Ask the doctor - bones and joints

Woman in a towel clutching her side in pain

Click here for the main Ask the doctor page, with questions and answers from our magazine doctors on 25 health topics

I have really brittle nails. I’ve tried taking gelatine and painting on various oils and nail hardeners, but nothing really works.
Silica is essential for strong, healthy nails and to strengthen ligaments, tendons and joint cartilage. It also promotes strong bones, but is di cult to absorb from the diet. A liquid supplement containing soluble silicon is therefore the best way to top up your levels and may help to strengthen your nails as well as improving brittle hair. Try Body Elements silicon food supplement (£17.95 from www.coreelements.co.uk).
Dr Sarah Brewer, Prima (Apr 12)

My 76-year-old mother has just broken her hip after a minor fall – would it be a good idea for me to be checked out for osteoporosis?
I can understand why you are worried and you should certainly talk to your GP especially if you are over 50. Before the menopause, women are
protected against bone loss by the female hormone oestrogen. After the menopause, when oestrogen levels drop, they lose bone more rapidly than men, which is why women are at greater risk. By the age of 70, some women have lost a third of their bone and about 80% of women over 80 are affected. Factors that increase your risk of osteoporosis include a family history (especially on your mother’s side) of hip fracture; being underweight or a history of being underweight (especially anorexia nervosa); having rheumatoid arthritis, Crohn’s disease or ankylosing spondylitis; going through the menopause before the age of 45; smoking; alcohol intake above four units a day; being immobile for prolonged periods, for example because of illness; and taking oral steroid tablets. While men are less likely to suffer from osteoporosis than women, they are by no means immune – about one in three UK women and one in 12 men over 50 are thought to have osteoporosis. As in your mother’s case, having a ‘low impact fracture’ – that’s a bone breakage with a fairly minor accident, such as a fall from standing height rather than a car crash or falling off a ladder – should raise suspicion about osteoporosis. From April 2012, GPs will have targets to try to ensure all patients who have such a fracture are checked out and treated appropriately. For people under 75, this will involve having a DEXA scan, which measures their bone density. If this shows evidence of osteoporosis, they should be treated. For over 75s, like your mother, the risks are so high that they should be treated automatically if they have a low impact fracture. Treatment usually involves a single daily or weekly tablet called a bisphosphonate.
Dr Sarah Jarvis, Good Housekeeping (Feb 12)

I suffer from a condition that affects my fingers called Dupuytren’s contracture. My GP has said I’ll probably need surgery, but my brother, who lives in America, has had a new injection – can I get it in the UK?
Famous sufferers of Dupuytren’s contracture – a thickening of the tough connective tissues of the palm of the hand that makes the fingers curl inwards – include Margaret Thatcher and Ronald Reagan (they had more in common than their political views!). It often runs in families and, although it’s rarely painful, it can be debilitating, so treatment may be advised. Surgical options include using a needle to cut the thickened tissue – a fairly minor procedure but not suitable for everyone – or opening the skin of the hand and cutting open the affected tissue or removing it. The new non-surgical treatment your brother has had involves injecting an enzyme that breaks down the thickened tissue. It has just been approved in the UK for people who have Dupuytren’s contracture with a cord of tissue that can be felt under the skin. Like many new treatments, it isn’t available everywhere yet – ask your GP about your options.
Dr Sarah Jarvis, Good Housekeeping (Nov 11)

I have Raynaud’s syndrome, and get very painful fingers in cold weather. Is there any way I can avoid the same thing happening again this winter?
Up to one in six Britons suffers from Raynaud’s syndrome, most commonly in the fingers – although the toes, ears and nose can also be affected. Constriction of your small blood vessels, especially in cold weather, makes your fingers white and cold, then bluish as oxygen is used up. When the blood vessels open again, the fingers go red and you can get numbness as well as pain and tingling. In most people there is no obvious cause, although it can run in families. Smoking can make Raynaud’s – like so many other conditions – worse. So, too, can some medicines including beta-blockers (used for heart problems), some anti-migraine medicines and some decongestants. If you’re taking any of these, changing to an alternative may improve your symptoms. Try avoiding caffeine (in tea, coffee and cola drinks) for a few weeks to see if this helps. Regular exercise can improve circulation too, and it is obviously important to avoid getting cold in the first place, so you should put on gloves and/or warm socks before you go outside. If your symptoms are severe, a medication called nifedipine may help.
Dr Sarah Jarvis, Good Housekeeping (Oct 11)

