How Arthritis Is Treated

The goals of arthritis treatment are to control pain and other symptoms, minimize joint damage and deformities, slow the progression of the disease, and preserve physical functioning. There are many arthritis treatment options to help with this, including medications, lifestyle changes, joint injections, surgeries, and more. You will likely need a combination of treatments, and you regimen may need to change over time.

Arthritis cannot be cured, but an effective arthritis treatment plan can help you manage the disease.

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 not take more than 4,000 milligrams (mg) per day; there isn't much leeway between a therapeutic dose and a toxic one that can permanently damage your liver.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Bayer (aspirin), Motrin (ibuprofen), and Aleve (naproxen) can also be used for pain relief. However, if you are taking large amounts of these or using them for a long period of time, you should talk to your doctor and be monitored for side effects.

In addition to monitoring how often you reach for an OTC drug for arthritis pain relief, check any other medications you are taking to ensure they don't also contain the same active ingredient (e.g., acetaminophen or ibuprofen). Hundreds do, and taking one while you're treating your arthritis in this way can put you over the maximum daily dosage.

Adult dosing:

  • Acetaminophen: 4,000 mg
  • Aspirin: 4,000 mg
  • Ibuprofen: 3,200 mg
  • Naproxen sodium: 1,650 mg

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

Transcutaneous electrical nerve stimulation (TENS) may also help with pain relief. While some units are available OTC, others may require a prescription to obtain them and/or to have them covered by insurance.

Prescriptions

Prescription medications are considered the 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 and is the only one currently available in the United States.

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. Many of the COX-2 selective inhibitors were removed from the marketplace due to this concern.

Besides Celebrex, and prescription-strength Advil (ibuprofen) and Aleve, these are examples of prescription NSAIDs used to treat arthritis symptoms:

  • Feldene (piroxicam)
  • Indocin (indomethacin)
  • Mobic (meloxicam)
  • Clinoril (sulindac)
  • Dolobid (diflunisal)
  • Relafen (nabumetone)

Analgesics (Pain Medications)

Analgesics are pain-relieving drugs that do not relieve inflammation. Acetaminophen is the most commonly used analgesic, and it may be found in some prescription medications.

Narcotic analgesic drugs may also be prescribed for more severe pain. They can cause drowsiness, nausea, constipation, abnormally shallow breathing, and euphoria. Older adults are more prone to these effects. There is also a risk of drug tolerance, dependence, addiction, and withdrawal.

Narcotics include Tylenol #3 (acetaminophen/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.

Examples of corticosteroids used for arthritis include Deltasone (prednisone), Cortef (hydrocortisone), and Decadron (dexamethasone).

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

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are slow-acting anti-rheumatic drugs that help stop disease progression and joint damage in certain forms of arthritis. However, they often 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, Xeljanz (tofacitinib citrate), is used when a patient has an inadequate response to methotrexate. Xeljanz is the first in a class of rheumatitis 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.

Krystexxa (pegloticase) is a biologic drug that works by breaking down uric acid and is used in treating gout rather than other arthritic conditions.

Other Drugs

In addition to analgesics and anti-inflammatory medications, gout may be treated with drugs that manage uric acid levels that lead to crystal formation in this condtion. These include Zyloprim (allopurinol) and Uloric (febuxostat). Colchicine is a drug with a specific effect in helping prevent gout attacks.

Cymbalta (duloxetine HCl), a drug originally approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia, is also approved for the treatment of chronic musculoskeletal pain stemming from osteoarthritis and other causes.

Note: According to the Arthritis Foundation, 20% to 30% of people with rheumatoid arthritis also develop fibromyalgia. As such, Cymbalta or another fibromyalgia drug—Lyrica (pregabalin) and Savella (milnacipran HCl)—may be prescribed along with your arthritis medication to treat this common comorbidity.

Surgeries and 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 a last resort treatment option that is only considered if conservative measures are unsatisfactory or have stopped working. Those who undergo joint surgery typically have severe joint damage and pain that interferes with daily activities.

Surgical options include:

  • 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, so you can start by following the basics of healthy eating; you may also benefit from incorporating anti-inflammatory foods.

Reducing stress may also help calm the pain and stiffness associated with arthritis. Being under stress can heighten your pain perception. A study also found that psychological stress was associated with flares and relapse in people with rheumatoid 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 self-massage. Beware of folk remedies.

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 and Alternative Medicine (CAM)

If you prefer a natural approach to treating arthritis, or would like to explore complementary options, it's imperative that you tell your doctor what you want to try (or are already using). There are many alternative treatment options that, while popular, are not fully endorsed for effectiveness and safety. Supplements and herbal products also pose the potential for dangerous drug interactions.

The National Center for Complementary and Integrative Medicine, a division of the National Institutes of Health (NIH), reports on the effectiveness of some CAM treatments for arthritis:

  • 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 therapy: 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.

A Word From Verywell

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 options—their benefits and their risks.

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Article Sources

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