Arthritis

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Arthritis Treatment

There are many different kinds of arthritis. Treatment varies, depending on the particular cause, how severe the disease is, which joints are affected, to what degree the patient is affected, and the person's age, occupation, and daily activities.

Treatment may focus on eliminating the underlying cause of the arthritis. However, the cause usually is NOT curable. Treatment therefore aims at reducing pain and discomfort and preventing further disability. It is critical to follow the prescribed therapy.

The symptoms are treated as necessary. They may be helped with simple modifications in daily activities, along with adequate rest and appropriate forms of exercise. For example, low impact aerobic exercise (such as swimming) significantly relieves joint strain. In other cases, more extensive therapies are needed. Treatment usually consists of exercise, heat or cold treatments, methods to protect the joints, various medications, and possibly surgery.

MEDICATIONS:
Medications to reduce joint pain and joint swelling may include acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other immunosuppressive drugs (drugs that slow the immune system).

• Acetaminophen -- recommended by the American College of Rheumatology as the first line treatment for osteoarthritis. Taken in doses of up to 4 grams a day, it can provide significant relief of arthritis pain without many of the side effects of the drugs discussed below. However, do not exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol, because these pose risks for liver damage.
• Aspirin and NSAIDs -- are available over-the-counter, and are often effective in combating arthritis pain. Though these medications can be prescribed in stronger doses by physicians, they may have many side effects. Therefore, they should not be taken in any amount without consulting with your health care provider. The most dangerous side effects of NSAIDs are the formation of stomach ulcers, bleeding from the digestive tract, and kidney damage. Patients with kidney or liver disease, or a history of gastrointestinal bleeding should not take these medicines without consulting their physicians.
• New prescription medications -- drugs, such as Celecoxib and Rofecoxib, treat arthritis pain in a fashion similar to traditional NSAIDs. However, they seem to cause less stomach irritation and confer a lower risk of ulcers and gastrointestinal bleeding. Because these drugs can still effect the digestive tract and can be toxic to the kidneys, they should be taken under careful medical supervision.
• Oral glucosamine and chondroitin -- these form the building blocks of cartilage, the substance that lines joints. They are available at health food stores or supermarkets without a prescription. Early studies indicate that these compounds are quite safe and may improve symptoms relating to arthritis.
• Corticosteroids (or "steroids") -- are medications that suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally, by injection, or occasionally injected directly into an affected joint. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, hypertension, thinning of bones, cataracts, and increased infections. These risks are most pronounced when steroids are taken for long periods of time or at higher doses. Close supervision by a physician is essential.

A number of other immunosuppressive drugs are used to treat autoimmune diseases that cause arthritis, including rheumatoid arthritis, scleroderma, and lupus. Rheumatoid arthritis traditionally has been treated with drugs that modify the immune system, such as gold salts, penicillamine, and hydrochloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve the patient's quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.

The most recent breakthrough in rheumatoid arthritis has been the development of so-called "anti-biologics" that target individual molecules to reduce inflammation. Such medications, including etanercept (Enbrel) and infliximab (Remicade), are administered by injection or vein (intravenously) and can confer dramatic improvements in the patient's quality of life.

Normal joints contain a lubricant called "synovial fluid." In joints with arthritis, this fluid is not produced in adequate amounts. A relatively recent approach is to inject arthritic joints with a manmade version of joint fluid known as hylan G-F 20 (Synvisc). This synthetic fluid may postpone the need for surgery at least temporarily and improve the lifestyle of arthritis patients. Many studies are evaluating the effectiveness of this type of therapy.

LIFESTYLE CHANGES:
Both rest and exercise are important. Warm baths, massage, and stretching exercises may be helpful. Modifications in daily activities or using assistive devices to protect the joints are often recommended.

OTHER THERAPY:
Physical therapy for muscle and joint rehabilitation may be recommended in severe cases.