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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Treatment may not be necessary for arthritis with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and antiinflammatory medications as below. Furthermore, heat/cold applications and topical pain creams can be helpful.

As a first step, rest, heat/cold applications, and topical pain creams can be helpful. For osteoarthritis, the over-the-counter food supplements glucosamine and chondroitin have been helpful for some, though their benefits are still controversial according to national research studies. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a two-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.

For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis. Obesity has long been known to be a risk factor for osteoarthritis of the knee. Weight reduction is recommended for patients  who are overweight and have early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. Of note, even modest weight reduction can be helpful.

Pain medications that are available over the counter, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and are often recommended as the first medication treatment. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal antiinflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis.

Some patients get significant relief of pain symptoms by dipping their hands in hot wax (paraffin) dips in the morning. Hot wax can often be obtained at local pharmacies or medical supply stores. It can be prepared in a Crock-Pot and be reused after it hardens as a warm covering over the hands by peeling it off and replacing it into the melted wax. Warm water soaks and wearing nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercises performed regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.

Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (Arthricare, Zostrix), diclofenac cream, salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.

There are a few forms of arthritis, such as gout, that can be impacted by dietary changes.

Finally, when arthritis symptoms persist, it is best to seek the advice of a doctor who can properly guide the optimal management for each individual patient.

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