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- What is arthritis?
- Symptoms of arthritis
- Causes of arthritis
- Prevention of arthritis
- Risk factors for arthritis
- Complications of arthritis
- When to see a doctor about arthritis
- Diagnosis of arthritis
- Conventional treatment of arthritis
- Alternative/complementary treatment of arthritis
- Living with arthritis
- Caring for someone with arthritis
Conventional treatment of arthritis
Conventional treatment depends on the type of arthritis and the severity of symptoms:
Mild to moderate osteoarthritis
Osteoarthritis that is mild to moderate in nature is treated with the following strategies:
- Exercise - a doctor will recommend the type and duration of exercise that is feasible, which can help to increase strength, stability and endurance of he muscles around the joint and help reduce symptoms. Gentle exercise, like walking, swimming or pilates are the most common types of exercise recommended to help support the joints, but if pain is experienced, then stop and try something else that doesn't cause pain
- Hot and cold packs - alternating hot and cold packs can help to relieve any type of inflammation in the joints. The heat relieves stiffness and the cold relieves muscle spasms. The heat should be warm by not too hot and the cold packs should not be used on people with bad circulation or numbness symptoms
- Medication - there are a number of medications that are recommended as either over-the-counter or by prescription, depending on the severity of symptoms and type of arthritis:
- Acetaminophen - acetaminophen (Panadol, Tylenol) can relieve pain, but wont reduce inflammation in people with mild to moderate osteoarthritis.
- NSAIDs - nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation in the affected joint. They can be purchased over-the-counter (ibuprofen and naproxen sodium) or prescribed by a doctor. NSAIDs that are prescribed by a doctor are just stronger versions of the ones that can be purchased at a pharmacy. Prescription NSAIDs have many side-effects that may occur when used long term
- Tramadol - this is an anaelgesic which is only available by prescription, which provides pain relief but does not provide any anti-inflammatory actions. Tramadol has fewer side effects than NSAIDs and is used on a short-term basis for acute symptoms (and is often combined with acetaminophen)
- Pain creams - there are a number of creams and gels which have a fast acting pain reliever that can be purchased over-the-counter from pharmacies. Pain creams work best to relieve pain on knee and finger joints. Always read the labels and ensure you know what you are using
- Rest - doctors recommended rest for 12-24 hours, not to use the joint that is in pain and if this is not possible, to have a rest every hour for about 10 minutes to give the joint some respite from movement
Severe osteoarthritis
The treatment of severe osteoarthritis consist of medication to reduce pain and inflammation:
- Cortisone shots - cortisone medication can be injected into the joint(s) to relieve severe pain and inflammation. This needs to be done by a doctor, who has to numb the joint area first and then inserts the needle with the cortisone medication into the space within the joint
- Strong painkillers - strong prescription pain medication can be used to treat severe pain. The stronger painkillers have a small risk of dependence in some people. Examples are: codeine, darvon
- Visco supplementation - are used for osteoarthritis in the knee only and consists of injections of hyaluronic acid derivatives (Hyalgan, Synvisc) which can provide pain relief by cushioning the knee joint. These treatments are made from rooster combs as this is similar in composition to the fluid found in the joints and are provided on a weekly basis for a number of weeks. People allergic to birds, feathers or eggs may not be able to have this treatment
Surgery
Surgery is also an option for very severe osteoarthritis that has not responded well to other treatment:
- Arthrodesis (fusing bones) - this surgery involves permanently fusing bones together in a joint to increase stability and reduce pain. The fused joint can bear weight after this procedure, but it no longer has any flexibility at all. This surgery may be an option for people who have very severe pain but cannot have joint replacement surgery
- Arthroplasty (joint replacement) - this surgery involves the removal of damaged joint surfaces and replacement with an artificial one, a prosthesis, which is made up of plastic and metal. The hip and knee are the most commonly replaced joints, but other types of joints are also getting replaced too. The artificial joints can last up to 20 years, giving people a much better quality of life with more movement and less pain
- Debridement - this surgery involves cleaning up the area around the joint so that loose pieces of cartilage and bone are removed to reduce pain and inflammation. Debridement is generally performed arthroscopically, with only small incisions in the joint, a tiny camera inserted inside to allow the surgeon to view the joint area that is being operated
- Osteotomy (re-aligning bones) - this surgery is used when joint replacement surgery is not a viable option (especially in younger people) and involves re-aligning the bones to reduce stress on the damaged part of the joint
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All forms of rheumatoid arthritis
The treatment of rheumatoid arthritis is aimed at reducing pain and inflammation and joint damage in order to slow the progression of the condition.
