QUESTION
Hi Dr Darren, I love your column and look out for your interesting topics every week.
I would like to know what you would recommend for Arthritis. My dad is 67 years of age and suffers from terrible pain in his left leg due to arthritis. He can barely walk at times. What would be the best medication you would recommend for him, do you think it could be his bones and when should we consider x-rays? What else could also affect his walking?
Thank you for taking time out in reading my mail – I really appreciate your response.

ANSWER
Thanks for your sincere email and very appropriate questions.
Products like osteoeze gold, procydin, spirulina and many more are used daily by thousands of people who claim that it not only assists with prevention of joint degeneration but also helps in acute cases. Science still maintains that the prime contributory factors remain genetic, activity and diet. Like any good machinery , maintenance is essential. The oil needs to be changed and the load on the joint spaces well regulated to prevent injury.
The treatment of arthralgia (joint pain) remains a major challenge in the medical field. The problems has become controversial for many different reasons. Here are a few of the challenges facing your doctor.

WHY IS TREATING JOINT PAIN CONTROVERSIAL ?

• Correct diagnosis pertaining to the cause of the problem
• Differentiation between disease modification or symptomatic treatment
• Consideration of comorbidities and individual patient profile
• The side effect profiles of medication
• Drug interactions that follow
• Addiction to pain killers

THE CAUSES:
There is a multitude of causes for joint pain – besides the ever common conditions like rheumatoid arthritis , osteoarthritis and gout.
Reactive joint pain after infections like a sore throat and influenza , is not uncommon whilst overtraining and poor diet also play a significant role. Large campaigns dedicated to protecting the joints seem to have made an impact on both active and sedentary people as products like chondroitin and cartilage enhancers move rapidly off our pharmacy shelves.
A gradual increase in workload instead of the sudden ‘high impact’ comeback to training is an important point to remember. Weight management and balanced dispersion of forces on the bones during movement is crucial when analyzing joint pain.
Along with the biokinetics of exercise comes the environmental factors like terrain (hard tarred roads and grass) , jogging versus swimming or cycling. The corporate identity of hard flat point shoes for males and the daring stilettos or platforms for ladies….these are the forces that drive our struggle against joint pain. Are you geared for comfort or speed and is a compromise possible?
There are family histories of joint pain and abnormal bone metabolism. Osteoarthritis from ageing and wear and tear is very common and leads to significant mechanical joint pain. Degeneration of the vertebrae of the spine compounded by dehydration of the discs has debilitating effects on mobility and agility.

THE DIAGNOSIS:
When consulting your doctor remember to describe the ONSET, COURSE AND DURATION of joint pain. Ensure your diagnosis is correct before agreeing to take medication chronically. No drug is without side effects. We use the age of onset, types of joints involved as well as the radiological (Xray) picture to guide us in making an accurate diagnosis. Remembering also that blood tests can also aid the diagnostics process. Raised Uric acid levels in gout and rheumatoid factors as well as the inflammatory markers like the ESR ( Erithrocyte sedimentation rate) and C- reactive protein( CRP) levels.
It is good to know that there is a group of conditions which physicians commonly refer to as “Connective tissue” disorders. These are often systemic illness or syndromes that include joint involvement. Some are caused on an auto immune basis . A simple example is SLE or ‘Lupus’ which is very common amongst the coloured female population in the western cape.

What about the children ?
Joint pain in young children is often mistreated and ascribed to growing pains – parents should be vigilant. Flagged conditions that shouldn’t be missed include Juvenile Rheumatoid Arthritis, Kifoscoliosis and Septic arthritis. The life threatening medical emergency called septic arthritis should never be missed. We see this in young children under 5 years when they present with a sudden limp or painful gait due to ankle or hip pain. Often we think it is just an injury or overuse , but fever can also occur and this should be investigated urgently with blood tests and a medical examination as delayed treatment could lead to permanent disability.
**Also remember that back pain in young people should be investigated and Ankylosing spondylitis is a condition that is often missed – it is associated with the HLA B27 gene and can present with spinal pain and poor flexibility in young adults too.

The MUST-DO HITLIST

  • Diet: Eat foods rich in omega-3 fatty acids, pain-fighting polyphenols, and vitamins C, K, and D.
  • Move to improve joint pain. Exercise triggers the production of lubricating synovial fluid and feel-good brain chemicals, and improves joint pain, function, and range of motion. It may even boost cartilage growth in the knees
  • Weight: Take pressure off your knees, and reduce hip and back pain
  • Work with your doctor: orthopedic specialist and/or physical therapist may be better equipped to tailor an effective pain-treatment plan
  • Don’t ignore joint pain
  • Pace yourself and avoid activities that aggravate your joint pain, such as running long distances, lifting heavy objects, or kneeling for hours pulling weeds
  • Use a daily pain diary to note the activities that worsen or improve your joint symptoms.
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    KING ARTHUR – IT IS, PAYS A VISIT !! – ACHES AND PAINS

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