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Judith Horstman Living with Arthritis
Judith Horstman, the author of The Arthritis Foundation's Guide to Alternative Therapies, is an award-winning journalist with 30 years of experience writing and editing for newspapers, national magazines, books, new media, and special-interest publications. Read more about Judith Horstman.
Horstman was a chat guest on June 7, 2000. This is an edited transcript of the chat.
PRx Host :
Welcome to PlanetRx Live Events. Thank you for joining us. Today's guest is award-winning journalist Judith Horstman, author of The Arthritis Foundation's Guide to Alternative Therapies. She joins us today to discuss living with arthritis. Welcome to PlanetRx!
Judith Horstman :
Thank you! I'm glad to be here.
PRx Host :
Your topic today is living with arthritis. What do you do for your arthritis?
Judith Horstman :
Living with arthritis is like having a grumpy old roommate who complains every time you do anything. My arthritis starts giving me a hard time almost as soon as I wake up most days, and sometimes even continues to nag at me long after I go to bed at night. So when you're living with such a disagreeable partner, you've got to develop strategies. Here's what I do to keep the peace.
I have osteoarthritis -- the wear-and-tear kind that's caused by damage to the cartilage lining the joints. I get moving -- and try to stay moving. And that's not easy, especially when my joints are really aching. I start the day by hobbling to a hot shower, and then do some gentle exercises, such as stretching and walking. If it really hurts, I'll ice the sore parts. Lately, even yoga -- my long-time favorite exercise -- is too much for my aching back. So I've been doing a tai chi program specially designed for people with arthritis, and once a week I do aqua aerobics in a warm-water pool.
PRx Host :
Here's an audience question:
chachee :
I am 26 years old and my doctor just told me I might have rheumatoid arthritis. Aren't I too young for this? What is it and how is it treated?
Judith Horstman :
Rheumatoid arthritis (RA) is an inflammatory condition that attacks the linings of the joints -- and no, you aren't too young to get it. It is most common among young women of childbearing age, and even small children can develop RA.
No one knows exactly what causes RA: It appears to be an autoimmune disease, which means your body attacks itself by mistake. There's some evidence RA could be sparked by an infection, and the tendency to develop it seems to be hereditary. It's important to get treatment pronto for any inflammation of the joints before there's permanent damage. Today's new prescription drugs can slow or stop joint destruction. So be sure to see a rheumatologist as soon as possible for a treatment plan.
Acker :
My mother, age 52, was recently was diagnosed with arthritis. What do I need to know? How can I be supportive?
Judith Horstman :
You don't say what kind of arthritis your mother has. I'm going to guess that it might be osteoarthritis -- the wear-and-tear kind. For any kind of arthritis, however, one of the best things to do is to control your weight, since any extra pounds put extra wear and tear on your joints, and to develop an exercise plan to keep your muscles strong so they can support aching joints. You can help your mother, if you live nearby, by joining her in an exercise program. That would be good for you, too.
Marilyn :
I live in San Francisco near the ocean. Are there better climates for me? What should I take into account (besides the fact that everywhere else is cheaper ;-)?
Judith Horstman :
Well, it's sure true that it's cheaper to live someplace else (I live there, too). Warmer climates tend to help people get out and exercise a little bit more. Cold weather can sometimes aggravate joint pain. But even if you live in a cold climate, you can do exercise, especially in warm water, and after all, San Francisco is a wonderful place to live.
Joanne :
My mother-in-law has had lupus for many years. My husband tells me it flares up occasionally. What exactly is lupus and what might cause a flare-up? Is my husband at risk for eventually getting it? How about my kids?
Judith Horstman :
Lupus can be a very serious inflammatory disease. It affects the skin and joints, and can sometimes cause damage to the internal organs as well. Like most rheumatoid diseases, it is not really inherited, but the tendency can be inherited. It affects women mostly -- about 90% of those with lupus are women in their childbearing years (between 18 and 45).
I hope your mother-in-law is getting good treatment from a rheumatologist. Lupus symptoms do come and go. Flares can be caused by stress, so it's important to relieve any stress in your life. Flares can also be sparked by exposure to sun and infections.
