Ask the doctor - bones and joints

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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What can I do about bunions?

I normally suffer from bunions, but they felt so much better when I was wearing flip-flops on holiday this year. Now that I'm home and having to squeeze back into my work shoes, they're causing me pain again. Any ideas?

A bunion is a bony swelling that develops at the base of your big toe and, when it rubs against a shoe, it becomes swollen and painful. In most cases, it's not clear what causes bunions, though some people blame poor footwear, but it's certainly true that badly fitting shoes do make the symptoms worse. Some sufferers, however, are genetically
prone to them, which may be the result of a weakness in their big toe joint. You should ensure that your shoes fit properly, in order to ease your symptoms. Ideally, seek the advice of a podiatrist or chiropodist, who will probably tell you to give up wearing high-heeled, pointed
or tight shoes and opt for comfortable trainers, sandals or slippers instead. Painkillers, like ibuprofen and paracetamol, can help to alleviate the discomfort and inflammation and, if your bunions become infected, you may have to take antibiotics. But for those people whose
symptoms are untreatable, surgery is an option. It may be just a case of ‘trimming down' the joint, though if the problem is severe you may
need an artificial replacement for your big toe joint. Bunion surgery can be complicated and there may be a prolonged recovery time, so discuss the pros and cons with your podiatrist or surgeon. But bear in mind that you'll probably need at least six weeks off work to recuperate after the operation.

Dr Louise Selby, SHE (Sept 09)

 

Will tomatoes exacerbate my arthritis?

I have arthritis and have been told I shouldn't eat tomatoes as they are acidic and could upset my joints. I love tomatoes - help!

Some naturopaths advise people with arthritis to eat more alkaline foods, and to cut back on acid foods. But this refers to the effects of the food on the acidity of your urine, not whether the food tastes acid. It is mostly protein-rich foods, such as meat, dairy products and grains that are acid-forming, while most fruit and vegetables - including tomatoes - are classed as alkaline, because they contain weak acids (citrate and malate) that are neutralised by the large amount of potassium in fruits, to form salts such as potassium citrate and potassium malate. These, in turn, react with other chemicals in the body to form bicarbonate, which has an alkaline effect on urine. However, tomatoes belong to a family of plants that produce varying amounts of chemicals known as alkaloids, which may make arthritis symptoms worse. Avoid them for a week, then eat a lot to see if they cause a flare-up. If not, keep enjoying them! For more information, read my book Overcoming Arthritis (Duncan Baird, £12.99).

Dr Sarah Brewer, Prima (Aug 09)

 

What are the risks of osteoporosis?

My mother is in her mid-sixties and has just been diagnosed with osteoporosis after a fall in the garden broke her hip. According to her consultant, her spine is crumbling and he's suggested injections of ‘bone cement' to improve her mobility. Can you tell me more about it? What are the risks and are there any other options for her?

Osteoporosis is a condition where the bones become thin and weak. This means that they are prone to breaking even after a minor injury. The wrists, hips and vertebrae are particularly vulnerable. A hip or a wrist can be fixed quite easily with an operation and/or a plaster caste. The spine, however, is more of a problem. It tends to crumble and collapse, leading to a lot of pain, but there is no easy solution beyond painkillers. The injection of bone cement (vertebroplasty) is used for people who have had a crush fracture of the spine and are experiencing chronic pain. The idea is to reinforce and improve the strength of the bones in the spine. Pain is reduced in about 80 per cent of cases, allowing better flexibility and mobility. Compared with traditional surgery, the recovery is quick and patients should be out of hospital within 24 hours. The main risk is that cement might leak out from the bone and cause pressure on the spinal cord, which could lead to nerve damage.

Meanwhile, it is important that your mother takes measures to prevent the bones getting even thinner. She needs regular weight bearing exercise and a diet that's rich in calcium. Calcium and vitamin D supplements are also important along with tablets to prevent bone thinning, such as Fosamax.

Dr Louise Selby, SHE (July 09)

 

Is jogging damaging my knees? 

I love jogging but I've started to get aches and pains in my knees afterwards. Should I stop? I'm only 40 and don't want to give up too soon!