I have osteoarthritis in my knees and hands. I’ve been taking ibuprofen for a couple of years, but a friend has told me this can damage the stomach. I feel fine, so do I need to worry?
Osteoarthritis is very common – it affects about 8.5 million people in the UK. Many people do need to take pain-relieving medicines, but you shouldn’t be relying on them alone. There are lots of other treatments that can also make a difference, either alone or combined with pain relief. If you’re overweight, losing it is key, as excess weight increases the strain on joints. Regular exercise is also important – many of my patients worry it will make their symptoms worse, but the opposite is actually true. You do need to avoid ‘high impact’ exercises such as jogging on hard surfaces, but swimming, yoga or cycling will reduce stiffening. National guidelines suggest you should only use NSAID painkillers such as ibuprofen or diclofenac if paracetamol isn’t enough, and only in conjunction with medicine to protect your stomach. Worryingly, a recent survey found almost half of patients don’t know that NSAIDs can raise your risk of bleeding from the stomach and aren’t being prescribed additional protection.
Dr Sarah Brewer, Prima (Jun 11)

I have osteoarthritis in my knees and hands. I take painkillers when I have to, but I don’t like taking them regularly. Are there any natural alternatives?
I’m not a fan of supplements except for specific health problems, and certainly most healthy people don’t need to take them regularly. However, for some conditions, herbal remedies and supplements can provide safe relief from symptoms. Old wives’ tales abound about the benefits of cider vinegar and other alternative treatments for arthritis, but few have been tested in proper trials. Glucosamine and chondroitin is a popular combination that does seem to help some people, although a recent review of the studies has sparked debate about how effective they are. More recently, there have been promising results in studies on GOPO, a compound isolated from rosehips. For instance, in one study comparing GOPO with placebo, eight out of 10 osteoarthritis sufferers reported an improvement in their symptoms with the ‘real thing’. You can buy it as LitoZin, but it’s not available on NHS prescription. However, as yet we don’t know if all rosehip preparations provide exactly the same benefits.
Dr Sarah Jarvis, Good Housekeeping (May 11)

My husband is 35 and has just been diagnosed with ankylosing spondylitis. He’s been told it can’t be cured, but is too scared to ask his doctor what the future holds.
What he has is a kind of arthritis that affects 200,000 people in the UK, three quarters of them men. The main symptoms are back pain and stiffness, often accompanied by fever and feeling generally weak and unwell. However, your husband may be well for long periods between flare-ups. Most people who have ankylosing spondylitis don’t have severe problems from it, even in the long term. Having said that, around one in 10 sufferers also get episodes of a very painful eye condition, and it can affect other joints as well as the spine. The mainstay of treatment is non-steroidal anti-inflammatory (NSAID) medicines, like ibuprofen or diclofenac, so regular anti-ulcer medication should also be taken to reduce stomach side-effects from these. If NSAIDs don’t control his symptoms, medicines used to treat other kinds of arthritis (such as rheumatoid arthritis) may help.
Dr Sarah Jarvis, Good Housekeeping (Apr 11)

I recently developed painful swelling in the joints of my hands. My GP did some blood tests and X-rays and says I have viral arthritis, but it should settle down. How can he be so sure?
Viral arthritis is simply an inflammation of the joints following a virus infection. We don’t know why one person gets joint inflammation from the same virus that in other people causes only mild symptoms like a sore throat or cold. It’s likely to be related to an over-reaction by your body’s immune system, which usually fights off disease. There is no specific test for it, but your doctor is likely to have ruled out other causes of arthritis with the tests you mention. Viral arthritis usually affects small joints – hands, feet, wrists and ankles – rather than bigger joints like the hips. It often starts with stiffness, followed by pain and sometimes swelling. In most people, viral arthritis settles on its own within a few weeks and doesn’t cause lasting damage. Fortunately, having it once does not mean you are at increased risk of getting it in the future.
Dr Sarah Jarvis, Good Housekeeping (Mar 11)

