DEAR DR. DONOHUE: Are osteoarthritis and polymyalgia rheumatica different stages of the same disease? How are they diagnosed and treated? – C.B.

ANSWER: The two are not different stages of the same disease. They have nothing in common except pain.

Polymyalgia rheumatica is a disorder that strikes later in life. It’s unusual to find it in anyone younger than 50. Its cardinal symptoms are morning stiffness that hangs on for hours after waking. The neck, shoulders, lower back and hips are the places where it most often shows up. It can cause a fever, so it is a systemic process. A systemic illness is one that involves many body tissues and organs. Fever is an indication of a systemic illness. When a person has polymyalgia, one lab test, the sed rate, is sky-high. A high sed rate is an indication that inflammation is taking place somewhere in the body, and it, too, is evidence of a systemic illness.

The sed rate and the patient’s story establish the diagnosis. Prednisone, a cortisone drug, can usually bring quick control to polymyalgia.

Osteoarthritis, in contrast to polymyalgia, is not a systemic illness. It is confined to joints and only joints. A joint is the place where two bones meet. The ends of joint bones are covered with cartilage. Cartilage allows the bone ends to rub against each other painlessly as they move. In osteoarthritis, the cartilage covering crumbles, and the abutting bones agonizingly grind against one another.

A physical examination of the joints, the patient’s description of the pain and X-rays provide evidence for the diagnosis of osteoarthritis.

Aspirin, Motrin, Advil, Aleve and many similar drugs lessen arthritis pain. Injecting cortisone into affected joints also provides joint relief.

Arthritis is a challenging topic and cannot be adequately covered in a few paragraphs. DEAR DR. DONOHUE: I went for a blood test, and they say I have anemia. I need more iron. What foods have iron, or should I take a vitamin with iron? – A.S.

ANSWER: At the risk of sounding like a broken record, I have to repeat the constantly repeated anemia warning. An anemia is nothing more than a red blood cell deficit. Its causes are many. Iron deficiency happens to be one of those causes, and iron deficiency can arise because of bleeding in places that are not obvious to a person. The digestive tract is a prime example.

You must see a doctor. The doctor will check you for all anemia causes, and, if iron lack happens to be the cause, then the doctor will search for the reason why the body’s iron stores are depleted.

It’s difficult to restore an iron deficiency with foods or even with vitamins with added iron. Iron-deficient people need to take iron tablets. Since you asked, meat is the prime food source of iron. Liver, shrimp, fowl, tuna, salmon, broccoli, leafy greens, peas, some beans, peaches, pears, dried plums (prunes) and blackstrap molasses also have fair amounts of it.

DEAR DR. DONOHUE: I have cracking at the edges of my lips, and they sting when I open my mouth. What has caused this? – P.B.

ANSWER: Cracks at the corners of the lips are most often the result of saliva pooling there. It can happen at night, and you might not be aware of it. The pooled saliva supports the growth of fungi and yeasts. Nizoral cream or Nystatin cream can often bring healing to these cracks. They are prescription medicines, so your doctor has to get in on the act.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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