Participation in sport is associated with an increased risk of osteoarthritis in the lower limb joints in former elite runners, footballers, weight-lifters and tennis players who receive sports injuries. Research suggests that recreational jogging does not seem to increase the risk, as long as your joints are otherwise normal. Wear good quality running shoes, fitted by a specialist running shop, and change them every 500 miles, or when they start to lose their cushioning. Some experts suggest buying two pairs of running shoes and alternating between them. Avoid walking or jogging on rough, uneven ground. Taking glucosamine sulphate, chondroitin sulphate, MSM, bromelain, Devil's Claw, rosehip or Pycnogenol can reduce joint pain and may reduce progression of early osteoarthritis. If pain continues, don't give up exercise - switch to low impact aerobic activities such as swimming, cycling and walking.

Dr Sarah Brewer, Prima (July 09)

 

I need help for my ligament pain

 

I fell recently and tore a ligament in my pelvis, and I'm in considerable pain. My GP tells me to remain mobile and take painkillers. Can anything speed my recovery?

One of the most effective supplements is glucosamine sulphate, which supplies building blocks needed for regeneration and repair of ligaments and associated tissues. Omega-3 fish oils help to damp down inflammation and can reduce pain and stiffness. Try rubbing in a skin treatment, such as Dynamint balm (£14.10 from www.wellnessdirect.co.uk), which contains essential oils of calendula, peppermint, tea tree and eucalyptus, to reduce pain and swelling. Cold or warm packs may also help. Both work by reducing transmission of pain signals to the brain. Cold reduces blood flow and swelling, while heat increases blood flow to boost healing.

Dr Sarah Brewer, Prima (Feb 09)

 

 

Will my inhaler give me brittle bones?

 

I have to use a steroid spray for asthma, and I've read that constant use of steroids can cause osteoporosis. Can I do anything to avoid this? I can't drink milk, as I'm allergic to it.

High-dose oral steroids can lead to osteoporosis, but inhaled corticosteroids don't pose a significant risk. This is because low doses are used, which go right to the lungs rather than around the body first like oral steroids. A good intake of calcium and vitamin D is vital - research has shown that adding calcium and vitamin D supplements to the diet of older people can reduce risk of a hip fracture by 40 per cent. Non-dairy sources of calcium include green leafy vegetables, oranges, tofu and almonds. Oily fish are rich in vitamin D and essential fatty acids that encourage calcium to build up in bones. Take regular exercise, which stimulates new bone production, especially high-impact exercise (such as aerobics, dancing, racquet sports and jogging).

Dr Sarah Brewer, Prima (Jan 09)

 

Should I consult a chiropractor?

I have carpal tunnel syndrome, with pain and weakness in my wrist and hand. Could a chiropractor help?

Chiropractic has helped many people avoid surgery for carpal tunnel syndrome. To find an accredited chiropractor in your area, contact the British Chiropractic Association on 0118 950 5950 or visit www.chiropractic-uk.co.uk. Some people with this condition have low levels of vitamin B6. Although supplements aren't effective for everyone, the pioneer of treating sufferers with B6, Dr John Marion Ellis, claimed that at least 85 per cent of patients responded to doses of between 50mg and 200mg daily, with improvement in a few weeks, and total resolution of symptoms in eight to 12 weeks. Doses above 50mg daily should be taken only under supervision of a doctor or nutritional therapist. Diuretic herbs such as dandelion and horsetail extract can relieve symptoms where they're linked with fluid retention. Try to lose any excess weight, which can make symptoms worse. Wearing splints designed to hold the wrist at a neutral angle at night often helps. 

Dr Sarah Brewer, Prima

 

I'm 35 and have developed joint pains in my hands. My mother had rheumatoid arthritis, which caused a lot of pain. I've read that alcohol might help prevent it, but I've always abstained for health reasons. What do you think?

 

 

A recent study reported that people who drink regularly are less likely to suffer from rheumatoid arthritis (RA). It is thought alcohol reduces the inflammatory response. But it shouldn't be an excuse to drink to excess, as the risks from overdrinking far outweigh any potential benefits of reducing your chance of RA. In fact, excessive alcohol can be dangerous for patients on some anti-rheumatoid drugs and may cause liver damage. If you want to enjoy an occasional drink, then yes, there may be benefits, but only in moderation. The NHS says that women shouldn't drink more than two units a day (14 units maximum a week) and should avoid alcohol altogether during pregnancy. I recommend you see your GP about being tested for RA, which affects over 400,000 people in the UK. It generally begins between the ages of 40-60 and is three times more common in women. Although there is no cure, there are effective treatments.
Dr Louise Selby, SHE

 

I don't want my fingers to seize up

I have developed arthritis in my hands, and now have lumps on my finger joints. I’m worried they’re going to make my fingers seize up. Can I get rid of them?

