DEAR DR. DONOHUE: I have degenerative joint disease. Could you please explain what it is and if it will get worse? – G.W.

ANSWER:
Degenerative arthritis, also known as osteoarthritis, is the most common kind of arthritis. At age 45, most people have X-ray changes that show the beginnings of this arthritis. By age 65, 85 percent have some symptoms of degenerative arthritis.

This arthritis is often described as “wear-and-tear” arthritis, indicating that the joint changes are a consequence of aging. That is not the whole truth. The cartilage covering the abutting bone surfaces that meet to form a joint frays and crumbles. Without the cartilage cushion, the joint bones become irritated and painful every time the joint bends. Changes in cartilage are the more likely cause of degenerative arthritis, and when doctors discover why those changes occur, a cure medicine will be possible.

For the present, treatment focuses on relieving joint pain and keeping joints limber. Tylenol is often the first medicine used for pain control. Some question its value. Those doctors prefer to start with anti-inflammatory, pain-relieving drugs such as Advil, Aleve and Motrin. Some doctors will immediately start with COX-2 drugs if patients have had stomach problems. COX-2 drugs are anti-inflammatory drugs that were designed to be less irritating to the stomach. Vioxx, Celebrex and Bextra are three such drugs.

An exercise program is essential for keeping joints limber. Physical therapists can guide you in exercises that help but don’t hurt your joints.

Joint injections with cortisone, when kept to a minimum, help. Synvisc and Hyalgan are two other drugs for joint injection. They are alleged to increase joint fluid viscosity, somewhat like getting an oil change.

Degenerative arthritis usually progresses slowly. If it reaches a point where it becomes impossible to handle day-to-day chores or to walk, then joint replacement can turn old joints into new ones.

For a more complete discussion of the many kinds of arthritis, the recently published arthritis pamphlet answers people’s most-asked questions. To obtain a copy, write to: Dr. Donohue – No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. along with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have had three surgeries for Dupuytren’s contracture. I have a new lump on my left hand. The previous ones were all on my right hand. The surgeon told me that he would not operate until my finger began to curl. Why not take care of it now? – J.M.

ANSWER:
Dupuytren’s (dew-pwe-TRAHNZ) contracture begins as a hard nodule in the palm of the hand. Tentacles of scar tissue spring from the nodule and encircle tendons running to the fingers. The ring and baby fingers are the ones most often involved. As the scar tissue grows stronger, it pulls on the tendon of the involved finger and draws the finger downward toward the palm.

I can understand how fed up you must be with so many battles with Dupuytren’s. Early surgery, however, can worsen mild disease, so surgery is usually delayed until finger motion is impaired. The current lump might never evolve to the full-blown stage where finger function becomes impossible.

A trial of injecting the enzyme collagenase into the lump and its scar tentacles is currently in progress. Collagenase dissolves collagen, the stuff of which scar tissue is made.

DEAR DR. DONOHUE: I eat a lot of TV dinners – at least four a week. I was told that some who did the same died from it. Please tell me if that can happen. – F.M.

ANSWER:
I have not heard, read or seen any evidence that the information passed on to you is true. I don’t believe it. If it is true, I am in your boat. I eat TV dinners frequently. I like them.

DEAR DR. DONOHUE: Will 2.5 mg of prednisone for treatment of polymyalgia be harmful? – M.L.

ANSWER:
No. Prednisone is the drug of choice for this illness that causes diffuse muscle pain. The 2.5-mg dose is a relatively small one.

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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