Osteoarthritis requires treatment vigilance – from medication to exercise – that, at times, can be taxing. But research shows that adherence to your treatment regimen can keep pain and disability at bay.

“If you don’t [comply with treatment], symptoms return,” says gastroenterologist Byron Cryer, MD, associate dean and professor of medicine at University of Texas Southwestern Medical School in Dallas. “In patients with OA, the principle issues are lack of mobility and quality of life.  If you improve adherence, you improve both.”

Taking the Meds You Need

In a 2012 study of 162 patients primarily with knee or hip osteoarthritis at Tufts Medical Center in Boston, researchers found that 37 percent were taking multiple medications on the same day, and 15 percent were using multiple medications plus supplements. Of those taking multiple medications, 40 percent used prescription and over-the-counter medicines.  Twenty-eight percent found treatment ineffective or sought stronger medications. Those who found medications ineffective were more apt to quit taking them after only two weeks.

“We were concerned that patients were taking multiple nonsteroidal anti-inflammatory drugs (NSAIDs) … [risking] increasing side effects like gastrointestinal distress,” says Jeffrey B. Driban, PhD, assistant professor of rheumatology, Tufts Medical Center.

Driban was also concerned that patients were seeking their own ways of managing symptoms because they didn’t feel prescribed medications were adequate.  In some cases, patients were taking friends’ medications. Other patients stopped taking prescribed medications as soon as the first prescription ran out.

“We worried that patients were increasing risks of side effects and increasing costs by taking multiple medications,” says Driban.

A 2011 study at UT Southwestern Medical School studied patients with GERD (gastroesophageal reflux disease) and osteoarthritis or rheumatoid arthritis. The patient information came from 543 patients who took celecoxib (Celebrex), a COX-2 inhibitor, and 2,118 who took NSAIDs, which, inhibit both COX-1 and COX-2 enzymes, resulting in gastric irritation. Celecoxib inhibits only COX-2, making it easier on the stomach.

After two years, 80 percent of patients were still taking celecoxib; only 60 percent were still taking non-select NSAIDs.  The reason? People taking celecoxib had fewer symptoms of GERD, says Dr. Cryer, and their stomachs suffered less.

So, what’s to be gleaned from such studies? How can you take meds as prescribed with effectiveness and few side effects?

• Talk to your doctor more, not less. “If you feel like your medication isn’t working after a few days,” says Driban, “rather than stopping, tell your physician and ask for [alternatives].”

  The same goes for side effects: Tell your doctor about them. “Gastrointestinal symptoms are a very common reason for discontinuing OA medications,” says Dr. Cryer. “Ask your provider if he can switch your medication or give you an additional medication to improve symptoms.”

  In some cases you can take a proton pump inhibitor (a prescription antacid) with an NSAID, or use a different pain reliever to reduce gastrointestinal symptoms, says Driban.

  “Ask about pros and cons of treatments,” says Driban. ‘‘And ask what over-the-counter medications will help you avoid problems. Sometimes, it’s a matter of [taking] a smaller dose.”

• Don’t let money rule treatment. Again, ask for your doctor’s help in finding a cheaper solution, says Driban. Some prescriptions are expensive because they’re new: Ask for alternatives.
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• Review your medical records. A 2012 study in the Annals of Internal Medicine of almost 5,400 patients found that 60 to 78 percent of those patients given access to doctors’ notes also increased medication adherence. Researchers speculate that seeing the notes provided a prod.  One patient said, “[Reading the notes] is almost like another person telling you to take your meds.”

Staying Active With Less Pain

In a 2012 study at the University of Ottawa in Canada, researchers divided 222 patients with mild to moderate knee OA into three groups. One group walked three times a week for 30 minutes per stretch at a walking club, directed by exercise therapists. Another group did the same but received more behavioral guidance. For instance, they were encouraged to keep log books and set realistic goals.  The third group walked at home without supervision.

“We found that during the first three months those in the behavior group adhered to the exercise program more than the others,” says lead study author Lucie Brosseau, PhD, professor, School of Rehabilitation Science, University of Ottawa. “But at 18 months, the people at home did better [possibly] because they got used to walking by themselves.” All had less pain, more function and better quality of life.

In a 2012 study at Ohio State University, researchers divided 80 patients with knee OA into two groups. The first group followed a traditional approach, asking patients to walk two times a week at an exercise center, increasing minutes as they could. Researchers offered basic exercise education after each session for 12 weeks.  The second group also walked for 12 weeks but were offered behavioral advice.  For instance, they were educated about pacing, dealing with pain and overcoming barriers.

“The amount of physical activity at both three and 12 months was significantly greater in the behavioral group,” says lead author Brian C. Focht, PhD, associate professor, College of Education and Human Ecology at Ohio State University.  “Those patients were doing 50 to 75 more minutes of exercise a week than those in the traditional group.”

Why? Focht speculates that the behavioral approach helped the patients learn how to exercise wisely and overcome barriers.

Adhering to exercise can be even more difficult than routinely taking medications; exercise is helpful but not instantaneously (although meds sometimes are not either).

“There are effective exercise treatments,” says Focht. “But sometimes they’re difficult because of pain, fatigue and stiffness.”
 

Still, working past such discouragements is possible.  Here’s how:

• Know what exercise can accomplish. “Ask your doctor what the best [exercise] is for you and why you should be doing it,” says Ray Marks, EdD, who researches OA and exercise adherence as an adjunct professor of Health and Behavior Studies at Columbia University in New York City.

   “Ask for clear written instructions and [exercise] pictures.” Patients need confidence that they can do the exercise their doctor recommends, she says.

• Set specific but realistic exercise goals.“Our participants set how many days and minutes a week they would exercise, based on individual capacity and tolerance,” says Focht.  The overarching goal was to progress toward 150 minutes per week set by the 2008 Physical Activity Guidelines for Americans.
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• Exercise throughout the day. If walking 30 consecutive minutes feels impossible because of pain or fatigue, says Focht, take three 10-minute walks through the day. “Participants found that plan motivating and felt the exercise was less time consuming,” he says.

  Marks suggests integrating exercise naturally, say, by getting off one stop early on public transportation, climbing office stairs or walking in a mall with a friend. “You add exercise without having to sweat or go to a gym.”

• Join a walking group. Although some people like to exercise alone, for others socializing can be a huge motivating factor, says Brosseau.

  “Tell your doctor you need to be in a group,” agrees Marks. “Ask if there are community-based walking programs.”

• Track your progress. “Many participants enjoyed using pedometers, an easy way to assess how much [walking] they’re doing,” says Focht.

  Participants also kept a daily log of exercise. “When many began, they couldn’t walk one lap around the gym,” says Focht.  “After 12 weeks, those people were walking 5 to 10 minutes at a time without stopping.”  Others could climb stairs or carry groceries for the first time in years.  “Doing things they thought they couldn’t do anymore became a huge motivator,” says Focht.

• Explore your neighborhood. “One common barrier to exercise is a lack of access to places where you can be active,” says Focht. “We asked patients to find walking trails or other resources around their neighborhoods.  One person created a walking trail in her house, a path from kitchen to living to dining room.”  You don’t always have to find a close-by park or shopping mall, he says.