Hello again,
{excrutiatingly long caveat/unsolicited advice}
I had given quite a bit of thought to your question and chose to offer
only some vague comments rather than answering your question.
However, on second look, I think I'll answer this to the best of my
knowledge. Osteoarthritis is one of the most common forms of
arthritis and your question merits a thorough response.
As researchers we have more than a few misgivings on medical questions
in that we would never try to second-guess a physician's advice. None
of us are medically degreed individuals. However, the length of
doctor office visits today is becoming quite abbreviated and during
these brief visits, often there is little time left over for patient
questions. We're hoping this service becomes a much needed
educational gap for the busy healthcare professionals. If we can act
as laision between doctors and patients by locating reliable health
information on the web, hopefully everyone will benefit.
Researchers' 11th Commandment, "Thou shalt not tread on the cadeusus."
My first suggestion would to be to have a face-to-face discussion with
your rheumatologist about your concerns with Bextra's side effects
{listed below}. So many patients just stop their medication entirely
instead of discussing these concerns. Your input along with an
explanation why your doctor is using a certain drug over another may
allay some of your fears. Open back-and-forth communication is key to
having a good doctor-patient relationship and I think by now they're
accustomed to patients bringing in web-related articles.
Another aspect of your question deals with an arthritis drug having an
interaction with your blood pressure and cholesterol condition. Only
your physician or pharmacist is qualified in determining these
contradictions. Your rheumatologist thinks Bextra is the best
medication for you, but there may also be others equally effective.
I'll list a few possibilities below and let you and your doctor decide
which side effects are the "most tolerable."
Also, with any new medication, ask your doctor for samples rather than
obtaining a full prescription. Sometimes there are drug reactions or
immediately annoying side effects that you won't tolerate. No sense
in buying a 30-day prescription that you'll only end up throwing away.
Whenever I find a medication that works for me, I keep taking it --
just less often or at the lowest possible milligram.
{/excrutiatingly long caveat/unsolicited advice}
....So on to your question....
From the Medline website, here is a general overview of
osteoarthritis. You're probably familiar with this information
already but here's a restatement for completeness sake:
http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
Osteoarthritis {definition}:
"A chronic disease causing deterioration of the joint cartilage and
the formation of new bone (bone spurs) at the margins of the joints.
Causes and Risks:
For most people the cause of osteoarthritis is unknown, but metabolic,
genetic, chemical, and mechanical factors play a role in its
development. It is associated with the aging process and is the most
common form of arthritis. It may first appear without symptoms between
30 and 40 years of age and is present in almost everyone by the age of
70. Symptoms appear in middle age. Before the age of 55 it occurs
equally in both sexes; however, after 55 the incidence is higher in
women.
The cartilage of the affected joint is roughened and becomes worn
down. As the disease progresses, the cartilage becomes completely worn
down and the bone rubs on bone. Bony spurs usually develop around the
joint.
Systemic symptoms, sometimes associated with other arthritic
conditions, are not associated with osteoarthritis. The joints of the
hands and fingers, hips, knees, big toe, cervical and lumbar spine are
commonly affected. The degeneration of the joint may begin as a result
of trauma to the joint, occupational overuse, obesity, or
mis-alignment of the joints (for example being bow-legged or
knock-kneed)."
For additional information including alternative therapy, clinical
trials, coping with arthritis, diagnosis and treatment,
prevention/screening, research, and support groups, this Medline page
will also be of interest to you:
http://www.nlm.nih.gov/medlineplus/osteoarthritis.html
This web page has a list of anti-inflammatory drugs available although
it may be a bit out of date:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202743.html
To list the side effect profile for the complete list would be a feat
indeed, so I will just list a few of the more popular drugs prescribed
these days. Should you wish to look up a side effect profile of a
drug from the Medline list, you may use this website:
http://www.gettingwell.com/drug_info/index.html and click on the first
letter of your drug of choice.
