Your questions on alternative treatments

Q) Are magnetic bracelets any good for arthritis?

Bridget - 2015

A) It's been suggested that magnets can be helpful for pain relief, including low back and knee pain. Magnets can be used in different ways, including wearing them in bracelets, taping them to your joints and using various magnetic devices, including mattress pads.

Unfortunately, the evidence is too patchy to make clear recommendations on the kind of magnet therapy that might help you and the use of magnetic bracelets isn't recommended in any of the guidelines for treating the symptoms of arthritis. But some people do find them beneficial for their symptoms and they are safe for most people.

However, there are certain situations where magnetic bracelets or devices should not be worn. You should never use magnetic bracelets if you're pregnant or if you have a pacemaker or any type of electronic medical device like an implanted defibrillator.

This answer was provided by Dr Tom Margham in 2015, and was correct at the time of publication.

Q) Both my knees are severely swollen as a result of osteoarthritis, but I am nowhere near ready to have a knee replacement as I can still walk distances and the pain is controllable.

My doctor says that there is nothing that can be done about it, even though I am too embarrassed to swim any longer or to wear a knee length skirt. I understand that acupuncture helps osteoarthritis. Will it get rid of the swelling? Is there any other way of getting rid of it, with or without surgery?

Diana, via email - 2015

A) Osteoarthritis can cause both bony growths, which can distort the knees, and fluid accumulation which can make the knees look and feel swollen. Some people have the bony distortion more than fluid, other people less so.

Diseases such as rheumatoid arthritis and psoriatic arthritis, when they start, are more likely to cause extra fluid in the knees, rather than the extra bone. The fluid comes from the lining of the knee, which is inflamed.

In diseases such as rheumatoid arthritis we often take the fluid off the knee with a needle and inject cortisone to keep the fluid at bay. This can also be done in osteoarthritis if extra fluid is present, but not all cases of osteoarthritis have this extra fluid. In your case, it might be worth having the fluid removed, and the knee injected. Acupuncture can help with pain relief but it is unlikely to help with the swelling.

This answer was provided by Dr Tom Margham 2015, and was correct at the time of publication.

Q) I’ve had osteoarthritis for about 10 years and have tried all sorts of dietary and medicinal treatments, but to no avail. I recall a well-known saying that beekeepers don’t get arthritis, so asked my GP if I could have regular injections of a small quantity of bee venom. My GP is bound by NHS regulations and can’t help. Is there any institution that could help me try this treatment?

David, Melton Mowbray, Leicestershire - 2013

A) Yet again there may be some truth to old wives’ tales! Bee venom has recently undergone some laboratory studies in mice and there is early evidence that it can favourably influence the arthritis process. The active ingredient isn’t yet known but no doubt it will be ‘discovered’ in due course. If you had regular injections of the venom your body would soon develop resistance to it so, even if you could get these on the NHS, it would be a futile exercise. My advice would be to wait until the active ingredient is available and has been shown to work in scientific studies, and is a licensed product with all the safety and quality implications that entails.

This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.

Q) I've recently been diagnosed with seronegative arthritis (presumed psoriatic arthritis at this stage). In addition to my rheumatologist I've been seeing a doctor specialising in nutritional medicine. She has suggested that removing my tonsils may benefit my arthritis. I did have a fair bit of tonsillitis as a child, and have some scarring on one tonsil, but have not had an episode since the age of about 12. I was wondering if you knew of any research where patients with inflammatory arthritis have benefited from tonsillectomy?

Angus, Bristol - 2006

A) Tonsillectomy was a recommended treatment for rheumatoid arthritis many years ago, as was removal of bad teeth. This was done as it was believed that there was a link between throat (and tooth) infection and arthritis. Many people still believe there's a link, but not with the microbes which commonly cause tonsillitis. On the other hand, rheumatic fever, which we still see occasionally, occurs when the body ‘reacts’ to infection with certain microbes (streptococci) frequently found in tonsillitis. This association may have encouraged doctors to remove the tonsils in cases of rheumatoid arthritis. It's an interesting bit of historical medicine. The bad news is that tonsillectomy doesn’t prevent you from getting throat infections, which are most likely to be caused by viruses anyway. Nor does tonsillectomy stop you getting, and neither does it cure, arthritis.

This answer was provided by Dr Philip Helliwell in 2006, and was correct at the time of publication.