There is a new treatment involving DHEA now undergoing clinical trials that might be available soon. This is a hormone that's been popular as an alternative treatment for some years. The version of DHEA they're using now, however, is a special prescription grade, so you don't want to try to self-treat with some off-the-shelf product -- tell her to ask her doctor about this.
Joely :
I am a 30-year-old runner. Is the daily stress on my joints something I should worry about eventually causing arthritis?
Judith Horstman :
The benefits of exercise are so well proven that you probably shouldn't stop running, but you want to be sure that you're not putting extra stress on your joints. The right kind of shoes (to give good support) is important, and be sure to warm up and cool down your muscles. You want to run on a surface that doesn't cause impact damage to your knees.
As you get older, you might want to consider adding some other kinds of non-impact exercise to your program, such as aerobic exercise in a swimming pool or stationary biking. Once you have OA in your joints, however, it's really important to see a physical therapist and get an exercise program especially designed for your individual problems. I've had to give up running and a lot of yoga asanas because they were stressing my back too much.
Remmie :
I hear a lot about glucosamine with chondroitin. What do you think of them?
Judith Horstman :
Glucosamine and chondroitin have both been used in Europe for decades to relieve the pain connected with osteoarthritis. Now, they're getting some respect in the U.S. as well. Studies show that both glucosamine and chondroitin can relieve osteoarthritis pain about as well as ibuprofen, and one study of each seems to indicate that they might also keep your cartilage from breaking down more, or contribute to cartilage repair.
There's a big NIH study about to get underway, which should give us even more information about both of these supplements. Generally speaking, rheumatologists today tend to say they're worth a try. However, this is only for osteoarthritis. They won't do a thing for rheumatoid arthritis.
You need to be careful about the brand you buy, since these are sold as supplements and thus aren't regulated like drugs. So you can't be sure you're actually getting a product with the proper amount of these ingredients.
Joanne :
Where can I find out about DHEA?
Judith Horstman :
There's an article about DHEA on the Arthritis Foundation website, that gives a good background on the drug. You'll be hearing more about it, probably, in the next couple of months as the clinical trials are finished.
PRx Host :
What exactly is DHEA?
Judith Horstman :
DHEA is short for the tongue-twister dehydroepiandrosterone, a mild male hormone, produced naturally by the body, that's used to make many other hormones. It was touted as one of the wonder cures a few years ago, that was supposed to do everything from improving your sex life to helping you live longer. These claims haven't been proven, but as I said earlier, some research using pure forms of DHEA to treat lupus have been very encouraging.
It's now in the final phases of clinical trials, so it may be available soon on the market as a prescription drug for lupus. One of the side benefits, too, that they discovered in research is that it seems to help improve bone density, which is particularly important for older women who are susceptible to osteoarthritis.
PRx Host :
A follow-up question:
Remmie :
How do I know which glucosamine brands are better?
Judith Horstman :
That's a tough question. When you deal with supplements, it's buyer beware. As I said, they aren't regulated as drugs, so there's no guarantee that they have any active ingredients in them or that they are safe. Your best bet in buying any supplement, glucosamine and chondroitin included, is to buy from a major manufacturer who stands behind the product. Dr. Jason Theodosakis, the author of The Arthritis Cure, has a website on which he lists brands that have been tested and found to be good quality. That website is www.drtheo.com.
jcc :
Why are women more likely to be diagnosed with rheumatoid arthritis than men?
Judith Horstman :
It's true more women than men get rheumatoid arthritis, lupus, and fibromyalgia. No one really knows why. It seems to be connected with hormones. However, osteoarthritis -- the wear-and-tear kind -- is pretty much an equal-opportunity disease, and gout attacks more men than women. However, after menopause, women also tend to get gout. Researchers are looking into the hormone connection.
Sarah T. :
Both my parents have arthritis. Does that mean I'll get it, too?
Judith Horstman :
Well, arthritis is not strictly a hereditary disease, but the tendency toward it can be inherited. For example, you might inherit a mechanical problem, a problem in the way your joints are put together or you may have a muscle problem which might lead to extra wear and tear which could contribute to developing osteoarthritis later. There is a genetic connection for rheumatoid arthritis, but again, the tendency appears to be inherited rather than the disease. If both your parents have it, you probably have a greater chance of getting it than someone whose parents don't have it, but it doesn't mean that you'll definitely get it.