These lumps (called Heberden’s nodes) are a common part of osteoarthritis. They do make your fingers look knobbly, but shouldn’t have any serious effect on the way your fingers work. It’s important to exercise your finger (as well as your other) joints when you have arthritis, though, to prevent them from stiffening up.
Dr Sarah Jarvis, Good Housekeeping
 

My osteoporosis medicine has terrible side effects

I suffer from osteoporosis and have already broken several bones as a result, but I get terrible side effects from the bisphosphonate medicine I have to take. I’ve been told there is an alternative called teriparatide, but my GP says it’s expensive and that as I’m in my 70s I’m not eligible for it.

I’m surprised you’ve been informed that your age makes you ineligible for expensive medication on the NHS. This is categorically not the case – nobody should be discriminated against on the grounds of age. Having said that, your GP is right – teriparatide is expensive. For many people, other medicines such as the one you’ve been taking work well, so it is appropriate to reserve the more expensive option for those who really need it. However, teriparatide can be prescribed either for patients where a one-year trial of a bisphosphonate hasn’t worked, or where the side effects mean that you really can’t tolerate it.
Dr Sarah Jarvis, Good Housekeeping

 

Osteoarthritis and steroids

I have osteoarthritis in both my knees, and my GP has suggested injecting them with steroids to help ease the problem. Is this dangerous and could there be any side effects?

Steroid injections directly into your joints are quite a common way of treating all sorts of joint conditions. A recent study in the British Medical Journal looked at whether or not this treatment really worked, and I'm delighted to say the results were very positive. Since the steroid is injected straight to where it's needed, you'll only need a relatively small dose, so it's quite safe, too.
Dr Sarah Jarvis, Good Housekeeping

 

Osteoporosis and HRT

Osteoporosis runs in my family and as a preventive measure I’ve taken HRT for 10 years. After all the scares about the link between HRT and breast cancer I discussed the options with my GP. She said there were other treatments to protect against osteoporosis, including one that could also reduce my breast cancer risk. I’ve now stopped HRT, but when I asked my GP about the alternative, she said she might not be able to prescribe it after all. Why is this?

The advice about taking HRT long-term has changed recently, so you're right to be concerned about taking it to prevent osteoporosis. New evidence suggests that the longer you take HRT, the greater your risk of developing breast cancer. Your GP's advice about alternative treatments is correct, though. There are two main groups of drugs that can help to protect you against osteoporosis and the type your GP mentioned, which also protects against breast cancer, is called a selective oestrogen receptor modulator.
Unfortunately, one of the bodies that decides which drugs can be prescribed on the NHS has been trying to stop GPs from prescribing these medicines unless you've already broken a bone through osteoporosis (although they should still be available at the moment). There are also lots of other ways you can cut your risk of osteoporosis, such as taking regular weight-bearing exercise, including enough calcium and vitamin D in your diet and (if you haven't already) stopping smoking. Your practice nurse should be able to help with further advice about these.
Dr Sarah Jarvis, Good Housekeeping
 

What is the treatment for Paget’s disease?

I’m 43 and have recently been diagnosed with Paget’s disease. I’ve read up on it but would like to know more about possible treatments.
 
Paget's disease affects your bones. No one knows what causes it, but it's the second most common bone disease after osteoporosis. It occurs in up to one in 25 people over the age of 40, although only about one in 20 of these have symptoms. It has two apparently contradictory effects: it makes extra bone develop where it shouldn't and causes thinning of the bones in other areas. It can cause pain in your bones and also make bone more vulnerable to fracture.

