A Closer Look at Arthritis Treatments

Arthritis, which causes pain, inflammation, and limited movement of joints, has several different forms. Two of the most common are rheumatoid (RA) and osteoarthritis (OA). Arthritis cannot be cured, but treatment can help manage the pain and prevent serious disability.

Variety of medications

Several types of medication are available for arthritis pain. Analgesics, such as acetaminophen, treat only the pain. Others relieve both pain and inflammation.

Acetaminophen

Because it is inexpensive, effective, and usually safe, acetaminophen is often the first medication recommended to treat the pain from OA. Taking too much acetaminophen, however, can lead to liver damage. Many over-the-counter (OTC) products, such as cold and flu medicines, also contain acetaminophen, so it is possible to take more acetaminophen than recommended without realizing it. Because of this, you should read the ingredient label for all your medications carefully.

The risk for liver damage may be increased if you have three or more alcoholic drinks a day while using acetaminophen-containing medicines. People with liver disease, those who drink alcohol heavily, or people who take blood- thinning medicines should not use acetaminophen without first discussing it with their health care provider.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve both pain and inflammation. They do this by blocking production of prostaglandins, chemicals produced by the body. Older NSAIDs, however, also block prostaglandins that protect the stomach and kidneys, which can lead to serious side effects such as intestinal bleeding, ulcers, and kidney damage. Newer NSAIDs can be used for RA, OA, and other forms of arthritis. Examples of older NSAIDs available without prescription are aspirin, Advil, Motrin IB, Aleve, and ketoprofen.

A newer form of NSAIDs called COX-2 medications initially seemed to offer pain relief without the serious gastrointestinal side effects of the older NSAIDs. Because of other safety concerns, however, two of these drugs, Vioxx and Bextra, were taken off the market in 2004. A third, Celebrex, remains available for certain conditions. Your health care provider can give you the latest information on the availability and safety of these medications.

Corticosteroids

Corticosteroids such as prednisone, cortisone, methylprednisolone, and hydrocortisone are powerful drugs that reduce inflammation and suppress the immune system. Some forms may be injected into the affected joints to temporarily relieve pain. Oral forms are available to treat RA and severe cases of OA.

DMARDs

Another class of drugs used to treat RA is called disease-modifying antirheumatic drugs (DMARDs). They may take months to show results, so they are not used for pain relief. They are used to suppress the immune system and slow the damage to the joints caused by RA. Examples of these drugs are gold salts, leflunomide (Arava), hydroxychloroquine (Plaquenil), methotrexate, chlorambucil (Leukeran), and sulfasalazine (Azulfidine).

Biologic response modifier drugs

Another class of drugs used for treatment is called biologic response modifier drugs (BRMs). BRMs are made from living sources, such as cell culture, and they block the reaction of tumor necrosis factor, an immune system protein. BRMs are monoclonal antibodies that recognize specific targets associated with RA and other autoimmune diseases. These drugs are injected or given intravenously. Examples of these drugs are etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret). These drugs may increase the risk of certain cancers, however. Because of this, benefits must be carefully weighed against the possible risks.

Other options

Two new medications for OA of the knee are sodium hyaluronate (Hyalgan and Supartz) and hylan G-F20 (Synvisc). These medications, which are injected into the joint, are fluids similar to a substance that normally lubricates and nourishes a joint. They are components of connective tissue (hyaluronic acid) and are found everywhere in the body, but the highest concentrations are in the cartilage. They relieve pain in the joint for six months to a year. These therapies are not for people who have joint or skin infections, or for people with allergies to eggs or other bird products.

Other treatments

Surgery

Surgery is another option for treating arthritis. Surgery can remove loose pieces of bone and cartilage, smooth bone surfaces, reposition bones, or replace joints. Artificial joints last 15 to 20 years, so patients and their doctors must determine the right timing for surgery.

RA can damage and even rupture tendons, the tissues that attach muscle to bone. Surgery can be done to reconstruct a damaged tendon by attaching an intact tendon to it.

Synovectomy is a surgery in which inflamed synovial tissue is removed. It is usually done as part of reconstructive surgery, especially tendon reconstruction.

In a procedure recently approved by the FDA, surgeons replace damaged cartilage using cartilage stem cells from a healthy knee cartilage. These stem cells then help regenerate the cartilage in the damaged joint and strengthen it.

Exercise

If you have RA, you need to balance rest and exercise. You should rest when the disease is active and exercise when it is not. Rest helps reduce joint inflammation and pain, and fights fatigue. Exercise helps maintain muscles strength, preserves joint mobility, and maintains flexibility. It can also improve sleep and reduce pain and help you lose weight. You exercise program should be based on your physical abilities, limitations, and needs.

For people with OA, exercise can improve mood, decrease pain, increase flexibility, manage weight, and promote physical fitness. The amount and type of exercise will depend on the joints affected and their stability, as well as whether a joint has been replaced. If you have OA, you should include exercises for strength, range of motion, agility/flexibility, and cardiovascular health.

Talk with your doctor or physical therapist about an exercise program that's appropriate for you.

Prosorba therapy

Another treatment option for RA is protein A immunoadsorption (Prosorba) therapy for the treatment of moderate to severe symptoms. In this procedure, blood is drawn from a vein in an arm. The liquid part of blood (plasma) is separated from the red blood cells in a machine. The plasma is sent through a sand-like substance coated with protein A, a substance that binds antibodies. The treated plasma is remixed with the blood cells, then both are returned to the body. The therapy is given in 12 weekly procedures.

Alternative medicine

Alternative medicine has also appeared in arthritis treatment, offering magnetic energy, acupuncture, and herbal remedies to relieve pain. Because little hard evidence exists that these therapies work, discuss these alternatives with your doctor before trying them. 

In addition to medications, exercise, and surgery, you can take steps to make your life with arthritis more enjoyable: Don't smoke and keep your weight down to reduce stress on your knees and hips.

For more information

The Arthritis Foundation offers an Arthritis Self-Help Course for people with the disease. The course lasts six weeks and includes basic information about arthritis and medications to treat it, relaxation techniques to manage pain and stress, and recommendations on how to start an exercise program. Check out the Arthritis Foundation's Web site.