Q) Could you give me your opinion of low-intensity laser therapy for osteoarthritis? Is it effective and safe, and how does it compare to other established therapies?

Norma, Co Dublin - 2008

A) It appears safe enough. However, the clinical trials in osteoarthritis to date haven't been very encouraging. In fact, a meta-analysis (where the results of all the trials are pooled together) showed only mild benefit for pain and no benefit for stiffness or function. How does it work? Well, it probably doesn’t, but users of this treatment say that the light penetrates and interacts with the deeper tissues of the body. You might like to have a look at a review of osteoarthritis treatments by the National Institute for Clinical Excellence (NICE) – see their website www.nice.org.uk. Here they review the evidence for all the treatments used for osteoarthritis, including physiotherapy, anti-inflammatory drugs and glucosamine.

This answer was provided by Dr Philip Helliwell in 2008, and was correct at the time of publication.

Q) Two years ago I twisted my ankle in the garden of our house in Spain. At first the pain was manageable, but over time it got worse.

Our GP diagnosed me with arthritis and recommended physiotherapy and electrotherapy. My understanding of my condition is limited because of the language barrier. I want to be able to get back to the life we planned when we moved out here, which involves being active and farming our land.

Walking on rough ground is particularly painful for me, so for the past year I've been very limited in what I can do. I take NSAIDs, paracetamol and tramadol for the pain.

What advice can you offer to give me back my mobility please?

Rachel Submitted by email - 2016

A) Nasty ankle sprains can lead to significant problems down the line. The phrase "just a sprain" is a big understatement for many people.

You can’t change the injury, so your focus is now about protecting the joint from further injury and managing any symptoms as they arise. I’d recommend a multi-pronged approach:

1. Physiotherapy

Physiotherapy is a good idea to work on the range of movement in the joint and help with guided exercises to strengthen the tendons and muscles that support the joint. You'll need to continue these exercises at home for the foreseeable future to keep the ankle strong and flexible.

2. Wearing a brace

Consider using an ankle brace to provide extra support for the ankle especially when working and walking on uneven surfaces. They need to have a stirrup splint which passes under the foot and provides stability to both sides of the ankle.

3. Appropriate footwear

You should consider wearing ankle height boots for working on your land to provide additional support and prevent injury.

4. Develop joint position sense

You need to do a lot of work on developing your joint position sense (this is called proprioception). When you twist your ankle you damage not only the ligaments around the ankle but the nerves that give the brain detailed information of what the joint is doing.

This needs retraining to prevent you continuously reinjuring the ankle.

5. Apply ice

If the joint swells or is painful then try applying ice. You may also find topical non-steroidal anti-inflammatory drugs (NSAIDs) are helpful to relieve pain.

You can buy ice packs from a chemist or you could use a bag of frozen peas. Make sure to wrap them in a damp towel as applying ice directly to the skin can burn or irritate it.

6. Steroid injections

If the pain in the joint continues despite the treatments outlined above, then sometimes an injection of steroid and local anaesthetic can help to relieve symptoms in the short to medium term.

I wish you all the best with your rehabilitation.

This answer was provided by Dr Tom Margham in 2016, and was correct at the time of publication.

Q) I have osteoarthritis in most joints and have had one hip and one knee replaced, but provided I do the majority of my physical activities before 2 pm I can cope with a few painkillers. Is it safe to use a magnetic device? I read they shouldn't be used by anyone with a metal prosthesis. Would I benefit?

Dorothy, Storrington, West Sussex - 2005

A) There's some evidence of benefit for wrist-mounted magnets in arthritis, but it's not very strong. Although generally safe, don't use any magnet therapy products if either you or your partner have a heart pacemaker, hearing implant or any other implanted electronic device as the weak magnetic field can affect the way they work. Most joint replacements are made from non-ferrous metals so there's not a problem using them in this circumstance.

This answer was provided by Dr Philip Helliwell in 2005, and was correct at the time of publication.

Q) I read with interest the letter from Josephine who found that glucosamine had an adverse effect on her Dupuytren’s contracture. I take glucosamine and some nine months ago noticed that I had a hard lump forming on the palm of my left hand, and my GP said it was the start of Dupuytren’s. In your opinion, has the glucosamine caused this? Should I continue with the tablet?

