Ouch!

November 26, 2005 2:07 AM

My mother is developing severe arthritis in one finger, and can't take most anti-inflammatories. Options?

Just thought I'd see if the collective expertise here extends to arthritis. She was showing me her right index finger yesterday, and the joint at the tip is actually becoming deformed... it looks terribly painful. Medications like Celebrex seem to work well, but even Celebrex gives her stomach problems. (I gather that one is supposed to be easier on the digestive system.) Ibuprofen is right out. I think the other mainstream ones all give her trouble too. I believe she's taking a glucosamine/chondroitin/MSM supplement, but I'm not sure how much that's helping.

I'm thinking she'll perhaps have to go to some kind of topical remedy... or, if there's some medicine out there that will improve digestive tolerance of anti-inflammatories, that would be good too. I don't think all that much of her doctor, from what she's told me, so I'm hoping for good ideas here.

As an aside, we easily forget what a blessing the modern painkillers are. What an amazing improvement they make to quality of life. If you're short on things to be thankful for, aspirin and ibuprofen definitely rate up there.

Thanks in advance for any suggestions.

posted by Malor to health & fitness (15 answers total)

If the joint is really becoming deformed, it could be more serious form of arthritis than just aching joints, and surgery could be an option. They'd probably go in, clean out the joint, debride any excess bone, they might even replace the joint altogether. Of course, I'm not a doctor, but maybe she should see a different one.
posted by Apoch at 3:18 AM on November 26, 2005

It's a wild shot, but after experiencing how a series of acupuncture treatments helped my various non-arthritis pain problems (back and shoulder) it might be worth a try.
posted by zaelic at 4:53 AM on November 26, 2005

I've been taking a combination of naproxen (anti-inflammatory) and pantoprazole (a.k.a. Protonix, Pantoloc; Google any one of these names) for years; the latter does wonders for the side effects of the former.
posted by mcwetboy at 6:12 AM on November 26, 2005

A friend of mine swears to the effectiveness of a TENS machine.
posted by the cuban at 6:21 AM on November 26, 2005

Has she tried Ascriptin (aspirin with Maalox)? I find it doesn't give me stomach issues at all.

My mother swore by capsaicin cream for her terrible knee arthritis pain (before she had both replaced).
posted by biscotti at 6:54 AM on November 26, 2005

As the local doctory guy, I figure I aught to get in here and say a couple of things. If it's a single digit and just the tip, I lean toward thinking about more than just traditional osteoarthritis. Has your mother been worked up for gout? Have the other possible causes of inflammatory arthritites been eliminated?

If so, then your pain control options are as follows: Tylenol, anti-inflammatories, and narcotics. Tylenol is always the first waypoint as it is the most common over-the-counter med available. Anti-inflammatories are good stuff but not everyone can take them. Ibuprofen and naproxen are common OTC ones. A number are available by prescription including the newer Celebrex (the first cousin of Vioxx which it turned out killed people).

Personally, though, I'm a fan of narcotic pain control for moderate to severe pain (mind yout his a purely arbitrary measure). Narcotics work and very well, properly dispensed they can be relatively free of side effects. Mind you, most doctors shy away from narcotics because of federal oversight issues and concerns over abuse.

As mentioned above, an orthopedic surgeon might be able to provide some significant relief. Otherwise, pushing her primary care to send her to a pain management doctor (somebody who is more comfortable managing such things) might be a good option too, assuming the arthritis has been fully worked up.
posted by shagoth at 7:11 AM on November 26, 2005

Just for the sake of completeness, I should also note that free medical advise is worth exactly what you pay for it. Any information provided in this forum is for entertainment purposes only. Any actual medical decisions should be made in concert with a physician who has conducted a full physical exam and evaluation after weighing all available options and conducting adequate due diligence. Cheers.
posted by shagoth at 7:14 AM on November 26, 2005

The supplements you describe do take time to work when they do work.

The arthritis is in just one finger? was it injured? If it's spontaneous, she may have rheumatoid, psoriatic or other serious arthritis conditions that may end up spreading, especially without good care- possibly treatment that goes well beyond just pain relief.

It sounds like she's been to a doctor to have it evaluated, given that she's tried prescription meds for it, but just in case she hasn't, don't skip that step! A rheumatologist, orthopod or other specialist may be called for, but the first step is to see the family doc. Knowing the cause of the arthritis is important.

Like the supplements you describe, one thing that won't hurt and might very well help includes the addition of SAM-e (at least 400mg daily). It's a basic building block in the body and is used to make the lubricant in the joints as well as the protective mucous in the stomach (not to mention the chemical protectant in the liver and serotonin in the brain, etc). I know some people who took it for other problems, but discovered that their arthritis got a LOT better.

SAM-e is easily available at any health food store or even Wal-Mart. Unfortunately, its main side-effect is poverty. You can get something that turns to SAM-e in the body and is much cheaper online. It's called TMG (also called betaine). It's totally cheap in bulk at beyond-a-century.com (benign taste) or in caps at swanson vitamins or puritan's pride.

