How Arthritis Is Treated

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An effective arthritis treatment regimen can help manage the disease. There are many treatment options, and your treatment plan may change over time. The goals include controlling pain and other symptoms, minimizing joint damage and deformities, slowing the progression of the disease, and preserving your physical functioning. Work with your doctor to find the best combination of over-the-counter products, prescription medications, and things you can do at home. In some cases, surgery is an option.

Over-the-Counter (OTC) Therapies

Pain relief is one of the goals of arthritis treatment, and most doctors recommend trying over-the-counter solutions first.

Tylenol (acetaminophen) is preferred because it has fewer side effects than some of the other options. However, you must be careful to never take more than 3 grams (3,000 milligrams) per day. You must be careful to check any other medications or OTC products to ensure they don't contain acetaminophen and put you over this limit. Unfortunately, there isn't much leeway between a therapeutic dose and a toxic dose that can permanently damage your liver.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can also be used for pain relief. However, if you are taking large amounts of these or for a long period of time, you should talk to your doctor and be monitored for side effects. As with acetaminophen, hundreds of OTC products contain NSAIDs and you must read labels carefully if you are taking any cold, flu, allergy, or sleep medication that may put you over the maximum daily dosage.

Maximum daily dosages:

  • Tylenol (acetaminophen): 3,000 mg
  • Aspirin: 4,000 mg
  • Ibuprofen: 1,200 mg
  • Naproxen sodium: 660 mg

Topical skin creams with NSAIDs are another option, as is Zostrix (capsaicin) skin cream that contains the ingredient that makes peppers hot.

Transcutaneous electrical nerve stimulation (TENS) units may also help with pain relief.

Prescriptions

Medications are considered traditional treatment for arthritis. Depending on the severity of your arthritis symptoms when you first consult with your doctor, one or more medications will likely be prescribed. Drug classes used to treat arthritis include the following.

NSAIDs/COX-2 Inhibitors

Prescription-strength NSAIDs are among the most commonly prescribed and widely used arthritis drugs. They relieve inflammation as well as pain. The three types include salicylates, traditional NSAIDs, and COX-2 selective inhibitors. NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. NSAIDs affect both forms. Celebrex (celecoxib) was the first COX-2 selective inhibitor.

NSAIDs can have side effects such as indigestion, nausea, and ulcers. With the exception of aspirin, NSAIDs and COX-2 selective inhibitors can also significantly increase the risk of heart attack and stroke in people with a history of cardiac disease. Many of the COX-2 selective inhibitors were removed from the marketplace due to this concern.

Analgesics (Pain Medications)

Analgesics are pain-relieving drugs that do not relieve inflammation. Tylenol (acetaminophen) is the most commonly used analgesic, and it may be found in some prescription medications. Due to overdose concerns, the amount of acetaminophen in each pill is capped at 325 mg, which is the same as OTC formulations.

Narcotic analgesic drugs may also be prescribed for more severe pain. They can cause drowsiness, nausea, constipation, abnormally shallow breathing, and euphoria. Older adults who are more prone to these effects. There is also a risk of drug tolerance, dependence, and withdrawal. Narcotics include Tylenol #3 (codeine), OxyContin (oxycodone), Percodan (oxycodone/aspirin), and Vicodin (hydrocodone/acetaminophen), and several others.

Corticosteroids

Corticosteroids reduce swelling and inflammation quickly. They are especially used in inflammatory types of arthritis such as rheumatoid arthritis, lupuspolymyalgia rheumatica, and vasculitis. They have the potential for serious side effects when given at high doses or over a long period. Doctors may prescribe short-term, high-dose intravenous steroids in some situations.

Local steroid injections can be used for a specific, painful joint. Three steroid injections per year into a joint is the maximum allowed by most doctors.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are slow-acting anti-rheumatic drugs that help stop disease progression and joint damage. They are second-line agents as they take weeks or months to work. DMARDs are effective in treating rheumatoid arthritispsoriatic arthritis, and ankylosing spondylitis, and early, aggressive treatment is recommended. Common DMARDs include methotrexate and Plaquenil (hydroxychloroquine). A newer option is Xeljanz (tofacitinib citrate), which is used when a patient has an inadequate response to methotrexate. Xeljanz is the first in a class of drugs known as JAK (Janus kinase) inhibitors.

Biologic Response Modifiers (Biologics)

Biologics stimulate or restore the ability of the immune system to fight disease or infection. They are derived from living sources rather than being synthesized. Biologics are most often used to treat rheumatoid arthritis when DMARDs have not given a satisfactory response. They are given by injection.

TNF blockers are one class of biologics that interfere with inflammatory activity. They include Enbrel (etanercept)Remicade (infliximab)Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab). Another type is Orencia (abatacept), a T-cell co-stimulation modulator. Rituxan (rituximab) is used in combination with methotrexate to treat rheumatoid arthritis, targeting one type of immune cells. Actemra (tocilizumab) is a monoclonal antibody that inhibits the interleukin-6 (IL-6) receptor.