Mr C, Spalding - 2009

A) One of the advantages of growing old, as a rheumatologist, is that you begin to experience all the musculoskeletal diseases you've been treating for years. For some years I took glucosamine (how could I not, having advocated its use in this column) and I developed a Dupuytren’s contracture in my left hand. (Dupuytren’s contracture occurs when the tissues in the palm of the hand thicken, causing one or more of the fingers to contract and bend into the palm. Steroid injections can be given at an early stage but surgery may be necessary later on.) I didn’t connect the two until I stopped the glucosamine, whereupon the Dupuytren’s contracture improved. This has been recognised by other people – see the International Dupuytren Society.

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

Q) I've been taking glucosamine (1500 mg) with chondroitin (1200 mg) for more than two years and this appeared to prevent severe arthritis in my hands and wrists. Last October due to a heart condition my consultant put me on warfarin, and the NHS standard instructions prohibit the use of glucosamine and chondroitin. This last month my arthritis has returned and I feel I could benefit from a return to glucosamine and chondroitin. (The consultant can't tell me anything definite and says 'please yourself'). Is there any recent information about taking glucosamine and chondroitin while on warfarin, or any Versus Arthritis opinion on its performance?

Brian, Chester - 2009

A) The evidence of interaction between warfarin and glucosamine is far from clear. What is clear is that if you wish to take glucosamine and chondroitin along with your warfarin you should first tell your doctor. Secondly, if you and your doctor agree that it's acceptable to go ahead you should probably have more frequent blood checks for the first few weeks after you start taking the combination. If any changes in your blood tests occur, you can then make appropriate alteration to the warfarin dose, or stop taking the glucosamine.

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

Q) The Versus Arthritis report on complementary medicines for the treatment of arthritis concluded that glucosamine sulphate seemed to be of significantly greater benefit than glucosamine hydrochloride. Is this not rather misleading, as all glucosamine, whether originally in the sulphate or the hydrochloride form, enters the intestine as glucosamine hydrochloride after breakdown by hydrochloric acid in the stomach?

Anthony, Sale - 2009

A) It sounds like you're a chemist! The whole business of giving a substance such as glucosamine is a little bit mystical. For example, why doesn’t the digestive tract reduce the glucosamine to its component parts? If it were absorbed ‘whole’ then the blood level of this substance would increase after taking it – it does but only a little (and even less gets into the joints). So, from a pharmacological point of view glucosamine doesn’t make a lot of sense, in whatever form it's given. However, some clinical trials have shown benefit and these have all been with the sulphate, so that's what's recommended!

This answer was provided by Dr Philip Helliwell in 2009, and was correct at the time of publication.

Q) I have always understood that fish oil tablets and oily fish were important for those suffering from gout and osteoarthritis. Having read a book called Beating Gout it seems that these are high purine foods and should only be eaten in moderation as they raise uric acid levels. I would very much appreciate your opinion.

Ann, Crickhowell - 2014

A) You are correct. There is a problem with the advice given. Fish oil has beneficial effects on inflammation (any form of tissue inflammation, including attacks of gout, but also it has been shown to help the pain of osteoarthritis). Fish oil is also beneficial for the heart, possibly by a similar action. On the other hand, high purine foods, such as meat and fish, are not recommended for people with gout as purines are converted to uric acid in the body. A compromise, which I recommend, is for the patient to take one or two fish oil capsules (or a capsule that contains omega 3 fatty acids – see Versus Arthritis information booklet on Diet and arthritis) daily instead of the oily fish.

This answer was provided by Dr Philip Helliwell in 2014, and was correct at the time of publication.

Q) I am 51 years old, have mild osteoarthritis and for years have taken 1,500 mg of cod liver oil. Recently the advice about taking cod liver oil seems to have changed. I now read that taking large amounts of cod liver oil may be unwise, and that taking fish oil might be a better bet. Can you explain the differences between these two types of oil? I'm becoming increasingly confused! What's your advice?

Lesley, Bristol - 2006

A) The reason that advice has changed relates to the high content of vitamin A in cod liver oil. Vitamin A can be harmful to pregnant mothers and the high concentration in fish liver means that you may approach the recommended daily limit for adults (3,000 micrograms a day). The oil derived from whole fish has less vitamin A. The signs of vitamin A overdose include loss of appetite, irritability, dryness of the skin, a coarseness of the hair and an enlarged liver. These, however, are common symptoms so it's important to be aware of the risk.

This answer was provided by Dr Philip Helliwell in 2006, and was correct at the time of publication.