Straight Talk and Paraffin Baths Favored Over NSAIDs

BEVERLY HILLS, CALIF. — A variety of practical and psychological approaches may be the best medicine for highly active seniors suffering from osteoarthritis and overuse syndromes, speakers said at a multidisciplinary forum at the annual meeting of the American Association for Hand Surgery.

An audience member asked the panel to recommend nonsteroidal anti-inflammatory drugs (NSAIDs) that would be safe for seniors aged 80 years and older who flock to sunny locales each winter to play golf and tennis four times a week, but then come in with aching joints.

“There are no safe nonsteroidals,” replied panelist Steven R. Ytterberg, a rheumatologist at the Mayo Clinic, Rochester, Minn.

Dr. Ytterberg said physicians need to consider “hierarchies” of risk according to side-effect threats. For example, he would rate aspirin as riskiest to the gut, with cyclooxygenase-2 inhibitors “maybe a little safer for the gut, but not nearly as safe for the gut as they were promoted to be.”

Cyclooxygenase-2 inhibitors have cardiac risks of their own, he noted, but may be safer than aspirin for heart-healthy patients with a history of peptic ulcer disease.

When patients absolutely require an NSAID, Dr. Ytterberg said he tends to favor “regular” nonsteroidals.

“For some reason a lot of rheumatologists like naproxen, twice a day,” he said. At this dose, the drug has a “relatively good safety profile … but none are absolutely safe.”

Attention then turned to several certified hand therapists (CHTs), who suggested that active elderly patients can benefit from education about ergonomics and joint protection principles.

They also may need to readjust their expectations and realize they might not be able to match the performance goals they had when they were 20, said Ann Lund, an occupational therapist and CHT at the Mayo Clinic in Rochester.

Paul Brach, a physical therapist, CHT, and director of The Hand Center of Pittsburgh, said referral for an analysis of a patient's grip and/or sporting equipment may be very useful in these patients.

Joint support devices and custom-designed grips can alleviate unnecessary aggravation of osteoarthritis, he said.

“How about paraffin baths? Do they do any good?” asked Dr. Robert Beckenbaugh, professor of orthopedics at the Mayo Clinic.

“They love the paraffin. Once they start the paraffin baths it's almost impossible to get them out of our offices,” Mr. Brach said. Getting serious, he concluded, “Supportive modalities and heat modalities certainly play an important role.”

None of the speakers disclosed ties to manufacturers of drugs or devices.

BEVERLY HILLS, CALIF. — A variety of practical and psychological approaches may be the best medicine for highly active seniors suffering from osteoarthritis and overuse syndromes, speakers said at a multidisciplinary forum at the annual meeting of the American Association for Hand Surgery.

An audience member asked the panel to recommend nonsteroidal anti-inflammatory drugs (NSAIDs) that would be safe for seniors aged 80 years and older who flock to sunny locales each winter to play golf and tennis four times a week, but then come in with aching joints.

“There are no safe nonsteroidals,” replied panelist Steven R. Ytterberg, a rheumatologist at the Mayo Clinic, Rochester, Minn.

Dr. Ytterberg said physicians need to consider “hierarchies” of risk according to side-effect threats. For example, he would rate aspirin as riskiest to the gut, with cyclooxygenase-2 inhibitors “maybe a little safer for the gut, but not nearly as safe for the gut as they were promoted to be.”

Cyclooxygenase-2 inhibitors have cardiac risks of their own, he noted, but may be safer than aspirin for heart-healthy patients with a history of peptic ulcer disease.

When patients absolutely require an NSAID, Dr. Ytterberg said he tends to favor “regular” nonsteroidals.

“For some reason a lot of rheumatologists like naproxen, twice a day,” he said. At this dose, the drug has a “relatively good safety profile … but none are absolutely safe.”

Attention then turned to several certified hand therapists (CHTs), who suggested that active elderly patients can benefit from education about ergonomics and joint protection principles.

They also may need to readjust their expectations and realize they might not be able to match the performance goals they had when they were 20, said Ann Lund, an occupational therapist and CHT at the Mayo Clinic in Rochester.

Paul Brach, a physical therapist, CHT, and director of The Hand Center of Pittsburgh, said referral for an analysis of a patient's grip and/or sporting equipment may be very useful in these patients.

Joint support devices and custom-designed grips can alleviate unnecessary aggravation of osteoarthritis, he said.

“How about paraffin baths? Do they do any good?” asked Dr. Robert Beckenbaugh, professor of orthopedics at the Mayo Clinic.

“They love the paraffin. Once they start the paraffin baths it's almost impossible to get them out of our offices,” Mr. Brach said. Getting serious, he concluded, “Supportive modalities and heat modalities certainly play an important role.”

None of the speakers disclosed ties to manufacturers of drugs or devices.

BEVERLY HILLS, CALIF. — A variety of practical and psychological approaches may be the best medicine for highly active seniors suffering from osteoarthritis and overuse syndromes, speakers said at a multidisciplinary forum at the annual meeting of the American Association for Hand Surgery.

An audience member asked the panel to recommend nonsteroidal anti-inflammatory drugs (NSAIDs) that would be safe for seniors aged 80 years and older who flock to sunny locales each winter to play golf and tennis four times a week, but then come in with aching joints.

“There are no safe nonsteroidals,” replied panelist Steven R. Ytterberg, a rheumatologist at the Mayo Clinic, Rochester, Minn.

Dr. Ytterberg said physicians need to consider “hierarchies” of risk according to side-effect threats. For example, he would rate aspirin as riskiest to the gut, with cyclooxygenase-2 inhibitors “maybe a little safer for the gut, but not nearly as safe for the gut as they were promoted to be.”

Cyclooxygenase-2 inhibitors have cardiac risks of their own, he noted, but may be safer than aspirin for heart-healthy patients with a history of peptic ulcer disease.

When patients absolutely require an NSAID, Dr. Ytterberg said he tends to favor “regular” nonsteroidals.

“For some reason a lot of rheumatologists like naproxen, twice a day,” he said. At this dose, the drug has a “relatively good safety profile … but none are absolutely safe.”

Attention then turned to several certified hand therapists (CHTs), who suggested that active elderly patients can benefit from education about ergonomics and joint protection principles.

They also may need to readjust their expectations and realize they might not be able to match the performance goals they had when they were 20, said Ann Lund, an occupational therapist and CHT at the Mayo Clinic in Rochester.

Paul Brach, a physical therapist, CHT, and director of The Hand Center of Pittsburgh, said referral for an analysis of a patient's grip and/or sporting equipment may be very useful in these patients.

Joint support devices and custom-designed grips can alleviate unnecessary aggravation of osteoarthritis, he said.

“How about paraffin baths? Do they do any good?” asked Dr. Robert Beckenbaugh, professor of orthopedics at the Mayo Clinic.

“They love the paraffin. Once they start the paraffin baths it's almost impossible to get them out of our offices,” Mr. Brach said. Getting serious, he concluded, “Supportive modalities and heat modalities certainly play an important role.”

None of the speakers disclosed ties to manufacturers of drugs or devices.