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    Texas Arthritis Program
    MC 1945
    PO Box 149347 Austin, TX 78714-9347
    1100 West 49th Street
    Austin, TX 78756

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    Texas Arthritis Program

Texas Arthritis Program(2)

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 How is Arthritis Treated?

There is no single treatment that applies to everyone with arthritis, but rather the doctor will develop a long-term management plan designed to minimize specific pain and improve the function of the joints.

The individualized approach to the treatment of patients with chronic arthritis should include both nonpharmacologic and pharmacologic therapies. Longterm goals should be set by the patient and a multi-disciplinary team which can include physicians, physical therapists, and occupational therapists.

 Non-Pharmacologic Therapies

(Adapted from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.)

Weight reduction: Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an
average of 11 pounds substantially reduced the development of osteoarthritis in their knees by 50%. In addition, if osteoarthritis has already affected one knee,
weight reduction will reduce the chance of it occurring in the other knee.

couple walkingPhysical activity: Swimming, walking, low-impact aquatic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching
exercises are helpful. A physical therapist can help plan an exercise program that will provide the most benefit. Assistive devices: Canes or walkers can provide
balance and safety, as well as take stress off painful joints. Splints can be worn on the fingers or the hands to protect inflamed tissues. Other items used on a daily basis, such as key rings, pens and door knobs, have been modified to provide greater ease of use for persons with arthritis.

Surgery: In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief
from pain but also improvement in motion for many people with arthritis.

 Pharmacologic Therapies

(Adapted from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.)

syringeThe types of drugs used to treat arthritis depend on the specific condition. Some drugs are familiar because they are commonly used to treat other kinds of pain.
Many of them are available over the counter at reduced dosages. However, long-term use of any drug should be discussed with a physician to avoid side effects. This list is not all-inclusive and is meant for information only. Any chronic use of medication, prescription or over the counter, should be discussed with a health care provider.

Acetaminophen: This non-aspirin pain reliever is safe for most people who limit their alcohol use, including the elderly. It is often the first drug tried for patients with
osteoarthritis but must be taken three or four times a day. It may not work for everyone and the maximum dose should not be exceeded due to the possibility of
liver toxicity.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These are a class of drugs including ibuprofen, naproxyn, indomethacin, and many others. Some of them are available as generic drugs at lower cost. These drugs relieve pain and inflammation in some people. One major concern with these drugs is the risk of ulcers when taking them. Newer drugs (rofecoxib, celecoxib and others) have been developed to lessen the risk of gastrointestinal side effects. Other problems include a risk of kidney disease and worsening hypertension. It should be remembered that aspirin is an NSAID and should not be combined with similar drugs without consulting a physician. Unlike patients with osteoarthritis, patients with rheumatoid arthritis are generally treated with other drugs to reduce or prevent joint destruction (see DMARDs below).

Corticosteroids: These are hormones that are very effective in treating inflammation but can cause many side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis or systemic lupus erythematosus. For rheumatoid arthritis, the doctor may inject a corticosteroid into the affected joint to stop pain. Oral corticosteroids are not used to treat osteoarthritis. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year.

Disease-modifying antirheumatic drugs (DMARDs): These are the major class of drugs used to treat people with rheumatoid arthritis. The most commonly used DMARD is methotrexate. Others include hydroxychloroquine, sulfasalazine, and leflunomide. These drugs are thought to influence the abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

Biological response modifiers: These are the newest drugs for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. They reduce inflammation in the joints by blocking the action of molecules directly involved in inflammation. These drugs include etanercept, infliximab, anakinra, and adalimumab. They have been shown to be extremely powerful; however, they may make patients more susceptible to infection. From a financial perspective, the high costs of these drugs may prohibit many from using them.

Hyaluronic acid: Hyaluronic acid products mimic a naturally occurring body substance that lubricates joints and permits flexible joint movement without pain. It can be injected into large joints (mainly the knee) and has been shown to be effective in some patients with osteoarthritis.

Glucosamine: This chemical is a normal constituent of normal cartilage. In the United States it is considered a dietary supplement, not a drug. It is often taken along with chondroitin, another cartilage component, to relieve the discomfort of osteoarthritis. While there is no convincing evidence yet that these compounds cause repair of damaged joints, there is some scientific evidence that they offer pain relief comparable to NSAIDs or acetaminophen.

Fibromyalgia medications: Currently, no drugs have been developed or approved specifically for fibromyalgia; however, a variety of medications are used to treat specific symptoms. There is increasing evidence that abnormalities of the nervous system involving heightened pain perception play a role in its development. Chemicals that convey pain messages from nerve cells to the spinal cord and brain have been shown to be altered in persons with fibromyalgia. Two such chemicals are substance P, which initiates pain signals after injury, and serotonin, which tones down the intensity of pain signals. Studies have shown elevated levels of substance P and low levels of serotonin in people with fibromyalgia. Accordingly, antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help correct this imbalance. Tricyclic antidepressants can help combat sleep disturbances and chronic pain. Muscle pain and spasms may be relieved with muscle relaxants and a seizure medication called gabapentin.



Last updated February 19, 2013