Dear Dr. roach: What is the best medicine for arthritis? My doctor prescribed diclofenac sodium and another doctor said that with prolonged use it will damage my liver and kidneys. As you know, arthritis is a chronic disease. Let me know what medicine can I take for arthritis.
— AA
Dear AA: I assume you mean osteoarthritis, the most common type, not an inflammatory arthritis like rheumatoid arthritis. If you don’t know which type you have, ask your doctor, as inflammatory arthritis requires a very different and aggressive treatment.
The best medicine for osteoarthritis is probably no medicine; it’s exercise. For people who are early in the course of arthritis, a regular exercise program improves both pain and function, but for people with more advanced arthritis, it can become more difficult to exercise. Severe hip and knee arthritis often benefit from swimming, which relieves stress on the joints and allows for less painful movements.
Diclofenac is a common non-steroidal anti-inflammatory drug that is effective for many people. All NSAIDs can cause stomach damage, including irritation, bleeding, and ulcers. Heart disease remains a concern, although diclofenac in particular is less likely to cause it than others. People with kidney disease should be very careful about taking NSAIDs because they can sometimes cause kidney disease. Liver disease is quite uncommon with diclofenac.
Some people, such as those with knee and hand arthritis, may work very well with topical NSAIDs such as diclofenac gel. It has little (if any) risk of gastrointestinal, heart, kidney, or liver problems. When topical therapy is ineffective, most people choose to continue taking these medications even after being advised of the low but not zero risk of toxicity. They are sometimes the most effective drug treatment.
More severe arthritis should prompt a discussion about complementary therapies, such as injections and surgery.
Dear Dr. roach: My doctor ordered a “microalbumin-creatinine ratio” test, but my result came out “unable to calculate”. Can you tell me what this means?
— JSB
Dear JSB: The test your doctors ordered looks for proteins in the urine, which is a concern because high levels can indicate one of several types of kidney disease.
The best way to determine the amount of protein in the urine – albumin is the main blood protein that can pass into the urine – is to collect each drop for 24 hours. Although we sometimes have to do it that way, a good replacement is the ratio of microalbumin to creatinine in the urine. People with moderately elevated urinary albumin (or a high ratio of microalbumin to creatinine) are at greater risk of developing overt proteinuria, which is a risk of chronic renal failure. They also have an increased overall risk of heart disease and death.
Experts recommend testing the ratio of microalbumin to creatinine annually, and a high result usually leads to better blood sugar control, aggressive treatment of high cholesterol, and often medication, especially angiotensin receptor blockers or ACE inhibitors, to control blood pressure properly. and control the kidneys.
If your result “wasn’t able to calculate” that’s great news because it means you don’t have microalbumin. Determining the ratio involves dividing by the microalbumin result, and any mathematician knows you can’t divide by zero.
Readers can email questions to ToYourGoodHealth@med.cornell.edu.