Medication for rheumatoid arthritis
The medications that are recommended for people with rheumatoid arthritis reduces pain, slows or halts progression of the disease and reduces inflammation. Main medications used for rheumatoid arthritis include:
- Abatacept (Orencia) - this medication reduces inflammation and joint damaging by inactivating T cells (infection fighting white blood cells) and is recommended when the TNF-alpha inhibitors have not worked to treat symptoms. Abatacept is administered on a monthly basis, by a doctor (or nurse) through a vein in the arm. This medication can cause potentially serious side effects
- Anakinra (Kineret) - this medication is similar to a naturally occurring protein in the body - interleukin-1 receptor antagonist (IL-1Ra) - which stops the messages in the body that promote inflammation. People who have not been able to get relief with DMARD medications may be recommended Anakinra, which needs to be injected (self-administered) under the skin on a daily basis. This drug has potentially serious side effects and should not be used in people with an active infection of any type
- Disease-modifying anti-rheumatic drugs (DMARDs) - these medications are prescribed in the early stages of rheumatoid arthritis to limit the joint damage, slow the disease and save the joint and other tissues in the body from permanent damage. The only challenge with these medications is that they can take weeks to months to start working, so they are usually combined with other medications (NSAIDs, steroids) to provide immediate pain relief
- Immunosuppressants - these medications are used to make the immune system stop attacking the body by suppressing some of its activity and so reduce the symptoms related to rheumatoid arthritis. The challenge with these medications is that they can potentially cause serious side effects by increasing susceptibility to infection and possible tumours
- NSAIDs - nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation and are the most commonly used medication for rheumatoid arthritis. They can be purchased over-the-counter (ibuprofen and naproxen sodium) or prescribed by a doctor. NSAIDs that are prescribed by a doctor are just stronger versions of the ones that can be purchased at a pharmacy. Prescription NSAIDs have many side-effects that may occur when used long term
- Rituximab (Rituxan) - this medication reduces the number of B cells in the body (B cells are white blood cells involved in immunity and cause inflammation as part of the healing process) and is recommended when the TNF-alpha inhibitors have not worked to treat symptoms. Rituximab is administered as an infusion into a vein in the arm. There are a number of potentially serious side effects that are associated with this drug
- Steroids - corticosteroid medications, such as prednisone and methylprednisolone can reduce inflammation and pain in the joint and even slow joint damage, but they cannot be used long term as there are a number of side effects associated with long term use. The corticosteroids are usually prescribed to relieve acute symptoms, with the goal of gradually tapering off the medication
- TNF-alpha inhibitors - this medication target or block the amount of TNF-alpha in the body, which is known to be responsible as the cell protein that causes inflammation. TNF inhibitors help to reduce pain, morning stiffness and swollen joints, usually within 1-2 weeks of treatment. While TNF inhibitors reduce pain and inflammation, there is no evidence to suggest they stop the progression of the disease
In 2008 the American American College of Rheumatology (ACR) made new recommendations for prescription of medication for rheumatoid arthritis. The ACR recommended:
- Hydroxychloroquine or minocycline - for mild rheumatoid arthritis that had been present for less than two years
- Methotrexate or leflunomide - for all forms of rheumatoid arthritis with or without a poor prognosis
- Sulfasalazine - for all forms of rheumatoid arthritis with a poor prognosis
- DMARDs or a TNF-alpha inhibitor - for more severe forms of rheumatoid arthritis
Surgery
If medication has failed to slow progression of rheumatoid arthritis, then surgery may be an option to repair damaged joints:
- Arthroplasty (joint replacement) - this surgery involves the removal of damaged joint surfaces and replacement with an artificial one, a prosthesis, which is made up of plastic and metal. The hip and knee are the most commonly replaced joints, but other types of joints are also getting replaced too. The artificial joints can last up to 20 years, giving people a much better quality of life with more movement and less pain
- Synovectomy - this surgery involves removal of the synovial lining if it is inflamed and also causing a great deal of pain
- Tendon repair - if inflammation and joint damage is severe, it may cause the tendons around the joint to become looser or even tighten. This surgery is done to repair the tendons around to joint to give it more stability, flexibility of movement and to reduce some of the pain and inflammation
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< 8: diagnosis 10: alternative treatment > Last reviewed: 3 January 2009 || Last updated: 8 February 2009
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NOTE: Mega doses of any type of vitamin, mineral, amino acid or herbal supplement cannot cure illnesses and in fact can be very dangerous and produce toxic side effects and interfere with medicine you are taking. Always ensure you consult your doctor before taking any type of complementary supplements.
Disclaimer: This guide is not intended to be used for diagnostic or prescriptive purposes. For any treatment or diagnosis of illness, please see your doctor.
