Is your dog's unusual barking a secret code for something mysterious?

[Charlottechicken]

I know a few of you on here suffer with this debilitating condition and wonder if you could offer advice please.

 

My mum has just been diagnosed with an arthritic knee and is in constant pain, limping instead of walking and with a very swollen knee and ankle. First GP she saw was unsympathetic but sent her for an X-ray as she was in so much pain. He said there was nothing wrong on the X-ray and sent her off with ibuprofen. The following week she was no better so took herself off to A&E, where they first booked her in for a scan but another doctor there said that it looked like an arthritic flare up, so the scan was unnecessary. She went back to the GP surgery and saw another GP who prescribed naproxen which didn't do much for the swelling or the pain, so she went back again and saw another GP who prescribed Tramadol. This just made her feel very ill (I did warn her as couple of colleagues take it) and again is not doing much for the pain and swelling. However, after two doses of Tramadol she did actually get a good nights sleep, something she hasn't had for ages. Now she is back on the ibuprofen, as she can't bear the tramadol side effects, but nothing is addressing the swollen joints.

 

Before all this she was an extremely active 70 year old, who looked like a 60 year old, and she is now getting frustrated, and I think depressed, by this sudden lack of mobility. Because she has no mobility in her knee and cannot weight bear she is having real trouble getting around in the house, and uses furniture and work surfaces to support her and help manouvre.

 

So, any advice on what does actually work on an arthritic flare up? How do we manage the pain and swelling? How long does a flare up last, this one has been going on for a couple of months now.

 

I think that mum has had this developing for a couple of years, as we both have high pain thresholds so I believe she didn't notice earlier symptoms. In 2008, when we both had our houses extended, she had a wet room built as she could not step over into the bath easily and without support, and I feel that this joint stiffness was an early sign maybe?

 

Any advice would be welcome!!

[ClaireG]

I would suggest your Mum goes back to the doctors and insists on a referral to a Rhumatologist. Naproxen did nothing for me either although i know it works for some, i found dicolfenac a lot better. The rub on gels may also help a bit. It's very hard to tell how long a flare will last, i've had some that last weeks and others months. If i'm ill in any other way and/or stressed that usually brings on a flare.

There is some useful information etc here

http://www.arthritiscare.org.uk/Home

[witzend]

same advice from me too - get a referral - but, also, keep moving........I know it's hard - I have osteo and fibro - but you seize up if you don't do something.

[Henchanted]

Dear Charlottechicken

 

I feel for your mum as I suffered for several years before having my hip resurfacing for arthritis and my unfortunate OH is waiting to be reassessed for his horrible knee problems at the moment.

 

What I found was that 'managing the pain' was paramount but also 'managing movement' was as important and of course the 2 are inter-related.

 

Firstly although it is tempting not to take the brufen/naproxen/diclofenac (antiinflammatory drug) unless really desperate, it has little to no effect if not taken at maximum dosage and regularly for at least a week to 10 days before trying to test if you can go without. It does not work in odd doses.

 

As the drug name suggests it reduces the pain by reducing the inflammation and needs to be taken (according to the normal prescription) trice daily so at roughly 8 hour interval or morning, mid afternoon and bedtime (but not on an empty stomach). So this is a long term 'take every dose' for at least one week to reduce the swelling.

 

To further help reduce the swelling/heat and pain, good old Paracetamol is still a very good pain reliever (also if used correctly) and particularly when it has caffeine added, as this boosts its pain relieving to almost double, so it can give the level of pain relief attributed to morphine-like drugs. Most stores like Sainsburys definetely sell paracetamol plus, as do pharmacies. This can and I suggest should be taken every dose again for at least a week to try and gain some rest particularly at night. This can be taken safely as well as the antiinflammatory drug, and this one is 4 doses per day so at waking, lunch, tea and bedtime. Its a good idea to keep a daily record so you do not overdose or miss a dose.

 

The Tramadol can be taken instead of (not as well as) the paracetamol at bedtime to help have a good night. It was my last resort before my operation and I was grateful for its pain relief but like your mum I hated the effects during the day. If and when she takes Tramadol it is also useful to take something like senna tablets at the same time as it does slow down the bowel causing, constipation and adding to discomfort.