Jessica :
I'd like to recommend some alternative arthritis treatments for my sister. What's safe and effective?
Judith Horstman :
That depends on what kind of arthritis your sister has. In my book, The Arthritis Foundation's Guide to Alternative Therapies, we talk about many treatments for different kinds of arthritis. Probably anyone with a chronic disease can benefit from stress reduction, since pain and stress often contribute to the discomfort of having a chronic disease like arthritis.
Stress-reduction courses are available through many hospitals, clinics, and even community centers, and yoga, meditation, and tai chi can help your mind and your body. In spite of all my warnings about supplements earlier, there are several that can help with the symptoms of different kinds of arthritis. You can find out more about those in my book, since the type of supplement you would use depends on what kind of arthritis you have.
Curios :
Do copper bracelets really help with arthritis pain?
Judith Horstman :
Probably not. The theory is that copper is absorbed through the skin. There is one study that shows that people who wore copper bracelets claimed to have a little less pain, but that hasn't been repeated. There are a bunch of studies from Europe that show that injections of copper supplements seemed to have some effect, although people had bad reactions to that as well. Bottom line, if the copper bracelet that you're wearing is shiny, you couldn't get any benefit from it because it's lacquered, and the copper isn't touching your skin. I think they make a nice fashion accessory.
Martyn :
What causes arthritis? In my case, it appears to have developed following injury. Is this typical?
Judith Horstman :
It sounds like you're talking about osteoarthritis, in which the cartilage is damaged or worn away. This kind of arthritis can be brought on by an injury. A lot of athletes, particularly football players, have osteoarthritis. Some people develop it after an accident, and some people who do heavy labor, such as carpenters, can develop arthritis in the joints that are repeatedly stressed. So that's why you need to be careful about the kind of exercise that you choose. As you get older, be particularly careful about high-impact exercise.
Bethy :
How do you know if you have osteoarthritis?
Judith Horstman :
Pain is probably going to give you the message, but you could be having pain from a sore muscle or something else as well. If you have any kind of pain in your joints that lasts more than 10 days or is connected with any kind of swelling or redness, go and see your doctor right away to make sure it's not an infectious arthritis. OA, or osteoarthritis, generally isn't determined by any kind of test. Your doctor can do an X-ray, which would show if the joint has narrowed due to cartilage loss or damage. It's generally diagnosed by pain and creakiness.
SMileyP :
I was diagnosed with JRA at age 11 and my doctor told me that it expired, meaning that it's gone from my body. I'm 21 now and still in pain. Have you ever heard of this? What is the cause?
Judith Horstman :
I think you should go to a doctor right away! It's true that people who get juvenile rheumatoid arthritis can sometimes find their symptoms lessen as they get older, but any kind of pain in your joints needs a doctor's attention -- especially if you were ever diagnosed with rheumatoid arthritis in the past. Call a doctor today.
One more comment about osteoarthritis and how you can tell if it's osteoarthritis: Generally, you tend to get osteoarthritis in joints on one side of your body or the other. You tend to get rheumatoid arthritis bilaterally (for example, in both your knees or both your hands). If you have one bad knee or a bad elbow, or spine or neck, it may be OA.
CatCrazy00 :
I was recently diagnosed with fibromyalgia after years of pain and seeing many doctors. What do I do now?
Judith Horstman :
Fibromyalgia is a difficult diagnosis. It's often confused with chronic fatigue syndrome. The main symptom of fibromyalgia is chronic pain, as you probably know very well. A rheumatologist who specializes in fibromyalgia can be a big help to you. Lifestyle changes are especially helpful, like mild exercise -- and by mild, I mean exercise that doesn't fatigue you, since extreme fatigue is one of the symptoms of fibromyalgia.
Fibromyalgia is often marked by sleep disturbances, so your doctor may want to give you low doses of an antidepressant or another drug that would help you sleep better at night. Several studies have shown that meditation, stress reduction, yoga, and/or tai chi help people with fibromyalgia.
JD1 :
I am approaching 30 and have arthritis. I want to get pregnant in the next year. Will pregnancy make my arthritis worse?
Judith Horstman :
I don't know what kind of arthritis you have, but anyone with a chronic disease who is thinking about getting pregnant should definitely talk to her doctor in detail. For one thing, you may need to be taking some pretty strong medication that could be dangerous to a developing fetus. Some of these medications have effects that last for some time after you stop taking them.
