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ASK THE DOCTORS by Robert Ashley, M.D. For The Salinas Californian 9:01 p.m. PT March 8, 2017

Dr. Robert Ashley MD(Photo: Provided)

Dear Doctor: Are there natural remedies for arthritis? Exercises that could help? My pain is in the upper arms and shoulders.

Dear Reader: Osteoarthritis, the kind that youre describing, is caused by degeneration of the cartilage within a joint. Without the cartilage, one bone rubs upon the other, leading to pain and degeneration of the bone.

Doctors typically recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and aspirin; acetaminophen; and, more rarely, opiates. But NSAIDs can increase the risk of stomach ulcers and kidney problems when used chronically; acetaminophen at high doses can cause liver problems when used chronically; and opiate medications can lead to addiction. So I can understand your desire to look for an alternative for the pain.

The supplements chondroitin sulfate and glucosamine have been used for osteoarthritis for years. Chondroitin is one of the building blocks of cartilage in our body, so many people naturally believe that taking chondroitin can decrease the pain of arthritis.

A 2015 review of 43 randomized trials compared the use of chondroitin alone or in combination with glucosamine against the use of a placebo. Most of these studies looked at treatment for arthritis of the knees, with some looking at arthritis of the hips and hands. The studies measured pain on a 100-point scale. The use of chondroitin was found to be beneficial, whether with or without glucosamine, showing a small 8-point difference in pain compared with placebo. It didnt ease the stiffness and lack of mobility associated with arthritis, however.

In another study, a randomized trial of 606 patients with pain from osteoarthritis of the knee compared the use of glucosamine with chondroitin against the anti-inflammatory drug celecoxib (Celebrex). After six months, both groups found a greater than 50 percent reduction in both pain and joint swelling. What was interesting about the study was that it took a while for the glucosamine/chondroitin to work. At one to four months, Celebrex was much better at improving pain, but at six months it was no different than the glucosamine/chondroitin combination. So with the use of glucosamine and chondroitin, it is important to be patient.

The supplements MSM (methylsulfonylmethane) and DMSO (dimethyl sulfoxide) are anti-inflammatory agents that have been studied in arthritis of the knees without evidence of benefit, but its possible they could decrease pain in the joints of the hands. Arnica montana is a plant-based therapy that has some potential in topical use for pain relief, with one study finding a slight benefit for arthritis of the hands. Topical use of capsaicin cream, made from chili peppers, has shown potential as well, specifically for arthritis of the knee. Other natural remedies and supplements, such as fish oil, are touted for arthritis, but their use has not been well studied.

As for exercises, I would recommend physical therapy to increase your range of motion for your shoulder and to help increase your muscular strength. Yoga, Pilates and tai chi can also be beneficial, potentially increasing your range of motion without undue stress on your already aching joints. Over time, you may well see a difference in your ability to function with less pain.

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.

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Ask the Drs.: Natural remedies for arthritis pain - The Salinas Californian

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