 

Assuming she will give herself permission to take these drugs regularly, full doses for at least one week, then the next hurdle will be easier to manage and that is movement. The longer she is off her feet the more the stiffness will be difficult to overcome. If she does not already have a stick to help take the weight on her bad side and take some of the strain off the good side, she ought to get her GP to refer her to the care of physiotherapists who will make sure the stick is correctly measured, for the correct side and to teach her how to use it. I did not get this for a few years until I was practically unable to walk and it made a tremendous difference to me getting about- in hind sight if I asked sooner (mind you it takes a while to get your head round the embarrassment of using a stick) or if the GP suggested it sooner I would have saved myself a good deal of pain. (If you would like some advice about buying a stick in the meantime do PM me

 

Warm water is a great pain reliever and healer. If she does not have a bath is there anywhere she can access a bath? A few drops of lavender essential oil in a warm bath is a well recognized muscle relaxant and will allow her to gently move and bend her leg in the bath to begin to loosen the muscles/tendons that have tightened around the knee because of the pain.(I do this for my OH) Also gentle massage using an oil or lotion and as 'claireG' suggested ibrufen gel or cream can give instant results and by the way can be used as well as taking the painkillers and anti-inflammatory drugs.

 

A long term measure in pain prevention and management, is looking to doing any exercise in water, its extremely beneficial in keeping the joints moving, building up strength in muscles around bad joints and of course without causing wear and tear as you are weightless in water.

 

Diet can help or hinder this inflammatory process and so things to avoid are alcohol, caffeine drinks (tea/coffee) and red meat and things to take more of greens, salads, veg and fruit in general, more fish particularly oily mackrel etc, I remember this did make a difference to me.

 

My OH flare ups can take hold for 3-8 weeks at worst and a few days at best. We have both used a TENS machine to varying degrees of effect, sometimes enough to take the edge off and break the cycle of pain sometimes nothing and sometimes complete pain relief though it doesn't last long. Some friends of ours used acupuncture with effect.

 

So despite the feeling that one should soldier on, please pass on that she ought to try taking both anti-inflammatory and painkilling drugs full time, full doses for one week to help break the pain cycle and look to getting that physio appointment (I had to wait 6 months) for walking support. I was lucky enough to get 6 sessions of hydrotherapy as well which helped, but I was in quite a state for some time, but she might be able to get this too, worth asking.

 

Wishing your mum relief soon

 

BTW It is worth noting that when the GPs or Physios take a history, they often complete a scoring chart to see how bad the pain is effecting you, and they assess your need for treatment depending on your replies. However if you are managing your pain with painkillers/anti-inflammatories then you need to answer the questions based on what it is like without the drugs. For example if the pain wakes you up at night normally and you have found the best drugs to help you get a good nights sleep, do not forget to say yes it does wake you at night because it does without the drugs.

 

Sorry this is so long...... but I learnt a lot through my suffering and so am keen to pass it on

[ClaireG]

Another thing i forgot to say earlier that Henchanted's reply reminded me, is that i try to avoid wheat if i have a flare. Wheat seems to make the immflamation worse for me. Also sometimes cold helps the swelling eg a bag of frozen peas wrapped in a towel and then placed on the joint but more often heat helps and i use one of those microwavable lavender wheat bags. I also agree that lavender oil is a wonderful thing, i use it for lots of stuff!

[Charlottechicken]

Wow, thank you for your informative replies I may print them all out for mum so she can read at her leisure.

 

Henchanted, you have written a wealth of information there, it must have taken ages. Thank you for going to so much trouble, although I appreciate the times you must have gone through to be so knowledgable.

 

Funny enough, as mum is very active anyway, she is continuing to be, albeit in pain and uncomfortable. She is also taking the ibuprofen regularly, and has a physio referral in August

[Henchanted]

Good to hear she has a physio appointment, may August come round sooner

Great that she is mobile and good that she is taking 3 doses daily of ibrufen, it means she can still safely take 4 doses of paracetamol or paracetamol-plus as well, to provide more relief.

Best wishes

[Sheilaz]

I would suggest your Mum goes back to the doctors and insists on a referral to a Rhumatologist. ........http://www.arthritiscare.org.uk/Home

This is the exact wording that I was going to type, then I saw Claire's post. Your poor Mum, I'm sure a rheumatology specialist will be the best route, she deserves proper advice on medication and management of her knee condition.

On reflection, a GP may suggest Ibuprofen etc. expecting that the patient will return if the pain persists, but this is rarely made clear in my experience! She should definitely return to discuss her progress, and insist on a referral if it's not suggested.

Some excellent advice from Omleteers above , but keep up the medical connection too.

All the best xx

[Omletina Kyckling]

I'm with the others, she needs to be referred to a rheumatologist. They know the treatments available far better than any GP.