On the other hand, some people with rheumatoid arthritis have found that pregnancy seems to give them a brief remission in the disease. But I don't think anyone would recommend pregnancy as a treatment for RA. Please talk to your doctor in detail about this, and see what she advises.
Budkate :
But how do you stop the pain with fibromyalgia?
Judith Horstman :
Pain is probably the symptom of all kinds of arthritis that bothers people the most, and it's certainly the major symptom of fibromyalgia. It can grind the joy right out of your life, and sometimes it seems it won't go away.
Support groups can be an enormous help to people who have any kind of arthritis, and the Arthritis Foundation has special support groups for people with fibromyalgia. Because people tend to think that fibromyalgia is "all in your head" or not a real disease, it's especially useful for you to be around others who understand what you're going through. Visit the Arthritis.com message boards for online support. Or take the time today to call the Arthritis Foundation and find out about a face-to-face support group. Their number is 1-800-283-7800.
The thing that helps me a great deal with my osteoarthritis pain is deep relaxation. That's where you basically lie down on the floor, and do breathing and relaxation exercises as you visualize your body relaxing, part by part. I use tapes to help myself do this. I've found them an enormous help for my pain. It doesn't work for everyone, and not every tape will be appealing to you, but it's worth trying.
joncohen :
Are there any dietary guidelines to follow to reduce arthritis symptoms?
Judith Horstman :
People are always looking for special diets to help relieve many kinds of chronic diseases. Alas, so far, no one has found any one special diet that can help with arthritis. There is some research that a diet that is lower in animal fats and high in omega-3 oils helps some people, and certainly, a diet based on the Heart Association guidelines is best for everyone. Frankly, the diet that would probably help all of us with arthritis the most is one that helps us keep our weight at a reasonable level. I know I'm about 20 pounds overweight now.
Bethay :
Does vinegar really restore fatty acid count to your joints for less inflammation?
Judith Horstman :
I asked doctors about that when I was researching my book. My father keeps telling me apple cider vinegar works for him, but there is no research that shows that it's true. There's also a theory going around that involves raisins soaked in gin. While the gin may make you feel better, and the raisins will give you some useful vitamin C, it isn't a therapy most doctors recommend for arthritis.
PRx Host :
Let's go back to your comments on exercise. A related question:
SarahT :
What are the best surfaces to jog on?
Judith Horstman :
Most sports specialists recommend that you run on a surface that's level and free of rocks or gravel that may cause you to turn an ankle or knee or fall. If you're having aches and pains in your knees, ankles, or hips, you probably want to run on a soft-firm surface such as a running track and not a highway. That's a question you might want to check with a sports specialist on. Common sense says you want to avoid injuring your joints more with impact on a hard road.
Julie :
How about magnets for relief of arthritis pain? I have seen neck and back pillows with magnets inside of them, and I have to wonder if it is a legitimate claim.
Judith Horstman :
Magnets are advertised everywhere these days for pain relief. There are two small studies in which some people said that magnets seem to relieve their pain. However, there are other studies that show they had no effect. Bottom line: few doctors believe that magnets do anything for pain; however, they also don't think they do any harm. If they make you feel better, and don't cost too much, you might try them. The placebo effect is pretty powerful. But you might want to spend your money on something that will definitely make you feel better, such as a massage or an exercise program.
Tiggerluv :
I want to start an exercise program and I have arthritis. What should I do? What kind of exercise is most suitable for someone with arthritis?
Judith Horstman :
The Arthritis Foundation has several exercise programs designed especially for people with arthritis. By calling the local chapter, you can find a program near you. They're generally low-cost, and they're geared toward people who have sore or damaged joints, so that you can exercise faithfully. They also sell exercise tapes that you can use at home alone, and as I said, the water aerobics courses are great for people with sore joints. It relieves gravity.
GSon :
My grandmother has arthritis really bad in her neck and shoulders. Is there something that is better for older people to do? She doesn't relax very well, so how could I trick her into it or something?
Judith Horstman :
Relaxing is important. I think that just about everybody likes a nice, gentle, soothing neck and back rub. You need to be careful if your grandmother is frail, but I think putting on some soothing music and offering to give her a nice back rub (fully clothed, since a lot of older people don't like to take off their clothes) might be really relaxing for her.
