Dear Doctor: Are there natural remedies for arthritis? Exercises that could help? My pain is in the upper arms and shoulders.

Dear Reader: Osteoarthritis, the kind that you're describing, is caused by degeneration of the cartilage within a joint. Without the cartilage, one bone rubs upon the other, leading to pain and degeneration of the bone.

Doctors typically recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and aspirin; acetaminophen; and, more rarely, opiates. But NSAIDs can increase the risk of stomach ulcers and kidney problems when used chronically; acetaminophen at high doses can cause liver problems when used chronically; and opiate medications can lead to addiction. So I can understand your desire to look for an alternative for the pain.

The supplements chondroitin sulfate and glucosamine have been used for osteoarthritis for years. Chondroitin is one of the building blocks of cartilage in our body, so many people naturally believe that taking chondroitin can decrease the pain of arthritis.

A 2015 review of 43 randomized trials compared the use of chondroitin alone or in combination with glucosamine against the use of a placebo. Most of these studies looked at treatment for arthritis of the knees, with some looking at arthritis of the hips and hands. The studies measured pain on a 100-point scale. The use of chondroitin was found to be beneficial, whether with or without glucosamine, showing a small 8-point difference in pain compared with placebo. It didn't ease the stiffness and lack of mobility associated with arthritis, however.

In another study, a randomized trial of 606 patients with pain from osteoarthritis of the knee compared the use of glucosamine with chondroitin against the anti-inflammatory drug celecoxib (Celebrex). After six months, both groups found a greater than 50 percent reduction in both pain and joint swelling. What was interesting about the study was that it took a while for the glucosamine/chondroitin to work. At one to four months, Celebrex was much better at improving pain, but at six months it was no different than the glucosamine/chondroitin combination. So with the use of glucosamine and chondroitin, it is important to be patient.

The supplements MSM (methylsulfonylmethane) and DMSO (dimethyl sulfoxide) are anti-inflammatory agents that have been studied in arthritis of the knees without evidence of benefit, but it's possible they could decrease pain in the joints of the hands. Arnica montana is a plant-based therapy that has some potential in topical use for pain relief, with one study finding a slight benefit for arthritis of the hands. Topical use of capsaicin cream, made from chili peppers, has shown potential as well, specifically for arthritis of the knee. Other natural remedies and supplements, such as fish oil, are touted for arthritis, but their use has not been well studied.

As for exercises, I would recommend physical therapy to increase your range of motion for your shoulder and to help increase your muscular strength. Yoga, Pilates and tai chi can also be beneficial, potentially increasing your range of motion without undue stress on your already aching joints. Over time, you may well see a difference in your ability to function with less pain.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I'm 63 years old, and even though my kids think I'm too old, I want to start running. Can you help me to prove them wrong?

Dear Reader: At the risk of wading into the middle of a family argument, we believe that it's never too late to become physically active. And if you're careful about how you begin -- and maintain -- your new exercise regimen, there's no reason why running can't be at least one part of the program.

To get your kids on board, let's start with all the good things that come from regular exercise. And when we say exercise, we're referring specifically to activities like walking briskly, jogging, running, swimming laps, dancing, raking leaves (you get the idea) that will increase your heart rate and breathing for an extended period of time.

Regular exercise can help you to control your weight, reduce your risk of serious health problems like heart disease, Type 2 diabetes and some cancers, and even improve your sleep and your mood. It also strengthens muscles and bones, which not only makes it easier to perform everyday tasks and activities, but also can help with balance and thus reduce the chance of a fall. If you're an older adult, regular exercise increases your chances of living longer.

To succeed at your new running program, you'll need to be smart about the way you get started. We believe it's always wise to enlist your primary care physician as your partner when making this kind of lifestyle change. She or he knows your health history and will be able to flag any potential risks or problems.

As for running itself, there are several things you can do -- must do, really -- to make a go of it. Before you even take your first step, be sure you have the right shoes. They'll not only cushion your step, they will also help with alignment and guard against knee, hip and ankle pain. Good socks and comfortable exercise clothes are also important.

Although your goal is running, you're best off beginning with a long, brisk walk. You'll be surprised at how quickly your heart rate goes up. Plan a route -- 20 minutes is reasonable to start -- and see how it feels. As the days and weeks go by, you can increase both pace and distance. When you're ready, start mixing a few minutes of running into your brisk walk.

Easing into a run-walk routine will help you build strength and allow your body to adjust to the physical impact. As with any physical activity, include a slow warm-up and a deliberate cool-down.

Some of our patients find that having a goal to train for, like a 5k charity run, helps them to stick to their routine. Others prefer the camaraderie of exercising with a class or a friend. The main thing is balance. Don't try to do too much too quickly. And whatever you choose, have fun.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My doctor recommends that I be tested for hepatitis C, and I've also seen commercials urging people to get tested for the virus -- but I have no risk factors. Is it really necessary to get tested for it?

Dear Reader: The majority of people who become acutely infected with hepatitis C will not have any symptoms. Of people who acquire the infection, 15 percent to 45 percent will clear it on their own; that is, their immune system will ward off the virus. However, anywhere from 55 percent to 85 percent of patients will develop a chronic infection and a chronic inflammation of the liver. Many of them won't have symptoms until the chronic infection leads to cirrhosis of the liver. That development can occur more than 20 years after the onset of infection.

New cases of hepatitis C are rare, with only 0.3 per 100,000 individuals, and are largely caused by injecting drugs via a needle used by someone with the virus. This practice was most common in the 1960s, '70s and '80s, and those at most risk were born between 1945 and 1965.

Based on this data, a 2012 Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention recommended a one-time testing for hepatitis C for those born in the United States between 1945 and 1965, saying that it would reduce death rates and liver cancer rates from the disease.

In years past, treatment of hepatitis C consisted of interferon-based therapy. This type of therapy was poorly tolerated by patients, with horrible side effects from the drug, and it cured patients only 45 percent of the time. New antiviral therapies for hepatitis C do not contain interferon and are well-tolerated. They are simple to take, with once-a-day dosing for 12 weeks and cure rates of 90 to 100 percent.

But the cost of the treatment is exorbitant. One 12-week course costs $94,500; another course of treatment costs $84,000. Due to the costs, insurers will not cover these medications unless there is some form of liver inflammation.

Now think about the population of people born between 1945 and 1965. These patients are between 52 and 72, and many of those at high risk have already seen a doctor and had multiple liver tests. The likelihood of them being newly diagnosed with hepatitis C is low, and the likelihood that the infection will lead to cirrhosis or liver cancer if liver enzymes have been persistently normal is similarly low. By screening people who have little risk of the complications of hepatitis C, we will be diagnosing more people without allowing them to get treatment.

Because of that, the focus on hepatitis C screening should be on those with high risk of infection and a high likelihood of transmitting hepatitis C to others. With injection drug use increasing in this country, this population needs to be actively screened.

If you've been seeing a doctor regularly, have had no previous risk factors and are not at a high risk of new infection, there may be no need to be screened for hepatitis C.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)