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Ask the Rheumatologist: Latest Answer

Q:

Donna from Calgary asks: I have been diagnosed with osteoarthritis, and experience a lot of pain in my shoulders , lower back , knees and hands.  My question is what medications can I take that won’t harm my kidney? I’ve had a lot of cortisone shots but was told I may not be able to have that much longer. I just not sure what to do at this time.

A:

The focus for management of osteoarthritis is around improving function and reducing pain.  Of course, we want to reduce pain in the safest way possible, and the safest way is different for different people.  For most people, acetaminophen (Tylenol) is one of the safest pain relievers.  While most individuals will use acetaminophen when the pain is worst, for those with chronic pain, acetaminophen is more effective when used on a regular basis to prevent pain flares, never using more than recommended on the bottle.  Anti-inflammatories (NSAIDs) arguably may be more effective, but do have other side effect concerns, and should be avoided for those with kidney problems.  Topical anti-inflammatories are available which are likely safe even for those with kidney problems.  Cortisone injections are a safe option as well and certainly there is no limit how long you can have cortisone injections, as long as they are effective.

Finally, often forgotten but perhaps most important is the role for physical and occupational therapy.  Maintaining range of motion and muscle strength is an important part of management of osteoarthritis, and by its very nature is safe.

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