One important warning- SAM-e and TMG require adequate body stores of B12 and folate. Those should be checked before using or bad things can happen. It's not unusual for one of those to be low. Alternatively, take supplements of these vitamins a while before starting the supplement.

Omega-3 Fish oils can help reduce inflammation as well. Add 4 grams of regular fish oil daily. (May thin the blood a bit).

I'm a doctor, but this is Not Medical Advice, just my opinion.
Your Mileage May Vary
posted by INFOHAZARD at 7:20 AM on November 26, 2005

Knowing the cause of the arthritis is important. It's impossible to over-emphasize that.

Some people have good luck with magnets, others do not. It's like the glucosamine/chondroitin stuff, if it works they swear by it, and others wonder what the first group sees in it.

They have some very tiny, very powerful magnets in a box at Walmart, and probably a lot of other places. She could just tape one on top of the joint for a while. (I don't think using two with opposing fields might be a good idea.) It wouldn't take long to see if it helps, maybe a week or so.

Yeah, it's voodoo, and junk science of the worst possible kind, and there's no chance of it doing anything. My training is all in science, and I know intellectually that there is no chance of a magnetic field affecting the human body. I don't believe in it either, except it does help a lot of people, and that's pretty hard to argue with. People in that much pain have a right to reach out to anything that might help, and if it doesn't, she's out about 15$. At a minimum, there are no side effects (that we know of) and it won't hurt her. Remind her not to handle credit cards, etc. with it on there.
posted by unrepentanthippie at 9:43 AM on November 26, 2005

Thanks, everyone, for the suggestions. Good stuff. I'll be sure to bounce them off her.

She has general arthritis in all her fingers, it's just much worse in that one digit. I think it's just the general, old-age arthritis like you see so frequently. I'm under 40 and already starting to get hints of it myself.

Is surgery really an option on a fingertip? Particularly the index finger? I'd be terrified of losing the use of the finger entirely, if it were me.. so many nerves there. I suppose that's something she'd have to decide for herself, but that would really worry me.
posted by Malor at 3:47 PM on November 26, 2005

Aren't etanercept (trade name Enbrel) and infliximab (trade name Remicade) red-hot for arthritis right now? One is a humanized anti-TNF antibody, the other is a recombinant solublized TNFr.

These are obviously prescription meds, but not narcotics or controlled substances. As a downside, they are shots and not oral or topical. Maybe it's worth for her to ask her physician, as unhelpful as he might be?
posted by NucleophilicAttack at 4:51 PM on November 26, 2005

NucleophilicAttack, at this time, insurance companies will not approve Enbrel for treatment of osteoarthritis, just autoimmune arthritis types. Even then, it's difficult to get. I had to take a mild chemotherapy drug first, and only when it proved ineffective, was Enbrel approved for me. The reason for this is the high cost. Without insurance the shots can cost anywhere from 12 to 24k a year.

Also, an elderly person might have reason to be reluctant to go on Enbrel or Remicade because it compromises the immune system to an extent.
posted by digitalis at 8:28 PM on November 26, 2005

Meant to add, Malor, that your mother might look into taking curcuminoids (turmeric) in pill form. You can get it at any vitamin/health store, and it works best in conjunction with ginger capsules. Turmeric is not upsetting to the stomach, but ginger might (it feels really warm...so if she takes ginger, tell her to take it with a meal). They're anti-inflammatories and work well for me in conjunction with my Enbrel treatments.

The glucosamine and chondroitin take about a month of continued use before a difference is noticed, and they will help keep further degeneration from happening in osteoarthritis. Get a *good* brand, and make sure the dosage is adequate. It's worth it. I use Rexall triple-strength, which also has boron (sometimes useful in autoimmune arthritis).

Good luck for your mother. And above all else, tell her to talk to multiple doctors, until she finds one who is both knowledgeable and a good communicator. I've found that's invaluable for dealing with a chronic disease. There's nothing wrong with a little shopping around to find a good fit.
posted by digitalis at 8:37 PM on November 26, 2005

You might want to read Inflammation Nation. I know the website is awful, but the book did have some good scientific information. It is not one of the many alternative health conspiracy theory books (see page 129, where the author addresses this). It is searchable online at amazon.
posted by davar at 10:05 AM on November 27, 2005

Thanks for the comments, everyone... I bounced them off my mother. For treating herself, I think she's going to look into the SAM-e (she loved the 'side effect being poverty' crack), after checking that she's taking B-12 and folate supplements already, and may try the capsaicin cream and the turmeric/ginger. (although ginger upsets her stomach, much as the anti-inflammatories do, so she may have to stick with just the turmeric.)

And I think she's going to get more aggressive about checking with other doctors and getting more opinions and options. I don't think she's going to go as far as surgery, and it sounds like the drugs Neophilic mentioned probably won't work, since it's not rheumatoid arthritis, just the regular kind.

Thanks much for all the pointers. Many good comments here. The home-style remedies were particularly helpful.
posted by Malor at 4:28 PM on November 27, 2005