Arthritis

What tests determine whether a person has arthritis?

No single test can diagnose arthritis.  Instead, a variety of examinations and diagnostics tests may be used to establish a diagnosis, including:

• Physical examination to check for tenderness, redness, warmth, stiffness or fluid in a joint
• Personal and family medical history
• Blood tests
• Urine tests
• X-rays and other imaging tests
• Removal of fluid from a swollen joint for examination (joint aspiration)

If you have pain, stiffness, swelling, or difficulty moving a joint or doing daily activities, see your doctor.  These may be signs and symptoms of arthritis.

Arthritis medications: Can I take them only when I need them?

I take a nonsteroidal anti-inflammatory drug (NSAID) daily for arthritis in my hands.  I don’t like taking so much medication, and I’m wondering if I can cut back and only take medication on days that I have pain.

If you are using an over-the-counter medication, such as ibuprofen, you can generally adjust the amount you are taking to match your level of pain.  This is especially true if the severity of your pain varies.  For example, some people experience a flare of arthritis symptoms after increased physical activity.  Using the full recommended dose of a medication for several days should help decrease pain and inflammation.  When symptoms improve, you can cut back to one or two tablets every few days.  If your symptoms don’t recur, you can stop taking the medication and just take it when you need it.

On the other hand, if your arthritis symptoms are more constant, you may find that staying on a set dosage of the medication all the time provides maximum relief of symptoms.  This is because nonsteroidal anti-inflammatory drugs (NSAIDs) must be taken for several days to achieve a consistent and adequate level of medication in your blood.  For this reason, taking an NSAID only when you have pain won’t be as effective as taking the medication on a regular basis.

If you are taking a prescription arthritis medication, discuss any possible dosage adjustments with your doctor.

Arthritis pain medications: Do they raise blood pressure?

I take acetaminophen (Tylenol, others) every day to control joint pain from osteoarthritis.  Recently, I heard that acetaminophen may increase my risk of high blood pressure.  Is this true?  If so, which arthritis pain medications are safe for my heart?

It is true, though there’s more to learn about how much additional risk you take on when you use acetaminophen regularly.  For years, heart and arthritis specialists thought that acetaminophen was relatively safe for your heart, but recent studies have found that the drug may increase your risk of heart problems.  The risk appears to be most significant if you already have high blood pressure or other risk factors for heart disease, but more studies are needed before we can be sure.

Other over-the-counter (OTC) arthritis medications — specifically, the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — also are associated with an increased risk of cardiovascular disease.  More is known about how — and to what degree — these drugs affect your heart, blood vessels and blood pressure. You need to be especially careful about using these drugs if you’ve had a heart attack or are at risk of heart attack, as they increase your risk and interfere with the preventive effects of aspirin.

NSAIDs also increase the risk of bleeding.  This is a particular concern for people who have heart disease and are already taking aspirin and other medications that increase bleeding risk, such as clopidogrel (Plavix) or warfarin (Coumadin).  In addition, because NSAIDs cause fluid retention, people with heart failure should avoid them.

Keep in mind that medication isn’t the only treatment for arthritis pain.  Mild to moderate arthritis pain may be relieved with a combination of self-care measures and lifestyle changes, such as weight loss, exercise, heat or cold therapy, and physical therapy.  Many doctors recommend trying this combined approach before starting medication.

If you need medication to help manage your arthritis pain, use the lowest dose necessary for the shortest time possible.  Also, discuss with your doctor which pain medication is most appropriate for your specific situation.  All medications — prescription and nonprescription — have risks and potential side effects.

When taking OTC pain relievers for arthritis, keep these tips in mind:

• Get your blood pressure checked regularly.
• Avoid alcohol.
• Tell your doctor about any herbal supplements, nutritional supplements or other medications you are taking.