two teaspoons of Certo
dissolved in three ounces
of grape juice. Do this
three times a day.
We have been told to cut
neighbors, as has also her brotherin-law. One man had to stop taking
it, as he was apparently allergic, but
others have come back to my sister
to say how grateful they have been
for the help and what a difference it
has made to them."
jellies thicken, can be mixed into grape
juice for an arthritis remedy that some
find very helpful:
"My high blood pressure prevents me
from taking anti-inflammatory drugs for
arthritis. I am in constant pain from this
condition, complete with degenerative
discs in my spine.
"Certo and purple grape juice made
from purple grapes help tremendously.
I take only one glass a day. I can really
The following recipe is said to have
been used by Sam Houston: "Make a
potion of five parts grape juice, three
parts apple juice, and one part cider
vinegar. A daily dose of this potion,
half a cup will do, helps relieve the
aches and pains of arthritis." The
most recent variation on this theme
supposedly comes from a former
owner of the Dallas Cowboys: "I
back to one teaspoon
put one teaspoon of a half-and-half
Certo in grape juice twice tell if I skip two days, however."
mixture of apple cider vinegar and
a day after the joints quit
honey into a 6-ounce glass of water
aching.
Other readers have suggested simple with a teaspoon of orange gelatin
We buy Certo in the
approaches to mixing the Certo with powder stirred in."
grocery store near the Concord grape juice. Some prefer a
canning jars. Ifs simple tablespoon of Certo in 8 ounces of grape
T h e r e i s n o s c i e n t i fi c e v i d e n c e f o r
and cheap and seems
juice daily. Others buy a 64-ounce bottle the activity of any of these home
to be helping. I am on of grape juice and add the entire packet
Coumadin so I can't take
anti-inflammatory drugs
like Advil or Aleve.
A. Certo contains pectin, a
natural ingredient found
in the cell walls of plants.
It is used as a thickening
agent in jams and jellies.
T h i s i s t h e fi r s t w e ' v e
heard of using pectin for
arthritis pain. It seems
safe, however, though
t h e r e i s n o s c i e n t i fi c e v i
dence to suggest it is ef
fective.
of Certo. (To avoid overflow, a small
amount of grape juice must be removed
first.) This makes it easy to pour out 6
or 8 ounces of the mixture daily.
Other readers prefer a mixture that
may include grape juice, apple juice
and apple cider vinegar, with or without
additions like honey. Apple cidervinegar
and honey have long been popular as
a home remedy. Dr. D. C. Jarvis wrote
about vinegar in his 1958 book, Folk
Medicine: A Vermont Country Doctor's
Guide to Good Health. He learned about
it from the farm families he cared for. Dr.
Jarvis claimed that a teaspoon of apple
cider vinegar in water with honey was
an excellent remedy.
"I gave the Certo and grape juice info
to my sister in England, as she was suf
fering from hip problems. It has helped
her enormously, and she takes it faith
fully every morning. She has also passed
the info to several other friends and
remedies against arthritic joint pain.
But there is now some suggestion of
a scientific reason to include Concord
grape juice in any such mixture. Dr.
Jane Freedman, associate professor
of medicine and pharmacology at
Boston University School of Medicine,
has found that Concord grape juice
r e d u c e s m a r k e r s o f i n fl a m m a t i o n i n
the blood, and also raises good HDL
cholesterol modestly but consistently
{Arteriosclerosis, Thrombosis, and
Vascular Biology, Nov. 2004). She
and her colleagues compared the
grape juice to a placebo purple
beverage, which had no effect on
i n fl a m m a t i o n .
"My high blood pressure prevents
me from taking anti-inflammatory
drugs for arthritis. I am in constant
pain from this condition, complete
with degenerative discs in my spine.
Certo and purple grape juice help
tremendously."
Does diet affect arthri
tis? Dr. Joanne Jordan,
Associate Director of the
University of North Caro
lina Thurston Arthritis
Research Center says it
Other fruits that may act to dampen
inflammation. Pineapple contains an
anti-inflammatory enzyme called brome
lain, and we have heard from a number
of readers who swear by it:
can: "It actually doesn't
"Several years ago friends told me that
take that much weight
drinking a glass of pineapple juice every
loss to make a difference.
You can lose as little as
day helped them. I have found it to be
10 to 12 pounds and cut
your risk of developing
symptomatic knee osteo
arthritis in half."
R e s e a r c h e r s a t Tu f t s
University have reported
more effective than the aspirin, prescrip
tion pain killers and acupuncture I had
tried previously. If s inexpensive, nutri
tious and has no side effects."
Herbs
In many parts of the world, people use
herbs to alleviate pain. Some of these
that small changes in
may also fight inflammation. The most
diet may help arthritis
pain. Omega-3 fatty ac
ids found primarily in
fish, but also in flax seed,
popular of these flavorings come from
pecans, walnuts, tofu and
green leafy vegetables,
can fight inflammation.
But other common oils
India: ginger, turmeric and Boswellia.
themselves on the sore joints. Other
less hardy souls may prefer a liniment
with a spirit extract of the leaves.
Speaking of liniments, creams and
rubs containing capsaicin have been
popular for years. Capsaicin gives
hot peppers their zing. By depleting
nerves of substance P, it makes sore
joints hurt less. OTC rubs with either
capsaicin oroil ofwintergreen (methyl
salicylate) have a long history in the
quest for arthritis relief. They can
cause buming, stinging and redness.