Additional information on anti-inflammatories along with other
treatment modalities:
http://www.arthritis.com/4_5_1.asp
and
http://www.osteoarthritis-treatments.com/html/oral_medications.php3
Even though you're probably familiar with Bextra's side effects,
{close your eyes} here they come again:
***Bextra***
More common side effects may include:
Abdominal pain, acid indigestion, diarrhea, gas, nausea
Less common or rare side effects may include:
Abnormal vision or tearing, acne, anxiety, appetite changes, asthma,
blood in the urine, breast pain, bruising, change in taste,
concentration difficulties, confusion, constipation, coughing, dark
tarry stools, decreased breathing, decreased or increased urination,
dehydration, depression, difficulty breathing, difficulty swallowing,
difficulty urinating, disorientation, dizziness, double vision, dream
abnormalities, drowsiness, dry mouth, eczema, excessive or
postmenopausal vaginal bleeding, eye infection, fainting, fatigue,
fever, frequent urination, gout, hallucinations, hair loss, headache,
hearing impairment, heartburn, hemorrhoids, high blood pressure, high
blood sugar, hives, impotence, increased heart rate, increased muscle
tone, increased nighttime urination, increased sweating, infection,
inflammation in the digestive tract, insomnia, irregular or increased
menstrual bleeding, irritability, irregular heartbeat, itching,
jaundice (yellowing of the skin and eyes), joint pain, loss of
appetite, low blood pressure, low blood sugar, migraine, mouth sores,
muscle pain, nervousness, night blindness, nosebleed, painful
menstruation, paranoia, pelvic pain, pinkeye, rapid breathing, rash,
rectal bleeding, rectal itching, ringing in the ears, seizures,
sensitivity to light, skin sores, skin rash, skin swelling, stomach or
intestinal bleeding, stomach ulcers, taste loss, throat swelling,
throbbing heartbeat, tremor, tingling/numbness, urinary tract
infection, vertigo, vomiting, weakness, weight changes.
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Bextra.
***Vioxx***
More common side effects may include:
Abdominal pain, diarrhea, headache, indigestion, nausea, swelling in
the hands and feet, upper respiratory infection
Less common and rare side effects may include:
Abdominal fullness, abnormal or bloody stools, abnormal taste, acne,
allergic reactions, anxiety, appendicitis, appetite changes, back
pain, bad breath, bad dreams, belching, blood disorders, breast pain,
brittle bones, burning or tingling sensation, cervical dysplasia,
chest pain, chills, clotting problems, colitis, confusion,
constipation, convulsions, coughing, cysts and tumors, dehydration,
depression, digestive tract inflammation, dizziness, drowsiness, dry
mouth, ear and vision problems, eye pain and problems, facial
swelling, fatigue, fever, gallstones, general feeling of illness,
generalized swelling, glandular problems, goiter, gout, hair loss,
heart and circulation problems, heartburn, hemorrhoids, hepatitis,
high cholesterol, high or low blood pressure, hot flushes,
incontinence, impotence, infections, inflamed tendons or bones,
intestinal problems and bleeding, joint problems, kidney failure, loss
of sensation, mania, menstrual problems, migraine, mouth inflammation,
muscle pain, muscle tension, nerve pain and problems, nervousness,
nosebleeds, pain, prostate problems, psychosis, rash and other skin
problems, respiratory problems, runny nose, skin inflammation, sleep
problems, sore throat, stiff neck, stroke, swallowing problems,
sweating, swelling around the eyes, tarry stools, thirst, tooth
disorders, tremors, tumors, twitching, ulcer, urinary problems,
vertigo, vomiting, weakness, weight changes
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Vioxx.
***Celebrex***
More common side effects may include:
Abdominal pain, diarrhea, dizziness, headache, heartburn, high blood
pressure, indigestion, nausea, respiratory tract infections, stomach
discomfort, swelling of the legs and ankles
Less common side effects may include:
Back pain, bronchitis, fatigue, flu-like symptoms, sinus inflammation,
urinary tract infections, weakness
Rare side effects may include:
Abdominal bloating or tenderness, allergies, anxiety, appetite change,
arm pain, asthma, back strain, baldness, black-tarry stool, blisters,
bloody nose, blurred vision, boils, bursitis, cartilage problems,
cavities, chest congestion, chest pain, chills, confusion,
conjunctivitis (pinkeye), constipation, cough, cysts, decreased mental
alertness, dental pain, depression, dermatitis, difficulty breathing,
drowsiness, dry mouth, dry throat, ear infection, ear pain, ear
ringing, ear wax, fainting, fever, flushing, fungal infection, gas,
gastrointestinal infection, gastrointestinal inflammation,
hallucinations, heartbeat irregularities, hemorrhoids, hepatitis,
hernia of the diaphragm, herpes infection, hives, impaired sensitivity
to touch, inability to urinate, increased nighttime urination,
increased potassium in the blood, infection, insect bite reaction,
insomnia, itching, joint pain and swelling, kidney failure,
laryngitis, low blood cell counts, menopausal symptoms, menstrual
disorder, migraine headache, mouth infection, mouth and throat sores,
muscle aches and pains, muscle stiffness, muscle spasms, muscle
weakness, nail problems, nasal congestion, numbness, pain, painful
urination, pelvic pain, pneumonia, rapid or slow heartbeat, rash,
runny nose, sciatic pain, skin dryness, skin inflammation, skin
tingling or burning, sore throat, sweating, swelling, taste
disturbances, tendon inflammation, tingling sensation, tonsillitis,
vaginal inflammation, vein problems, vomiting, weight gain, yellow
skin and eyes.
