advice the doctor Whether its a health niggle, emotional problem or youre just looking for guidance, Inspire magazines Dr Sarah Jarvis gets straight to the point Q I have rheumatoid arthritis, osteoarthritis and osteoporosis, and can have no medication because of allergies. Last year I had what was thought to be a transient ischaemic attack (TIA) and it was, in fact, an allergy to soya. One doctor told me not to get my high blood pressure treated because it was all down to allergies but my GP has said it needs treating. What do I do? Glennis, via email Q I have suddenly developed inflammatory arthritis of the hands. It was confirmed three months ago and I am still awaiting my urgent referral with the rheumatologist. I work as a phlebotomist, so my hands are of the upmost importance. I cant even do up my bra, turn on the shower tap or squeeze the toothpaste. While I await my appointment I have been prescribed naproxen. I have tramadol to take at night as well. Ive been told that cider vinegar with manuka honey and molasses is a miracle cure. I am desperate now, so I am giving it a go while I wait for my appointment but do I continue to take the naproxen or try this on its own? susan, via email Do you a probl have like an em youd s so, wri wered? If Inspire te to us at: magaz 275 ne wmark ine, Cambr e idge CB t road, 5 8JE, or ema arthrit il inspire@ iscare. org.uk dr sarah Jarvis answers: Pretty much all medicine can cause side effects, including allergic reactions, and some people are more prone to these than others. However, its important to bear in mind that conditions for which you are treated can cause side effects so there are significant side effects to not treating. all medicines are assessed on the basis of their risk to benefit profile. When you have a long-term condition such as rheumatoid arthritis with potentially very severe side effects, the extent of the risk that will still be outweighed by the benefit is fairly high. That is why drugs that suppress your immune system such as methotrexate, sulfasalazine and biologics are still widely used,because their potential benefit isso great. However, conditions such as high blood pressure, which may cause no symptoms in the short term, are also potentially serious. High blood pressure is the single biggest risk factor for stroke and one of the biggest for heart attack. its particularly important for people with rheumatoid arthritis, who have been found to be at higher risk of cardiovascular disease. However, its normal for blood pressure to go up and down such as when were stressed and during exercise. The big risk comes from consistently high blood pressure. severe life-threatening allergy, called anaphylaxis, causes a rapid drop in your blood pressure. However, if youre feeling generally unwell and anxious because of a less severe side effect, your blood pressure may go up temporarily. To work out if your high blood pressure needs treating, speak to your GP about getting ambulatory blood pressure monitoring (aBPm). This involves wearing a blood-pressure cuff attached to a small monitor for 24 hours. if your average blood pressure over that period is raised, take your GPs advice and consider treatment to lower it. dr sarah Jarvis answers: While i wish i could tell you that there was a natural, side-effect-free solution to your distressing and debilitating arthritis, im afraid i cant. Honey and vinegar is one of grandmas remedies that has been around for centuries i remember my mother trying it but theres no clinical evidence it works. The best i can say is that it probably wont do any harm, so theres nothing to stop you from taking it. Doctors and scientists cant afford to rely on single (or even several) people raving about a treatment they need evidence from clinical trials. ideally, these are randomised controlled trials, comparing the activetreatment to a placebo or inactive treatment importantly, in the best trials, neither the doctor nor the patient knows if theyre taking the real thing until the trial is over. This stops people feeling better because they think what they are taking will work, or vice versa. We suspect this may account for much of the benefit people talk about from cider vinegar and honey. Glucosamine and chondroitin combinations are another natural treatment thats widely used, but studies have shown conflicting results in osteoarthritis and little benefit in inflammatory arthritis. Gopo, a supplement made from rosehips, has had some promising results in studies involving patients with osteoarthritis and rheumatoid arthritis. as to whether or not you should take naproxen while you wait for your appointment that depends entirely on how bad your symptoms are. Naproxen is a member of the NsaiD anti-inflammatory family that also includes ibuprofen and diclofenac. all NsaiDs relieve pain, but they can causeindigestion, and sometimes inflammation and bleeding from the stomach lining. if you are getting significant pain, taking naproxen isnt going to make your condition worse in the long term although, if you take it for any length of time, its worth considering taking it with a regular tablet to protect your stomach lining. Arthritis Cares helpline is staffed by qualified counsellors who can give you emotional support, and its free and confidential. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. Arthritis Care also has a number of free booklets about arthritis that you can download. Click here for more information.