Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, November 14, 1995                   TAG: 9511140049
SECTION: EXTRA                    PAGE: 3   EDITION: METRO 
SOURCE: JANE E. BRODY
DATELINE:                                 LENGTH: Medium

GUIDELINES OFFER HELP FOR SUFFERERS OF OSTEOARTHRITIS

For those who had to take pain relievers many times a day, drug companies even produced specially coated ``arthritis strength'' tablets to counter the stomach irritation that can result from chronic aspirin use.

But now aspirin, and its newer rivals, ibuprofen and naproxen, are being relegated to second place, behind another over-the-counter pain reliever, acetaminophen, as the drug of choice for the 16 million Americans with osteoarthritis. The recommendation is part of new guidelines issued by the American College of Rheumatology to treat arthritis in the two most debilitating joints - the hip and the knee - and help those afflicted continue to lead active lives.

For patients hoping for a magic bullet - like a pill that will allow them once again to dance the night away without pain - the guidelines will prove disappointing. There is no single cure for osteoarthritis short of surgery to replace the joint totally. In addition to medication, the treatment plan developed by a committee of experts includes weight management, a wholesome diet and regular exercise, including activities to strengthen the muscles that support arthritic joints.

Osteoarthritis is a degeneration of the cartilage that normally acts as cushioning between bones.

While osteoarthritis can occur as early as the age of 40, especially in those who have suffered sports injuries that change the biomechanics of joints, it is mainly a disease of deterioration associated with the elderly. For unknown reasons, women are especially at risk.

According to the new guidelines, joint replacement is the treatment of last resort, to be used only after simpler, less costly and less hazardous remedies fail. The experts recommend acetaminophen, in doses up to 4,000 milligrams a day, as the first treatment because it is least likely to cause serious side effects.

Aspirin and other nonsteroidal anti-inflammatory drugs can cause irritation of the gastrointestinal tract and may precipitate an ulcer in susceptible patients, even if they take antacids. The drugs can also increase internal bleeding and bruising and may interact with medications taken to treat high blood pressure or heart disease.

On the other hand, acetaminophen has been linked to liver disease in patients who consume excessive amounts of alcohol. And long-term use of both acetaminophen and nonsteroidal anti-inflammatory drugs can increase the risk of kidney failure.

But if acetaminophen and the other even more helpful measures outlined fail to provide adequate relief, the guidelines suggest switching to nonsteroidal anti-inflammatory drugs, which may prove more effective. Furthermore, Dr. Marc C. Hochberg of the University of Maryland School of Medicine said that anyone free of potential complications who was currently effectively using another over-the-counter painkiller should not necessarily switch to acetaminophen.

Even before mentioning medications, the guidelines discuss what patients can do for themselves to minimize the discomfort and disability associated with osteoarthritis. A personalized exercise program to strengthen muscles and increase aerobic capacity can significantly improve patients' mobility and quality of life.

Perhaps most important is maintaining a proper weight. Regular aerobic exercise and a diet low in fat and rich in vegetables, fruits and complex carbohydrates can help people control weight and at the same time reduce risk of heart disease and certain major cancers.

To find an Arthritis Self-Help Course in your area, ask your local chapter of the Arthritis Foundation. Dr. Kate Lorig and Dr. James Fries of Stanford University Medical Center have written an excellent book, ``The Arthritis Help Book,'' which describes a tested self-management program for coping with arthritis and fibromyalgia. The book is available at bookstores. It can also be ordered through local chapters of the Arthritis Foundation and through the foundation's national office at 67 Irving Place, New York, N.Y. 10003, for $14.50 including postage and handling.