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Celebrex.
***Relafen***
More common side effects may include:
Abdominal pain, diarrhea, headache, indigestion, nausea, respiratory
infection, sinus inflammation
Less common side effects may include:
Back pain, dizziness, gas, insomnia, rash, runny nose, sore throat,
swelling
Rare side effects may include:
Allergic reactions, anxiety, belching, blisters in mouth and eyes,
blood disorders, blood infections, blurred vision, bone disorders,
breast pain, breast problems, bronchitis, cataracts, chest pain,
colitis, conjunctivitis (pinkeye), constipation, coughing, cysts,
dark-tarry stools, deafness, depression, dermatitis, diabetes,
difficult urination, difficulty breathing, difficulty swallowing,
drowsiness, dry mouth, dry skin, earache, ear infection, ear ringing,
esophageal perforation, eye infection, eye pain, fainting, fatigue,
fever, flu symptoms, fungal infection, gallstones, gangrene, general
swelling, glaucoma (pressure in the eye), hair loss, heart failure,
heart irregularities, hemorrhoids, hepatitis, hernia of the stomach,
herpes infection, hives, hot flashes, increased appetite, increased
blood pressure, increased heart rate, increased muscle tone, increased
urination, infection, inflammation of the digestive tract,
inflammation of the bladder, inflammation of the blood vessels,
intestinal bleeding, intestinal obstruction or perforation, itching,
jaundice, joint pain or inflammation, kidney problems, laryngitis, leg
cramps, liver problems, loss of appetite, loss of balance, low blood
sugar, menstrual disorders, migraine headache, mouth ulcers, muscle
ache, nail disorders, neck stiffness, nerve pain, nervousness,
nosebleeds, pain, painful urination, pancreatitis, phlebitis,
pneumonia, poor coordination, prostate problems, severe diarrhea,
severe skin rash and peeling, skin reaction due to sunlight, skin
sensitivity, skin tingling, stroke, suicide, sweating, swollen face
and throat, taste disturbances, tendonitis, tiredness, tooth
disorders, urinary incontinence, urinary tract infections, vaginal
problems, vomiting, weakness, weight gain.
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine whether it is safe for you to continue taking Relafen.
***Mobic***
More common side effects may include:
Abdominal pain, constipation, diarrhea, dizziness, fluid retention,
gas, headache, indigestion, itching, nausea, rash, ringing in ears
Less common side effects may include:
Dry mouth, fatigue, inability to fall or stay asleep, increased
sweating, inflammation of the mouth, inflammation of the stomach,
nervousness, sleepiness, vomiting
Rare side effects may include:
Agitation, anxiety, confusion, bloody stools, depression, difficult or
labored breathing, difficulty swallowing, fluid retention, general
feeling of illness, hives, increase or loss of appetite, kidney
failure, large blisters, liver failure, pins and needles, pneumonia or
lung inflammation, sensitivity to light, severe allergic reactions,
skin peeling, stomach and intestinal inflammation and/or bleeding,
tremor, ulcers, vaginal bleeding, vertigo, vision changes, weakness,
weight gain, yellow eyes and skin
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Mobic.
***Arthrotec***
More common side effects may include:
Diarrhea, flu-like symptoms, indigestion, nausea
Less common or rare side effects may include:
Abdominal bleeding and pain, allergic reaction, anemia, angina,
anxiety, asthma, back pain, belching, black stools, blood in urine,
breathing difficulty, colitis, confusion, constipation, convulsions,
coughing, depression, difficulty sleeping, dizziness, dream
abnormalities, dry mouth, facial swelling, fainting, fatigue, fever,
frequent urination, gas, hair loss, headache, heart attack, heart
failure, heartbeat irregularities, high or low blood pressure, hives,
hot flushes, increased appetite, inflammation of the throat, itching,
joint pain, kidney disorders, liver disorders, nervousness, pain,
peeling skin, pinkeye, rash, red or purple spots on skin,
regurgitation, respiratory infection, ringing in ears, skin eruptions,
sleepiness, stomach or intestinal inflammation, sun sensitivity,
sweating, swelling due to fluid retention, taste disturbance, tingling
or pins and needles, thirst, tremor, ulcer, unwell feeling, urinary
infection, vertigo, vision disturbances, vomiting, weight increase or
decrease, yellow skin and eyes.
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Arthrotec.
