ArcaMax

DEAR DR. ROACH: Are there any studies that show who might be more seriously affected by COVID, whether it's based on risk factors such as genetics, vitamin deficiencies, etc.? -- F.F.

ANSWER: There are many disease conditions that put a person at risk for a severe illness if they get infected with the virus that causes COVID. These include any chronic heart or lung diseases, immune system diseases, and diabetes, but they also include very common conditions that aren't diseases. Just being over 65 is a risk, as is being overweight or obese, a current or former smoker, or physically inactive. Another risk is having mental health disorders, including depression.

Some genetic conditions, like alpha-1 antitrypsin deficiency, puts people at an increased risk as well. Vitamin D deficiency seems to increase the risk of getting COVID and having a severe case; however, vitamin D treatment has not been convincingly shown to improve outcomes.

People in high-risk groups should get the updated vaccine available now and strongly consider wearing masks in public when community transmission is high. Your local health department can help tell you how much community transmission there is.

DEAR DR ROACH: I have been having knee pain from mild arthritis for almost a year now. Over the course of this year, I have had two cortisone shots and one hyaluronic acid shot in my knee. I've also had months of physical therapy. Nothing has helped. I don't want to take pain meds, and there aren't many I can take.

Would taking hyaluronic acid tablets be of any benefit? I am on blood pressure medications as well as thyroid medication. Your insight would be appreciated. -- A.H.

ANSWER: Osteoarthritis of the knee is exceedingly common and can be frustrating, as the therapies we have don't work for everyone. Exercise remains the most important treatment because it improves function and relieves pain for most. But it doesn't sound like it's been working so well for you.

Cortisone shots sometimes provide benefit, but are usually used in people with moderate-severe osteoarthritis and are not recommended to be repeated frequently, as they can damage the cartilage over time. Hyaluronic acid shots, although frequently tried, seem to help only a minority of patients in my experience, and the studies have not shown a consistent benefit. Although I've had patients try platelet-rich plasma, a recent well-done study didn't show benefits, and the process is expensive and usually not covered by insurance.

When it comes to oral treatments, most people get some relief from standard pain medicines (called NSAIDs) like ibuprofen or naproxen or their by-prescription cousins, but it sounds like those might be the kind that you can't take. Some supplements, including hyaluronic acid, turmeric, Boswellia, and glucosamine/chondroitin, all have mixed data showing effectiveness, but they are generally safe.

For my patients who want to try these, I recommend a minimum of a two-week trial. Keeping a daily record of how severe the symptoms are can really help identify an effective treatment for you.

Finally, it's always worth trying topical anti-inflammatories. Only a minority of people get a real benefit from diclofenac gel, but it is very safe and sometimes provides dramatic relief.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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