Your good health: The best cure for arthritis is regular exercise

Dear Dr. Roach: What is the best medicine for arthritis? My doctor prescribed me diclofenac sodium and another doctor told me it will damage my liver and kidneys with prolonged use. As you know, arthritis is a chronic disease. Please let me know what medicine I can use for arthritis.

AA

I assume you mean osteoarthritis, the most common type, not inflammatory arthritis like rheumatoid arthritis. If you’re not sure which type you have, ask your doctor, because inflammatory arthritis requires very different and aggressive treatment.

The best medicine for osteoarthritis is probably not a drug; it’s exercise. For people who are early in the course of arthritis, a regular exercise program improves both pain and function, but for people with more advanced arthritis, exercise may become more difficult to do. Severe arthritis of the hip and knee often benefits from swimming, where the load is taken off the joints and allows less painful movement.

Diclofenac is a commonly used nonsteroidal anti-inflammatory drug that is effective for many people. All NSAIDs can cause stomach damage, including irritation, bleeding, and ulcers. Heart disease remains a concern, although diclofenac in particular seems less likely than others to cause it. People with kidney disease should be very careful when taking NSAIDs, as they can sometimes cause kidney disease. Liver disease is quite unusual with diclofenac.

Some people, such as those with arthritis of the knee and hand, may do just fine with topical NSAIDs such as diclofenac gel. It poses little (if any) risk of gastrointestinal, heart, kidney or liver problems. When topical treatment is not effective, most people choose to continue taking these drugs, even after being counseled on the low but not zero risk of toxicity. They are sometimes the most effective drug treatment.

More severe arthritis should prompt a discussion of additional therapies, such as injections and surgery.

Dear Dr Roach: My doctor ordered a “microalbumin creatinine ratio” test, but my result came out “unable to calculate”. Can you tell me what this means?

JSB

The test your doctors ordered looks for protein in the urine, which is concerning because high levels can indicate one of many types of kidney disease.

The best way to determine the amount of protein in urine – albumin is the main blood protein, which can leak out in urine – is to collect every drop for 24 hours. Although sometimes we need to do it this way, a good substitute is the urinary microalbumin to creatinine ratio. People with moderately high urine albumin (or a high microalbumin to creatinine ratio) are at higher risk of developing overt proteinuria, which is a risk for chronic kidney failure. They are also at an increased overall risk of heart disease and death.

Experts recommend testing the microalbumin to creatinine ratio annually, and a high result usually leads to better blood sugar control, aggressive treatment for high cholesterol, and often medications, especially angiotensin receptor blockers or blockers. of ACE, to tightly control blood pressure and protect the kidney.

If your result was “impossible to calculate”, that’s great news, because it means you don’t have microalbumin. Determining the ratio involves dividing by the microalbumin result, and any mathematician knows you can’t divide by zero.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected]