Arthritis: New, Old Therapies Can Help Ease Pain

Arthritis: new, old therapies can help ease pain

Doctors recommend exercise to alleviate the joint pain that comes with the most common form of arthritis.

(modified from

The Miami Herald Living Health

Posted on Monday, 04.16.12

By Laura Isensee

Twenty years ago, Cookie Wright would walk a lot, in the neighborhood and from her home in Palmetto Bay to the Chapman field to watch her son’s baseball game.

The first signs of rheumatoid arthritis hit her while walking that stretch.

“All of a sudden my feet were hurting. They were like cramping,” recounted Wright, 64. Then came flu-like symptoms. By the next day, the rheumatoid arthritis had flared up so much she could not open her mouth to eat a hamburger at a neighbor’s barbecue.

The condition, when for unknown reasons the immune system attacks the joints and sometimes other organs, has gotten better for Wright over the years with various medications.Exercise has helped considerably, too, said Wright, who also developed osteoarthritis in her knees.

“The osteoarthritis was in my knees and my knees don’t hurt anymore. I can walk farther now,” she said. “It means I’ll be walking at art shows. That was my favorite activity in the winter, to go to all the art shows.”

Doctors say exercise is important for people with arthritis, whether it’s inflammatory rheumatoid arthritis or the more common condition of osteoarthritis (Wright has both.) Physical activity can help patients lose weight, lessening the stress on aching joints. It can help strengthen muscles around the joints, easing chronic pain. Some suggested exercises: low-impact water exercise, Pilates or yoga, tai chi, riding stationary bikes or walking. Physical therapists can instruct patients in specific exercises.

Range of motion

Dr. Michael Weitz, a rheumatologist affiliated with Baptist Hospital and incoming president of the Florida Society of Rheumatology, said exercise can increase a person’s range of motion, especially strengthening the quad muscles — the four muscles that make up the front of the thigh.

“The quad muscle is often weak. By strengthening these muscles, it gives stability to the knee. People have less pain, better function and it can really delay the need for surgery,” Weitz said.

Some people, he noted, can avoid knee or hip-replacement surgeries, which are common in arthritis patients.

Dr. Carlos Lozada, a professor in the division of rheumatology at the University of Miami Miller School of Medicine, said once a patient has knee pain, it can become harder to exercise, creating a “self-perpetuating cycle.”

“It can be difficult to break the cycle,” Lozada said. “Someone who doesn’t find it easy to do exercise outside the water, sometimes if they get in the water, they find it a lot easier to exercise on a regular basis.”

‘put out the fire’

For patients who have inflammatory rheumatoid arthritis, it’s important to “put out the fire” first, said Dr. Carlos Sesin with Mount Sinai Medical Center’s rheumatology department. That means getting the disease under control to prevent joint damage and deformity.

He recommends patients try walking 15 minutes in the morning and again later in the day.

“It sounds quite simple and it can be very effective,” he said. “Obviously an important rule of thumb is if it hurts, don’t do it.”

Wright has built up to a rigorous exercise routine. It includes morning stretches, a 15-minute workout tape that features short bursts of intense activity, plus half an hour of walking on her treadmill or stationary bike and a Pilates class once week. She works out three days on, one day off. In two and a half months, she’s lost nearly 15 pounds. Her arthritis has also been in check with a series of infusions of the drug Rituxan, which targets a type of white blood cell to limit how much the immune system attacks the body’s joints.

Time for surgery?

When a patient can no longer physically function with their debilitated joints or they can’t manage the pain, it’s time to consider surgery, Sesin said.

More patients want to learn about the options for stem-cell therapy, eyed as an emerging treatment to regrow worn-out or damaged cartilage in the joints.

Some doctors in the United States and in foreign clinics do offer types of stem-cell therapy. Dr. Joseph Purita, an orthopedic surgeon based in Boca Raton, said he has had success with his patients, in particular those with knee problems. Among his patients: professional athletes like New York Yankees pitcher Bartolo Colón.

Purita uses a patient’s own stem cells, taken from their bone marrow or fat, and injects them in the damaged area, together with an injection of a platelet-rich concentrate. “We inject the whole soup into the knee. That seems to grow the cartilage. In many cases it makes the patients feel significantly better,” Purita said.

Many doctors advise patients considering stem-cell therapy to research providers and be wary of those charging fees in the tens of thousands of dollars. Stem-cell therapies for arthritis are not approved by the Food and Drug Administration, especially the use of human embryonic stem cells. There are, however, FDA-approved research studies.

Sesin noted stem-cell therapy for arthritis, and nearly every medical specialty, is still in the research phase.

Said Lozada: “The ideal therapy for osteoarthristis is one we don’t yet have. One that not only relieves symptoms, but also slows down or stops the disease progression. While weight loss and exercise can help those effects, we don’t have therapy yet to cure it.”

Squier, who has lived and worked with arthritis for decades, said her advice for other patients: learn to cope.

“Once you’re able to do that and not give in to your aches and pains and carry on as best you can, it’s amazing how you can get by,” she said. “It’s definitely a frame of mind.”