Here is My Question:
I think my SPMS is being made more uncomfortable by arthritic changes and I'm wondering what meds will help?
This is a really good question. MS never exists in a vacuum; instead it co-exists with everything else life throws at you, including old age and arthritis. In most cases your joint problems are a result of osteoarthritis, especially if the pain involves knees, hips, shoulders and/or spine. You can think of this as a form of wear and tear arthritis that can be accelerated by the muscle weakness and sensory alterations associated with Multiple Sclerosis.
There is no single treatment for osteoarthritis . You need to take an integrated approach that involves exercise (especially Tai Chi and Yoga), mindfulness/meditation and relief of pain with non-steroidal anti-inflammatory medications (think motrin). Additional approaches may include corticosteroid injections in several different types of joints for short term relief of pain and injections of the knee joint with hyaluronic acid for more long term pain reduction. Glucosamine and chondroitin sulfate may also be beneficial for knee pain in some people. More recently, platelet rich plasma injections have been used to treat joint, tendon and ligament injuries.
For patients with more advanced osteoarthritis involving the hip and knee and, in some cases, the shoulder, your doctor may recommend total joint replacement surgery even if you have more advanced progressive disease. This type of surgery done in the right hands in well selected patients can dramatically improve function and quality of life
In my experience it is best to be evaluated by specialists in sports medicine and pain medicine for relief of joint, bursa (the lining around the joint), ligament and tendon pain. The correct diagnosis is of utmost importance. They will refer you to an orthopedic surgeon if they believe surgery is a good option
Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
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