I’ve been told I need a knee replacement, but I’m worried I’ll be out of action for ages while I recover and that the replacement might wear out before I do. I’m only 52.
Hip and knee replacements are now common practice because they are so effective – but they do involve major surgery and tend to wear out within 10-15 years. However, by avoiding high-impact exercise and keeping your weight down, you can keep the life of your new knee to a maximum before a further replacement is necessary. The operation itself lasts about two hours and you may be in hospital for five days – less if you’ve recovered enough to get around easily and can manage stairs. After the operation the hard work begins, and you will need to do daily physiotherapy exercises. However, this should allow you to be off crutches and back to non-strenuous movement within four to six weeks. You will need to avoid driving, though, until you can perform an emergency stop without problems.
Dr Sarah Jarvis, Good Housekeeping (Feb 11)

I’ve had multiple sclerosis for 12 years, and have such bad muscle spasms that I’m now housebound. I’ve read about a new treatment based on cannabis, but is it as risky as it sounds?
Muscle spasm affects almost all of the 1 million multiple sclerosis (MS) sufferers in the UK at some point, and can make activities like washing, dressing and picking things up difficult or impossible. MS sufferers have long known that cannabis can help, and the MS Trust has campaigned for years for a licensed, regulated version. Sativex contains strictly controlled doses of cannabinoids – the active ingredients of cannabis. It doesn’t always work, but in trials it relieved symptoms in at least half of people. The most common side effects are tiredness and dizziness, but it’s worth considering if other measures haven’t worked for you.
Dr Sarah Jarvis, Good Housekeeping (Jan 11)

I take a medicine called celecoxib for my arthritis, but one of my friends said she’d read somewhere it might increase my risk of having a heart attack. What should I do?
In short, don’t panic! Like you, every year millions of people in the UK take drugs from this family of Non Steroidal Anti-Infl ammatory Drugs or NSAIDs. Unfortunately, indigestion or even bleeding from the gut is a common side effect of NSAIDs. That’s why drugs like celecoxib, which control pain and inflammation but are gentler on the gut, were introduced. A few years ago, some studies noted people taking these drugs were more likely to have heart attacks. But research since has shown the risk isn’t much different from taking other NSAIDs. What’s more, a recent study found celecoxib is much safer in terms of gut side effects than common alternatives, even for people taking anti-ulcer medicines to protect their stomachs. If you aren’t at high risk of heart disease, I see no reason for you to worry about continuing.
Dr Sarah Jarvis, Good Housekeeping (Nov 10)

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 10)

My pharmacist recommends a magnetic bracelet for my joint pains, but I’m sceptical. Do they work?
I wear a magnetic bracelet every day and often a necklace, too, as I find them helpful for my knees. Research, published in the 'British Medical Journal', looked at almost 200 people with osteoarthritis who were given either a real magnetic bracelet or a dummy one to wear for 12 weeks. Those wearing the real bracelets had a greater reduction in hip or knee pain than those with a dummy bracelet.
Dr Sarah Brewer, Prima (Sept 10)

My mother has dreadful bunions and had to have major surgery. I've never worn high heels, but now I'm getting bunions too. Are there any medical advances that can stop them from getting worse?Unfortunately, bunions often run in families. If your second toe is longer than your first, you may be particularly prone to them. As you’re aware, high heels or tight shoes make bunions worse by putting additional pressure on the big toe joint and causing friction, which may result in inflammation, soreness or even infection over the skin covering the joint. Surgery is still the only permanent solution to bunions, but it’s not always as dramatic a procedure as it used to be. Traditional bunion surgery involves breaking the foot bone at the base of the big toe and then pinning the toe back into place. These days, a few hospitals offer the experimental option of ‘keyhole’ surgery, which is less invasive. The bone still needs to be broken and re-aligned, but the accompanying swelling and pain are less marked.
Dr Sarah Jarvis, Good Housekeeping (Aug 10)

I try to keep active by walking and jogging, but get pain in my knees from mild osteoarthritis. I take fish oil and glucosamine supplements. Do rub-in creams work?
Many people find painkilling gels containing analgesic drugs (such as ibuprofen) helpful, and stronger ones are available on prescription. Research has shown that comfrey cream can also significantly reduce pain and improve knee mobility. Try ComfreyCare Joint Cream (£9.95 for 150g from healthspan.co.uk) or Seven Seas Jointcare Comfrelieve Cream (£7.19 for 50g from lloydspharmacy.com). It is also effective in treating ankle sprains and back pain.
Dr Sarah Brewer, Prima (Jul 10)