You also mentioned the possibility of increasing your Ecotrin versus
taking one of the above drugs, so I found this information for you:
http://www.library.duq.edu/eresources/clinref/datasets/nursap_f/html/chapter/mono/bt009000.htm
***Ecotrin***
Adverse Reactions for Salicylates:
>10%: Gastrointestinal: Nausea, vomiting, heartburn, epigastric
discomfort, heartburn, stomach pains
1% to 10%:
Central nervous system: Fatigue
Dermatologic: Rash, urticaria
Gastrointestinal: Gastrointestinal ulceration
Hematologic: Hemolytic anemia
Neuromuscular & skeletal: Weakness
Respiratory: Dyspnea
Miscellaneous: Anaphylactic shock
<1% (Limited to important or life-threatening symptoms): Iron
deficiency, occult bleeding, prolongation of bleeding time,
leukopenia, thrombocytopenia, anemia, hepatotoxicity, impaired renal
function, bronchospasm
Overdose/Toxicology Symptoms of overdose include tinnitus, headache,
dizziness, confusion, metabolic acidosis, hyperpyrexia, hypoglycemia,
and coma. Treatment should be based upon symptomatology. Maximum
Dosing: 4 g/day (4,000 mg)
If you have trouble taking pills, another possibility would be a
topical anti-inflammatory gel called ketoprofen or branded Orudis.
I've read that this is available over the counter in Alaska, so you'll
have to check your own state's availability requirements. If this is
still being compounded, you need only to take the prescription to your
local apothecary. Here's a conversation discussing it:
http://www.i-depth.com/P/r/ry03191.frm.forum4.msg/206.html
The nutrition supplement method of treating arthritis swung into high
gear with Jason Theodosakis' 1999 bestseller "The Arthritis Cure."
http://www.amazon.com/exec/obidos/ASIN/0312969163
So far, the medical literature seems to be on the fence with regard to
the efficacy of glucosamine/chondroitin sulfate so, once again, we're
left to our own best judgment. If you'd like to read the analysis of
the 1998 clinical trials, it's here:
http://www.nlm.nih.gov/cgi/medlineplus/leavemedplus.pl?theURL=http%3A%2F%2Forthoinfo%2Eaaos%2Eorg%2Ffact%2Fthr%5Freport%2Ecfm%3FThread%5FID%3D220%26topcategory%3DKnee
For side effects of glucosamine/chondroitin sulfate:
http://www.nlm.nih.gov/cgi/medlineplus/leavemedplus.pl?theURL=http%3A%2F%2Fwww%2Earthritis%2Eorg%2Fconditions%2Falttherapies%2Fglucosamine%2Easp
"The most common side effects are increased intestinal gas and
softened stools. If you experience these problems, you might want to
try another supplement brand before you stop using them altogether."
Some information about MSM: http://www.bluestuff.com/msminfo.htm My
mom swears by this "Blue Stuff" product but it really hasn't done
squat for me. I'll stick with my Flexall QuikGel, thank you very
much.
I hope by now you've had your physical therapy appointment and have
been instructed on some range of motion exercises.
Addressing your specific questions on:
Physical therapy: http://www.arthritis.org/resources/arthritistoday/1999_archives/1999_03_04movementtherapies.asp
Aquatics:
http://www.arthritis.org/AFStore/StartRead.asp?idProduct=3368
Acupunture:
http://www.arthritis.org/resources/arthritistoday/2000_archives/2000_05_06_acupuncture.asp
Other useful information can be had at the Arthritis Foundation site:
http://www.arthritis.org/research/research_program/osteoarthritis/opportunities.asp
I like to cover a gamut of therapies and let the client decide which
is best for him/her, so here's a holistic list of treatments:
http://www.holistic-nline.com/Remedies/Arthritis/arth_OA_home.htm
I must say "humor therapy" is my favorite.
Rheumatology Links:
http://www.rheuma21st.com/links_index.html
Of course, you also can't argue with the semi-low tech treatment with
warm moist heat. Stick a washcloth under the faucet, wring out
excess, pop in microwave for 20-30 seconds {careful, it's hot!},
unwrap and apply to affected area. Repeat as cloth cools {as often as
necessary}. I've done this for a recalcitrant shoulder injury and,
although inconvenient, it works like a charm.
I hope I've covered all the aspects of your question, but if not
kindly ask for a clarification before rating my answer. Since we
have a 100% satisfaction-guaranteed policy, we want to give you 100%,
but sometimes it takes a couple whacks at a complete answer. Please
let me know if I've missed something along the way and I will be more
than happy to find any additional information.
Thanks for your question and using our little service. Hope to see
you back again soon and best of luck getting your OA treated.
Warm {moist heated} regards,
V |
