How To Treat Arthritis And Get Relief

Before we explain how to treat arthritis, let’s start with a brief explanation of arthritis.

What is Arthritis?

Arthritis is a joint disorder involving inflammation of one or more joints accompanied by pain of varying severity. There are over 100 different forms of arthritis, the most common form being osteoarthritis which is a degenerative joint disease resulting from either trauma or infection to the joint, or from the natural aging process. Other fairly common forms of arthritis are:-

  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Septic arthritis-caused by joint infection.

The major complaint by individuals who have arthritis is joint pains which is often a constant, and is usually limited to the affected joint. This pain may be due to any one of the following situations occurring around the joint:-

  • Inflammation.
  • Damage to the joint from disease.
  • Daily wear and tear of the joint.
  • Muscle strains caused by forceful movements against stiff, painful joints and fatigue.

How to treat arthritis?

Medical science is yet to find a cure for arthritis, but the various modes of treatments help to reduce pain and maintain joint movements so that affected individuals can go about their daily tasks with minimum inconvenience. Treatment regimes vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications, and sometimes surgery.

For the majority, the aims of treatments are to:- 

  • Educate the patient
  • Control pain
  • Optimize function of joints
  • Beneficially modify the disease process.
These aims of treatment are interrelated and success in one area often benefits the others. Successful treatment inevitably requires careful assessment of the affected individual, as well as the severity of his or her arthritic condition in relation to his or her whole musculo-skeletal system (MSK). 

 

The treatment regime needs to be individualized according to:

 

  • The person’s daily activity requirements and work and recreational aspirations.
  • The person’s perceptions and knowledge of his or her condition.
  • Medications and coping strategies already tried by the patient.
  • Co-morbid disease and its therapy.
  • Risk factors and associations of the arthritic condition with that of the whole musculo-skeletal system (e.g. obesity, muscle weakness, non-restorative sleep).
The wide variety of treatment approaches may require the expertise of a number of health professionals, necessitating a coordinated multidisciplinary team approach for some patients. The patient’s symptoms and signs will change with time, and require review and readjustment from time to time, rather than rigid continuation of a single treatment plan.
The principal core interventions that should be considered for every patient with a painful arthritic condition are :-

Core
  • Education
  • Exercise
    • Aerobic conditioning
    • Strengthening
  • Reduction of adverse mechanical factors
    • Pacing of activities
    • Appropriate footwear
  • Weight reduction if obese
  • Simple analgesia
Other treatment options
  • Other analgesic drugs
    • Oral NSAIDs
    • Topical creams
    • Opiod analgesics
    • Amitriptyline
  • Slow-acting antirheumatic drugs
  • Corticosteroids
  • Local injections

Physical treatments

  • Heat, cold, aids, appliances
  • Surgery
  • Coping strategies

How to treat arthritis – Medications:

Dozens of drugs are used to treat arthritis. Some relieve pain, some reduce inflammation and others control the underlying disease. These include:-

  • Painkillers (analgesics)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Steroids
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic drugs

Painkillers (analgesics)

The commonest, simplest and safest painkiller is paracetamol and is often tried first at a dose of 1g every 6 or 8 hours. Other anti-inflammatory drugs such as aspirin and ibuprofen can be used in low doses, while stronger painkillers, like codeine or morphine are only available by prescription from the individual’s personal physician.

Pain killing patches may also be used, although they are not widely available. They are applied to the skin and their slow release pain killing effects last from three to seven days.

In cases where none of the above is effective, a much stronger analgesic may be prescribed by your doctor.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These decrease inflammatory reactions in the joints and reduce swelling. They also provide some pain relief. Long term usage causes stomach problems and other side effects.

Various Types include:-

  • ibuprofen (Brufen, Nurofen and others)
  • diclofenac (Voltarol, Diclomax)
  • nabumetone (Relifex)
  • indometacin (Indocid and others)
  • naproxen (Naprosyn and others)

Celecoxib (Celebrex) and Etoricoxib (Arcoxia) belong to the newer type of NSAIDs, which are Cox-2 inhibitors, designed to be gentler on the stomach.

Steroids

Steroids (corticosteroids) are very effective in reducing inflammation. Prednisolone (Deltracotril) is the commonly prescribed steroid for people with arthritis.

Weight gain and Osteoporosis are some of the many side effects which may be experienced with long term usage, which must always be done under careful medical supervision. Stoppage of steroid usage must always be done in a gradual decremental fashion and never suddenly.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are a family of drugs including immunosuppressants which damp down the activity of the immune system. They slow down the progression of the disease process and reduce the amount of damage it does to the joints – so they should be commenced immediately the diagnosis is established.

They are used to treat such forms of inflammatory arthritis as: – rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and ankylosing spondylitis.

Different Types used include:

  • methotrexate (Maxtrex)
  • sulfasalazine (Salazopyrin EN, Sulazine EC)
  • azathioprine (Azamune, Imuran)
  • cyclosporin (includes Neoral)
  • cyclophosphamide
  • hydroxychloroquine (Plaquenil)
  • gold by injection (Myocrisin)
  • leflunomide (Arava)

These drugs can exhibit serious side effects, therefore careful medical supervision and monitoring is necessary for all individuals on such medications.

Biologic drugs

An enzyme called tumour necrosis factor (TNF) is said to play an important role in driving the inflammation and tissue damage seen in certain kinds of inflammatory arthritis.

Anti-TNFs are a type of biologic drug which work by blocking the action of TNFs on tissues of the various joints. These drugs are not appropriate for everyone and are not free of side effects. They can offer good control to some people with severe inflammatory arthritis, who have not responded well to other disease-modifying drugs.

Strict guidelines have to be followed in assessing who is eligible and this is usually done by a rheumatologist (a doctor who specializes in the treatment of various forms of arthritis especially, rheumatoid arthritis).

These drugs include:-

  • Adalimumab (Humira), given by fortnightly injections.
  • Etanercept (Enbrel), given by once or twice-weekly injections.
  • Infliximab (Remicade), given by infusion every eight weeks in hospital.
  • Certolizumab pegol (Cimzia) given by fortnightly injections.


Parent page: How To Treat Arthritis And Get Relief