Also, if her arthritis is really hurting her, she might want to join a support group of people her own age. I'm assuming that your grandmother is older, but you know, you're never too old to learn how to do stress-reduction stuff. And don't underestimate the power of humor. A funny movie on video might help her relax.
PRx Host :
What is the best way to get pain relief?
Judith Horstman :
That depends on what's causing you pain. For most kinds of joint achiness, alternating hot and cold can help a lot. I often start the day with a hot shower, just to get moving. I often end the day by getting into bed with an ice pack under my sore joints. You can get reusable gel packs that can be re-frozen and you can get packs with rice or other softer things in them that can be reheated in a microwave. A lot of people get relief also with rubs, made either of hot pepper (capsaicin), eucalyptus, or an aspirin-type ingredient. These can be bought over the counter. I rub them into my knees and ankles when they hurt.
But be sure to wash your hands thoroughly afterward, because these ingredients can really burn your mucous membranes in your eyes or other delicate body parts. By the way, for the person whose grandma has the sore back and neck, some of these rubs might be useful for you to use in a gentle massage.
PRx Host :
A long question for you:
JennieBez :
I have been suffering from what I'm quite sure is arthritis since I was 16, maybe earlier. It started in my knees, then appeared in my hands, and just this year has been affecting my feet and ankles. I've tried to get three different doctors to give me a definite diagnosis, but all have seemed generally apathetic about helping.
The first simply told me "If you think it's arthritis, it probably is," and left it at that. He never actually performed any tests or X-rays to diagnose me.
The second said it sounded like arthritis from my description, but that if it wasn't bothering me seriously, he wasn't going to diagnose me because he didn't want to adversely affect my insurance premiums.
The third, my current doctor, did the most in that she had a blood test performed to see if it was rheumatoid arthritis, which came back negative (I have no swelling or redness associated with my joint pain). She told me that beyond this blood test, there was little she could do to diagnose or treat osteopathic (non-rheumatoid) arthritis.
Is she correct that there is nothing she or I can do to treat my pain? It has gotten so bad that I have trouble walking in the morning because my feet are so stiff and sore. I am always seeing advertisements for arthritis medicines -- are these only for rheumatoid arthritis? Where is the best source of information for non-rheumatoid arthritis?
Judith Horstman :
It sounds like you do have osteoarthritis, which is caused by wear and tear or damage to the cartilage. So far, there is no cure for this, and no one has found any way to stop its progression. There are things you can do to relieve the pain. We've talked about some of them before, such as the supplements glucosamine and chondroitin, which have been shown to be as effective as ibuprofen and other nonsteroidal anti-inflammatories. And these may help stop further cartilage loss -- no one knows for sure yet. The rubs that I talked about, which come under many commercial names over the counter, can help with the pain.
There is also a treatment in which fluid to replace your hyaluronic acid is injected into the knee joints that offers temporary relief -- six months or so -- for many people.
I know exactly what you mean about getting up in the morning. As I said, I have to hobble into the shower myself. A nice massage can help. Now, about the advertisements that you see for arthritis medicines: If you're talking about the ones that are nonprescription, most of these don't have much evidence to support them. Some of them might even be harmful.
You might want to check the PlanetRx.com satellite site on arthritis, called Arthritis.com. It has a lot of good information on living with arthritis. My book, which is produced by the Arthritis Foundation, also has some good basic information on dealing with pain, and the Arthritis Foundation has some excellent information. Good luck to you. I know what it feels like!
PRx Host :
Can you comment on how arthritis is diagnosed?
Judith Horstman :
Arthritis can be a difficult diagnosis sometimes. Generally, osteoarthritis, as we said earlier, is diagnosed by pain and stiffness in the joints. Sometimes it is confirmed by X-rays. More than half of people older than 65 have some kind of osteoarthritis. Rheumatoid arthritis is diagnosed with a series of blood tests, as well as examination. That's treated more aggressively since untreated inflammation can rapidly do permanent damage to your joints.
PRx Host :
You've mentioned tai chi as an exercise you enjoy doing. Can you talk a little about this?