My husband has Dupuytren's contracture in his right hand that restricts movement and can be quite painful. Would osteopathy or acupuncture help?
Dupuytren's contracture is a thickening of fibrous tissues in the hand. This causes gradual puckering of the skin and pulls the ring and little fingers down towards the palm. Unfortunately, osteopathy and acupuncture are unlikely to help as this is a structural problem. Surgery is the treatment of choice when the condition is advanced, although recurrences are common. Some researchers claim that high-dose vitamin E can improve contractures. Other antioxidants, such as vitamin C, Pycnogenol, grape seed extract, green tea extract and co-enzyme Q10 may help, but there is little research into their effectiveness. Information about medical treatments for patients (NHS and private) is available at dupuytrens.co.uk.
Dr Sarah Brewer, Prima (Jun 10)

I had a bone density scan recently to check for osteoporosis. Apparently I don't have it, but my doctor says I have osteopenia and need to take calcium supplements. The trouble is, I've tried several different calcium tablets from the pharmacy and they taste revolting! Do I really need to take them?
Osteoporosis is diagnosed when your bones are found to be thin on a bone density or DEXA scan. Osteopenia is a precursor to full-blown osteoporosis, so it’s hugely important to stop your bones getting thinner – 180,000 people in the UK break a bone every year because of osteoporosis. Taking weight-bearing exercise and avoiding more than four units of alcohol a day will help. Calcium and vitamin D supplements may also be useful – different guidelines suggest you need between 700mg and 1,200mg of calcium a day. Sadly, calcium carbonate is basically chalk, which is why many supplements taste terrible. You could try a new over-the-counter product, Calci-plus, which many of my patients prefer – two tablets provide 800mg of calcium.
Dr Sarah Jarvis, Good Housekeeping (Jun 10)

I love wearing heels, but my feet are starting to suffer. I've got painful bunions and my feet look very ugly. Can I have something done about it that doesn't involve being laid up for several weeks?
A bunion is a bump that develops at the base of the big toe and becomes sore and swollen, especially if it rubs against shoes. No one knows why people get them, but high heels and ill-fitting shoes can make the symptoms worse. You need to see a podiatrist for treatment. If you're lucky, a change of footwear may help (but it's likely you'll have to stop or limit the time you spend wearing very high heels) and taking painkillers can ease your discomfort. If that doesn't help, surgery may be your only option - but recovery tends to be long and you might be unable to walk for six weeks. The procedures available range from simply shaving the bunion to replacing the joint of your big toe. Talk the options through with your specialist - but taking time out may be best for a long-term solution.
Dr Louise Selby, SHE (May 10)

I'm in my mid-forties and have been diagnosed with early stage osteoporosis. My mother has serious osteoporosis (and several collapsed vertebrae in her back). Is there anything preventative I can do to help reverse my condition?
Osteoporosis is a thinning of the bones, occurring in three million women in the UK and affecting about 20 per cent of women aged 60-69. When your bones are thin, they turn brittle and fracture easily. In the worst cases of osteoporosis the bones in the spine collapse, as they can't support the weight and activity. In other cases, even a minor fall can lead to either a fractured hip or wrist. There isn't currently a treatment to reverse osteoporosis, but it is possible to help prevent further thinning. People with a family history are, of course, at greater risk. Other risk factors include steroid use, a poor diet, being underweight, excessive alcohol consumption and smoking; some bowel and hormonal disorders are also associated with osteoporosis. You have developed osteoporosis at a young age, so it's important that you do regular weight-bearing exercise and include at least 700mg of calcium a day in your diet. It's also advisable to take calcium and vitamin D supplements. A bisphosphonate, such as alendromate, is the standard osteoporosis medication prescribed by your GP. However, there are some side effects, including abdominal pain and indigestion. But exciting new research into a treatment called denosumab (a twice-yearly injection) is looking positive and there are few side effects. If denosumab proves to be effective, it could be available some time in 2010.
Dr Louise Selby, SHE (Jan 10)

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