 

I had to tell my GP to refer me as he was messing around with various silly pain killers/anti inflammatory drugs and most forms of arthritis can actually damage the joints long term, she may well need a DMARD (Disease modifying anti rheumatic drug) such as methotrexate, which I'm on. This basically suppresses the immune system because in psoriatic and rheumatoid arthritis, it's the immune system attacking the joints. The side effects aren't great, but long term, it's the best way to stop the condition advancing further. If you read up on the drugs online, they sound scary but so long as your mum is monitored whilst taking them (regular blood tests etc.) all should be ok.

 

My GP prescribed Diclofenac, which is an old style painkiller for arthritis and my consultant threw his hands in the air when he heard.....he prescribes Etodolac for me which I take in addition to my DMARDs when needed.

 

I hope this helps.

 

Hope your mum gets sorted soon!! I sympathise with her! x

[Charlottechicken]

Thanks everyone for your informative replies, I've now printed the whole thread off for mum to read at her leisure. She appears to be coming to the end of the flare up, but the knee is weak and won't take any weight. She managed to get hold of a smart fold up walking stick (only a fiver from the markets) and is using it to get out, this has certainly helped with other aches and pains associated with her limping gait.

 

She is now calling herself "the old lady"

[Sam Palmer]

This thread had made interesting reading for me too. I've had an ongoing hip and thigh problem, plus (probably) unrelated back issues since last October. I've had physio, x-ray, blood test, MRI and a recent referral to a consultant. I'd eased off on the Diclofenac and other painkillers since the pain had eased and have only taken it 'as and when' it's flared up. I can see now I should be taking it for much longer periods.

I'm going to print all this useful information off too!

[Henchanted]

Hi

 

if I may just relate one more thing and that is how to use the walking stick.

 

1) Firstly it is used in the hand on the side of the good leg and not on the bad side.

 

2) To walk, you put the stick in front followed by the weak /bad leg and move your weight forward bringing your good leg up last as in jake-the peg with his extra leg (diddle-diddle-dum ) There are several videos on you-tube showing how to use a stick '(or cane in the US).

 

3) Also the technique for going up and down stairs in (as I remember my lovely physio teaching me ) 'good leg to heaven', 'bad leg to hell', meaning you lead with your good leg going up stairs (and one at a time- no heroics) and with your weak/bad leg going down, again using the stick or bannister to help take your weight when actually moving your bad leg.

 

I'm glad your mum is improving, Claire, well done for getting the walking stick, hope she gets the treatment that suits her best from the medics.

 

Kindest regards

[Charlottechicken]

Just resurrecting this thread as I would really appreciate some more advice/guidance please.

 

Mum received a phone call from the GP surgery today, to say they have received a letter from the hospital (she went to hospital A&E several weeks ago, but has seen several GPs at the practice since then) and they would like to rethink her treatment. They want her to have steroid injections in her knee, administered by the GP. Not sure if she should have this, or what the implications or results would be. She appeared to be coming out of the flare up but is no better around the house, as the knee does not want to bear weight, and is using a stick outside most days now.

 

Has anyone else had steroid injections for arthritis?

[Chicken Licken]

I had steroid injections in my knees as a teenager. They did reduce the inflammation, but also hurt like hell!!

[bluekarin]

My YD has these for her Juvenile Arthritis. They do help, and not sure if they hurt as she has anaesthetic, but they have helped less and less each time. The Dr's say this is due to where she is in her flare up cycle. We are worried that they are becoming less effective. Maybe they want to do one to see if this boosts the strength in her joints to help her bear weight, and then maintain with the anti inflammatorys. She is also on twice daily Naproxen as well as weekly Methrotrexate, but her's is due to over active antiibodies and not a wearing out of the joints.

[Omletina Kyckling]

I think a lot depends on the type of arthritis your mum has. Osteoarthritis is very different from rheumatoid, psoriatic, juveline types. In the latter types it is the immune system which attacks the joints as opposed to wear and tear on the joints over time. Treatment for these is via DMARDS such as methotrexate or leflunomide or various others or biologics as these aim to suppress the immune system which is attacking the joints.

Sorry I don't know anything about steroid injections.

There's lots of information on the arthritis UK website

http://www.arthritisresearchuk.org/arthritis_information/arthritis_drugs__medication/local_steroid_injections.aspx

[laurmurf]

I've had steroid injections in my shoulder and the relief from pain is just bliss!

So much benefit for a little discomfort!