The first treatment for Paget's disease is painkillers, which can be very effective. Then there are two other main treatments: one, calcitonin, stops bone from being reabsorbed; the other, a group of drugs called bisphosphanates, is also used to prevent osteoporosis. Which drug is best depends on your symptoms. Calcitonin, for instance, is used if symptoms are mostly caused by areas of your bones becoming thinner. If your symptoms are very severe, you may also benefit from physiotherapy.
Dr Sarah Jarvis, Good Housekeeping
 

Contraception and osteoporosis

I’m 47 and have been using the hormone-releasing coil, Mirena, for several years now. It suits me really well but I’m worried after hearing that contraceptive hormones can increase your risk of osteoporosis.

I'm pleased to say that you don't need to be concerned. The contraception you've heard of is the contraceptive injection, which has been linked with thinning of the bones. The Mirena coil doesn't cause any problems in this respect. It has recently been licensed not only as a contraception and a treatment for heavy periods but also as the progesterone element of HRT, so if you do need HRT in the next few years, you can carry on with confidence.
Dr Sarah Jarvis, Good Housekeeping
 

Osteoporosis and hereditary factor

I’m 45 and I’ve just found out my bone density is a little lower than it should be and I’ve been told I’ll need another bone scan in a couple of years. As my mother has osteoporosis I’m worried about my daughters – if my mother and I both have it, how can I stop them getting it, too?

You're quite right to say your daughters have a higher than average chance of developing osteoporosis, or thinning of the bones, if it runs in the family on your mother's side. You're also very sensible to start thinking about it as soon as possible. As well as family history, some of the other risk factors include physical inactivity, not having regular periods (this could be as a result of anorexia nervosa, for instance), smoking, overactive thyroid disease, premature menopause, or taking steroid tablets long-term.

On the whole, the complications of osteoporosis, such as back pain and broken bones, are uncommon before middle age. However, doctors are increasingly recognising that some of the related problems may start much earlier than this - perhaps in childhood. Therefore, it's very important to make sure your daughters get plenty of calcium in their diet - dairy products, beans and pulses, and tinned fish with bones are all excellent sources. Many dairy products are also high in saturated fat, though, which can lead to obesity and heart disease, and lack of exercise can also make these conditions worse. So overall, eating low-fat dairy products and taking plenty of weight-bearing exercise are essential.
Dr Sarah Jarvis, Good Housekeeping
 

Frozen shoulder and steroid injections

I’ve had a frozen shoulder for the past three months, and have been taking anti-inflammatory tablets and having physiotherapy, but neither has helped. Now my doctor has told me she could inject my shoulder with steroids. It sounds a bit scary. Do you think I should I go ahead?

Frozen shoulder - pain and reduced movement over your shoulder joint - is probably the most common joint problem I see in younger people (although it can affect all age groups). Non-steroidal anti-inflammatory drugs and physiotherapy are both common treatments - although there's limited evidence that physiotherapy helps. However, Clinical Evidence (the GPs' ‘bible' on evidence-based medicine) says local steroid injections can increase the range of movement and reduce pain and stiffness. Steroid injections are also very safe, on the whole. I would certainly consider them a possible course of action.
Dr Sarah Jarvis, Good Housekeeping
 

Osteoarthritis and cod liver oil

I suffer from osteoarthritis and have recently heard that taking cod liver oil capsules might help to relieve the symptoms. Is this true and, if so, how many should I take?

There's quite a lot of evidence that fish oils can help with rheumatoid arthritis - a form of arthritis caused by inflammation, which often affects women in particular. However, the jury is still out on whether fish oil supplements work when it comes to osteoarthritis, the most common joint problem of all, which is largely caused by ‘wear and tear'. Instead of relying on supplements, though, my advice is to eat at least two portions of fatty fish each week - you would certainly benefit from this. Fatty fish include salmon, mackerel, sardines and trout. The oils found in these fish will also help to protect you against heart disease. But if you're still thinking about taking a supplement, the kind with the most solid evidence behind it is probably glucosamine sulphate. It's available from good health food shops in a recommended dose of 1500mg a day.
Dr Sarah Jarvis, Good Housekeeping
 

Osteoarthritis and painkillers

Is there any way to manage the discomfort of osteoarthritis without resorting to painkillers? I hate taking too many drugs if I can avoid it.

