1. Dr Pete Rose Medical Therapy

2. Supplements Over-the-counter medicines Prescription medicines Injection therapy

3. Supplements Little scientific evidence for/against products –Not subject to FDA regulations –Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms –No evidence for other compounds

4. OTC Medicines Tylenol NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve) –Equally effective in all major studies –Quite safe when taken with supervision Stomach ulcers Kidney trouble

5. Prescription Medicines Prescription NSAIDs –Celebrex, Mobic, etc –No better than ibuprofen or naprosyn in comparable doses Benefits for select patients Primary benefit is convenience –Cardiovascular risks unknown

6. Prescription Medicines - Opiates Synthetic derivatives of morphine –Effective –But… tolerance building and habit forming –Frequent depression and side effects –Used very selectively and carefully under specialty supervision

7. Physical Therapy Important aspect of joint care in SS Particularly important before and after any surgery

8. Injection Therapy Injection of cortisone or hyaluronic acid derivatives Effective in ~2/3rds patients Effect often fades Safe for up to 3-4 times/year