February 8, 2011

Medications and Supplements

Since Vioxx has been withdrawn from the market I?ve been having a lot more pain with my osteoarthritis. I have thought about using Celebrex, but it doesn?t seem as good. Now they are talking about it being a risk too. What do you advise?


We are answering this question because there are probably thousands of people in your same situation. Vioxx and Celebrex are what are called Cox-2 inhibitors. They belong to the larger group called nonsteroidal anti-inflammatory drugs (NSAIDs).

The older NSAIDs such as aspirin, naproxen (Naprosyn, Aleve), diclofenac (Voltaren, Arthrotec) or ibuprofen (Advil, Motrin IB, Nuprin) all are very effective against arthritis. However, they can be harsh on the stomach. When taken over a long period of time, or in susceptible persons, they can cause heartburn, stomach irritation, and even ulceration and bleeding. The beauty of the Cox-2 inhibitors (such as Vioxx and Celebrex) was that they were kind to the stomach. They have, however, been associated with a greater risk of heart attack and stroke if taken for more than 18 months.

So here is the dilemma: What to do?

The older NSAIDs work well against osteoarthritis pain. Often the patient has no gastric side effects when the medication is taken with food. If that is the case with you, then select the cheapest effective medication, and use it at the lowest dose that achieves results. Many do not require strong medication because their pain is mild or moderate. Acetaminophen (Tylenol) is not irritating to the stomach, and is effective for many. However, consider some alternatives. Ice packs reduce inflammation, and are good pain relievers. They are reusable, can be used several times a day, and can be kept readily available in a refrigerator.

Some have found the use of elastic supports helpful. These can be purchased over the counter for wrists and ankles, even for knees--though the latter can cause skin burns by friction.

Your doctor may order some ?unloader? braces that transmit the weight around the joint, particularly in knee-joint arthritis involving one side of the knee joint.

Shoe insoles can also help redistribute weight, and soft heels and soles are a boon.

Regular exercise can strengthen muscles that protect the joints. You may benefit from professional advice on the best kind of exercise, depending on the location of your arthritis. A physical therapist is the specialist to do this for you.

Topical creams may help. They are those that make the skin feel hot or cold, called counterirritants. They distract by stimulating another set of nerves. It is believed that creams containing capsaicin from chili peppers help by interfering with the transmission of pain signals to the brain.

Glucosamine-chondroitin slows the destruction of cartilage. Though it does not work for everyone, it does work for some.

Cortisone injections provide temporary relief, but repeated use may lead to thinning of the bone and cartilage. They can be ?magical? in effect, particularly on a swollen ?boggy knee.? Newer joint injections of hyaluronic acid preparations that mimic natural joint fluids (Synvisc and hyolgan) have proved helpful to some.

Protection of our joints by avoiding obesity, repetitive stress to joints, wearing impact-reducing shoes, and avoiding high-impact exercise all play a preventive role.

A diet rich in calcium and vitamin D, as well as antioxidants, may also prove protective. It is very important to get a little sunshine, eat a good source of calcium, and exercise when young to build a foundation that will support us into old age.

What is the role for magnesium? I take a calcium supplement, and my wife says I should get magnesium as well. Is she correct?


I?m surprised you have ?the temerity to question your wife?s judgment!? You should know, most wives read more health literature than men! Joking aside, yes, magnesium is important. But whether a supplement is required is what we need to discuss.

Muscle, bone, brain, heart--every cell of the body requires tiny amounts of magnesium. It is essential for cardiac rhythm. It is a regulator of blood pressure. It helps in the manufacture of proteins. And, along with calcium, it is very important in maintaining bones.

A person eating whole grains, a wide variety of fruits and vegetables, legumes, and nuts should have no problem with magnesium. Have you heard of such a recommended diet before? Sure you have! It?s the good Adventist diet, recommended by Ellen White more than 100 years ago. The problem is many adults fall short of the recommended 420 milligrams for men and 320 milligrams for women. This is especially true in the United States, and in persons more than 70 years of age.

Some gastrointestinal disorders such as Crohn?s disease or chronic diarrhea may interfere with magnesium absorption. Severe depletion is rare, but mild to moderate deficiency is more prevalent. Diabetes, by causing excessive urination, can result in increased urinary loss of magnesium.

Multivitamins often contain 100 milligrams of magnesium. A regular one-a-day vitamin pill may be the cheapest and best all-around supplement. Most people don?t need separate magnesium supplementation. I would recommend closer attention to the whole grains, nuts, beans, and vegetables--avocado, milk, orange juice, even a little chocolate. I want to stress that ?little? there, because, though it?s rich in many nutrients, it is extremely calorie-dense.

Allan R. Handysides, M.B., Ch.B., F.R.C.P. (c), is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20905. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.