Sadly, osteoarthritis is by far the most common joint disease in the UK, with about eight million people affected and about one million seeking help with treatment. Your knees, hips and hands are most likely to cause you problems - although neck and lower back pain are also common. Strange as it may seem, exercise is among the most effective treatments. Try strengthening exercises to improve the tone of the muscles that lie over and around your affected joints, as well as aerobic exercise (the kind that makes you mildly out of breath). Reducing the impact on your joints is absolutely essential - that means flat heels, supportive insoles (which act as ‘shock absorbers') and low-impact exercises - swimming and certain gym routines are ideal. For more advice, contact The Arthritis Research Campaign (ARC) on 0870 850 5000 or write to PO Box 177, Chesterfield, Derbyshire S41 7TQ.
Dr Sarah Jarvis, Good Housekeeping

 
Why do my hands hurt?

 I have arthritis in both my knees and back. My hands are now painful and swollen – does this mean arthritis has spread to them, too?

There are several different types of arthritis, so it’s important to ask your doctor exactly what type you have and whether your hand problems are related. Glucosamine sulphate is helpful for people with osteoarthritis and has been shown to help preserve the knee joint space as well as reduce pain. Omega-3 fish oil supplements help to reduce inflammation and are especially helpful for rheumatoid arthritis. You can obtain support and advice from one of the self-help organisations for people with joint problems. Try contacting Arthritis Care (call 0808 800 4050 or visit www.arthritiscare.org.uk) or The Arthritic Association (call 0800 652 3188 or visit www.arthriticassociation.org.uk).
Dr Sarah Brewer, Prima
 

Am I at risk of developing osteoporosis?

My mother has osteoporosis and I'm worried that I'm at risk too. Constant dieting as a teenager may have affected my bone density. Is there a test? I'm 38.

Osteoporosis does tend to run in families, but there are lots of other factors involved. It affects roughly 15 per cent of UK women in their 50s. By the age of 80, almost 70 per cent of women are at risk. Our bones start to thin after the menopause because levels of the protective hormone, oestrogen, decline. Other factors that contribute are drinking too much alcohol, smoking and immobility. It is unlikely that teenage dieting would make you more susceptible to osteoporosis unless you had a severe eating disorder. Unfortunately, osteoporosis has no warning symptoms. People don't usually realise that they have it until their 70s when a minor fall can cause a major fracture. If you think you are at risk talk to your GP. The ultimate test is a DEXA scan but it is not easily available, so you may have to go privately. Some places do a heel scan, which can identify those who need further investigation, but this is not necessarily available in all areas of the UK.

Tips on prevention:
●Try to take regular exercise; (at least 30 minutes of moderate exercise or physical activity, 4-5 times per week).
●Calcium and vitamin D are both important for maintaining healthy bones. The recommended daily intake of calcium for adults is 700mg. Try taking Osteocare tablets, £8.99, which are available at Boots and most leading chemists.
●Stop smoking.
●Cut down on alcohol to the recommended limit of 14 units a week or below.

For more information, visit the National Osteoporosis Society
Dr Louise Selby, SHE
 

Can I control my lupus?

I was diagnosed with mild systemic lupus when I was 24. Now I’m 36 and have recently had some severe episodes, and it seems to be getting worse. Any advice?

Lupus is an autoimmune disease, which means your body’s immune system is fighting its own tissues. It affects many parts of the body but in particular the joints, muscles and skin. No one really knows why this happens, but lupus tends to affect young women. Unfortunately there is no cure, but there are steps you can take to control it. Non-steroidal anti-inflammatories (NsAIDs) such as ibuprofen can reduce muscle and joint pain. The main side effect is the risk of a stomach ulcer, so tell your doctor if you start to get indigestion. Prescription steroids, such as prednisolone, will reduce inflammation and suppress the immune system, but the dose should be kept as low as possible. Immuno-suppressant drugs such as cyclophosphamide, azathioprine and cyclosporin suppress the immune system, but this leaves you open to infections, so you’ll need regular blood tests. Anti-malarial drugs such as hydroxychoroquine are particularly good for the rashes, fatigue and joint pain associated with lupus.

Lifestyle can also play a part in controlling the illness so try to take moderate exercise, eat a balanced diet, don’t smoke and avoid stress. Lupus skin rash is often sensitive to the sun. Fish-oil supplements may also help. To find out more, visit the Arthritis Research Campaign (www.arc.org.uk).
Dr Louise Selby, SHE

 

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