Two major concerns with these drugs include the risk of serious infection or lymphoma.

Fibromyalgia Drugs

The FDA approved drugs specifically for the treatment of fibromyalgia starting in 2007. These now include Lyrica (pregabalin)Cymbalta (duloxetine HCl), and Savella (milnacipran HCl).

Gout Drugs

In addition to analgesics and anti-inflammatory medications, gout may be treated with drugs to manage uric acid levels (such as Zyloprim (allopurinol) and Uloric (febuxostat) or prevent gout attacks (such as colchicine). Krystexxa (pegloticase), a biologic drug that works by breaking down uric acid.

Surgeries any Specialist-Driven Procedures

Viscosupplementation is a procedure that involves the injection of gel-like substances (hyaluronates) into a joint (currently approved for knee) to supplement the viscous properties of synovial fluid. Steroid injections were used long before viscosupplementation became a treatment option.

Joint surgery is usually considered a last resort treatment option. Joint surgery is typically considered if conservative treatment measures are unsatisfactory or have stopped working. When joint damage is severe and when pain interferes with daily activities, joint surgery may be an option with the goal of decreasing pain and restoring function.

  • Arthrodesis (fusion)
  • Arthroplasty
  • Osteotomy
  • Joint replacement
  • Revision joint replacement
  • Resection
  • Synovectomy
  • Partial knee replacement

Home Remedies and Lifestyle

Regular exercise is strongly recommended for arthritis patients. Exercise can reduce pain and improve physical function, muscle strength, and quality of life for people with arthritis. While it can be difficult to be motivated to exercise when you are having symptoms such as pain or fatigue, choosing the right exercise to enjoy can make a big difference in your quality of life.

Eating a nutritious diet is important for maintaining ideal weight and for bone health, too. There is no known diet that can cure arthritis, but eating well is important.

Stress management may also be useful as a complementary treatment. Reducing stress may help to calm the pain and stiffness associated with arthritis.

Home remedies to manage pain and stiffness can help you keep it from interfering with daily living. You can try tactics such as cryotherapy (cold packs), heat therapy or warm water therapy (especially for stiffness), or massage.

Assistive devices can help protect your joints and make it easier for you to go about your day. Look into canes, walkers raised toilet seats, grabbers, and other helpful devices.

Complementary Alternative Medicine (CAM)

Some people are more interested in natural treatments than traditional medications. If you prefer a natural approach to treating arthritis, it's still imperative that you tell your doctor what you are taking or what you want to try. There are many natural treatment options, also referred to as alternative treatments, which are popular but not fully endorsed for effectiveness and safety. Any supplements or herbal products need to be discussed because they can interfere with other medications or lead to dangerous drug interactions.

The National Center for Complementary and Integrative Medicine of the National Institutes of Health reports on the effectiveness of these CAM treatments:

  • Acupuncture and acupressure: Studies have not shown clear evidence of a beneficial effect for rheumatoid arthritis, but as practiced in the U.S. it may help some patients with knee osteoarthritis manage their pain.
  • Biofeedback and relaxation techniques: Some small studies have been promising for rheumatoid arthritis.
  • Magnets: Static magnets have not been shown to have any effect on osteoarthritis. Electromagnetic field therapy is still being explored.
  • Massage: Only a few studies have been done of massage, so it isn't possible to give a definitive recommendation. The practitioner needs to take care not to stress the joints.
  • Meditation: Four studies have found that mindfulness meditation has been found to be helpful in managing symptoms of pain and in helping patients cope with their condition.
  • Tai chi: Studies have found tai chi to be beneficial for well-being in osteoarthritis patients and rheumatoid arthritis patients.
  • Yoga: Yoga should be a beneficial form of exercise for people with arthritis, but modifications may be needed to minimize joint stress.
  • Omega-3 fatty acids (fish oil): A 2017 review of studies found some favorable effects on pain for patients with rheumatoid arthritis.
  • Glucosamine and chondroitin: After much study, it appears chondroitin doesn't help osteoarthritis pain, and it's unclear as to whether glucosamine has any effect.

Be wary of dietary supplements sold for arthritis relief. The U.S. Food and Drug Administration (FDA) warns that many are tainted with prescription drugs. You could experience dangerous side effects from these supplements.

The terms complementary medicine and alternative medicine are sometimes used interchangeably. The difference is that complementary treatments are used together with your usual treatment regimen. Alternative treatments imply that they are used instead of your usual treatment.

A Word From Verywell

People with early symptoms of arthritis are often inclined to self-treat with over-the-counter medications, topical creams, or conservative measures, such as ice or heat. The Arthritis Foundation recommends seeing a doctor if you have joint pain, stiffness, or swelling which persists for two or more weeks, whether or not your symptoms began suddenly or gradually. Only a doctor can diagnose arthritis. An accurate diagnosis is needed so appropriate treatment can begin.

A rheumatologist (arthritis specialist) will help you understand all of your treatment options and also help you steer clear of unproven remedies. Discuss the potential benefits and risks of each treatment option with your doctor.

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