Judith Horstman :
I love doing yoga, and I've done it for more than 30 years. But after an accident two years ago set off OA in my neck and back, I found that doing a lot of yoga asanas, like the sun salutation, which has a lot of forward bending, was causing flares and giving me a lot of pain in my back. In fact, my doctors actually suggested I stop doing most yoga.
That's when I discovered tai chi, which I had heard about before. What I like about tai chi is that it combines some of the mental and spiritual benefits of yoga. It involves breathing and a relaxed state of awareness, and a focus on very controlled and simple movements in the moment.
Tai chi doesn't require any special clothing or any special equipment, but it does require a good teacher. My current teacher is an Australian family practitioner who is also a tai chi expert, Dr. Paul Lam. He has a video called "Tai Chi for Arthritis" that is endorsed by the Australian Arthritis Foundation and available most places.
I've been using Paul's video, and I was fortunate enough to take some classes from him when he was in the country last month. What is wonderful about tai chi is that it really seems effortless, and yet you are building your muscle strength gently. It also improves posture and in studies has been shown to improve balance so much it reduced the risk of falls in the elderly by nearly 50%. It requires you to have your posture correct and lined up so you aren't stressing your joints. I feel very relaxed after doing it, too.
GSon :
Is stretching good for arthritis? I'm thinking about my grandmother again.
Judith Horstman :
Stretching is good for just about anything, but it has to be the right kind of stretching. Some people have learned to do stretching by getting into position and then "bouncing" gently or even hard. This is the wrong kind of stretching and can tear your muscles or ligaments. The kind of stretching you or your grandmother will want to do is very gentle. It shouldn't hurt while you're doing it or after you stop doing it. It shouldn't be an extreme posture.
You can check out one basic stretch yourself. One of the common hamstring stretches people do is to stand facing a wall. Put both your hands on the wall at chest level and take one of your feet and step it back about 21/2 feet behind you. Gently lower that heel to the floor while bending the knee of the other leg. You hold this stretch for perhaps 30 seconds, not bouncing and not pushing, just breathing and relaxing into it. Then you do the other leg the same way. You'll feel your hamstring muscles gently let go a bit. That's the kind of stretching you want to do.
Again, the Arthritis Foundation offers a number of courses and videos that will help people do stretching that's good for them. For your grandmother, you may want to look into senior centers. The one near me offers tai chi and mild aerobics classes. I'm often in tai chi class with people who are in their late 80s who are doing great.
PRx Host :
Can you talk about herbs for arthritis?
Judith Horstman :
There are a lot of herbs that are being promoted for arthritis right now. There is scientific evidence that some of them can help. For example, ginger is known to have an anti-inflammatory effect. It helps with nausea as well. St. John's wort can help with mild depression, which affects a lot of people who have a chronic disease like arthritis. Green tea in some animal studies has been shown to help with inflammation for arthritis.
However, just because they are "natural" doesn't mean they are safe. If they are powerful enough to help you, they can also do harm. And the main problem with herbs is, again, the lack of both government and quality control. You just don't know what you're getting when you buy them, even when you buy them shrink-wrapped and professionally packaged to look like official over-the-counter drugs. In fact, there have been a number of concerns lately about herbs that are contaminated with heavy metals and perhaps even adulterated with drugs of some kind. It's a buyer-beware situation.
PRx Host :
We've just about run out of time. Is there anything else you'd like to share?
Judith Horstman :
Yes. Remember that attitude is really important when you're living with a chronic ailment like arthritis. Don't forget the value of humor in movies and other entertainment, as well as companionship from your friends, family, and loved ones. Stay active. Keep moving and be happy!
PRx Host :
Thanks so much for joining us, Judith. Good night, everyone!
M O R E A B O U T J U D I T H H O R S T M A N
Judith Horstman is an award-winning journalist with 30 years' experience writing and editing for newspapers, national magazines, books, new media, and special-interest publications. She has won two Fulbright Scholar grants, a Vannevar Bush Fellowship for the Public Understanding of Science from MIT, and numerous awards from the Associated Press and the Best of Gannett for feature writing. Horstman has taught at Keene College, Oregon State University, and Santa Clara University.
She is the author of the award-winning book The Arthritis Foundation's Guide to Alternative Therapies, a thoroughly researched review of alternative and complementary arthritis treatments, including herbs, magnets, acupuncture, and acupressure, as well as tai chi, yoga, and meditation.
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