Ssac
When we first heard the suggestion
Boswellia serrata is the Latin name for
helpful.) But we were rathersurprised
when we began hearing from readers
Indian frankincense, used in traditional
Indian medicine for stiff, sore joints.
and safflower oil are full
inflammation and joint
be taken for joint pain. Some people
with access to fresh leaves sting
that soap under the bottom sheet
Animal research confirms that the resin
can alleviate stiffness and reduce in
pain.
ing nettle, Urtica dioica. An extract or
tea made of leaves and stems can
Ginger and turmeric show up on the
spice shelves of American kitchens,
but Boswellia, a resin from a tropical
tree, is not commonly used in cooking.
such as corn, sunflower
of omega-6 fatty acids and
may actually promote
Anotherherbforrheumatism is sting
flammation. There are few good studies
in humans, though, and some people
develop allergies.
Ginger is mostly thought of as a diges
might ward off nighttime leg cramps,
we were skeptical but interested. (We
then tried it ourselves and found it
that soap could also ease arthritis
pain:
"I have arthritis in my hands, so
when I go to bed I hold a bar of soap
and the pain goes away immediately."
"I recently read your article concern
gests 1000 to 2000 lU of
vitamin D daily. Accord
tive aid, but it can help block the manu
facture of some prostaglandins. It has
had promising results in experimental
ing soap for relief of arthritis pain
and decided to give it a try. I have a
ing to Dr. Jordan's re
arthritis in animals {Journal of Natural
bar of soap under the fitted sheet of
Dr. Michael Holick sug
search, adequate vitamin Products, Feb. 13, 2009). It appears our bed and have been astounded at
D helps to protect against that it might be helpful against joint in how well it works.
"Small pieces of soap in my socks
arthritis.
flammation. Allergies to ginger are rare.
Turmeric (the spice that gives curry work for me. My husband thought F d
lost my mind, but I encouraged him
powder its yellow color) is another flavor
ing much favored in South Asia. Turmeric to try the soap in a pocket or sock. It
contains curcumin, which has shown works for him too. F ve been pain-free
strong anti-inflammatory activity in the for the first time in several years. After
laboratory. One reader is enthusiastic:
trying many arthritis medications
experiencing is all but gone."
simply satisfied thatit works for me."
and finding none that my stomach
"I take two capsules of turmeric per could tolerate, I thought I would just
day and I have good movement in my have to live with the pain. I, too, am
fingers now. The pain I was previously curious how the soap works but am
R H E U M ATO I D
ARTHRITIS
Methotrexate
Rheumatoid arthritis can be devas
tating. This auto-immune disease
can strike people of any age and can
eventua I ly leave thei r j oi nts deformed
and painful. Doctors sometimes may
end up feeling nearly as frustrated
and powerless as their patients,
because pretty much all the treat
ment options they can offer have
significant drawbacks.
On the first page, we discussed
corticosteroids. They were among
the first drugs, otherthan aspirin, that
Methotrexate is quite
showed clear benefits for rheumatoid
often used as a first-
arthritis patients. But in many cases,
the risks outweigh the benefits.
line treatment for RA.
It is potentially very
helpful, but it has a
number of significant
complications, includ
ing liver toxicity, bone
marrow suppression,
lung disease, digestive
problems, lymphoma
and infections.
As with other medica
tions, discuss benefits
and risks, doses and
duration of treatment
with the doctor before
beginning treatment.
NSAI Ds too were used for rheuma
toid arthritis as well as for osteoarthri
tis. But they are equally problematic
when used at high doses for long
Unfortunately, the TNF blockers
also have their share of serious
s i d e e ff e c t s . T h e F D A w a r n s t h a t
these drugs can increase the risk
of certain cancers (lymphoma and
leukemia). Because these drugs
suppress the immune system,
both bacterial and fungal infections
may become life threatening. In
addition, people who never had
psoriasis may develop this skin
problem when they stop the medi
cine. Liver damage is another rare
but very serious reaction.
In January 2010 FDA approved
another medicine for rheumatoid
arthritis. Like so many of its pre
decessors, it is being heralded as
a potential "blockbuster" against
this serious disease.
Patients should be aware that
periods. One classic study concluded
that more than 16,000 people died Actemra (tocilizumab) may also
each year of digestive tract bleeding have a dark side. In Japan, where
as a result of taking NSAIDs (New it has already been on the market
England Journal of Medicine, June for years, this immune system
17, 1999). The COX-2 inhibitors modulator has been linked to se
that were developed in the hopes r i o u s i n f e c t i o n s a n d d e a t h s . T h e
of minimizing Gl side effects were drug can cause life-threatening
somewhat successful, butincreased allergic reactions (anaphylaxis),
the risk of heart attacks and strokes.
gastrointestinal perforations,
In the late 1990s, "biologic medi
headache, hypertension, elevated
c a t i o n s " c a l l e d T N F b l o c k e r s w e r e liver enzymes or cholesterol. Like
introduced. (TNF stands for tumor other immune-suppressing drugs,
necrosis factor, a natural compound there is also concern that Actemra
produced in the body.) Drugs such as may increase the risk of cancer.
What does this mean for people
adalimumab(Humira), certolizumab
(Cimzia), etanercept (Enbrel), go- w i t h r h e u m a t o i d a r t h r i t i s ? I t ' s
limumab (Simponi) and infliximab important to discuss the benefits
(Remicade) were heralded as a n d r i s k s o f t r e a t m e n t w i t h t h e
miracles against rheumatoid arthritis. doctor before starting treatment.
By affecting the immune system, There are also many approaches
that are equally important in help
such drugs were supposed to elimi
nate inflammation in the joints, slow ing people cope with RA: getting
or reverse the disease process and regular exercise, adequate rest
prevent joint deformities. They were and good nutrition, not overdoing,
expected to change the treatment of using helpful tools, and maintain
rheumatoid arthritis radically.
ing social contact are all critical.