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General: Osteoarthritis, rheumatoid arthritis, and periarthritis are managed with medications that reduce pain and inflammation. Patients with rheumatoid arthritis may also require treatment with medications that weaken the immune system, such as corticosteroids or immunosuppressants. In severe cases, surgery may be necessary to repair damage. In order to properly manage pain and prevent joint damage, patients should take their medications exactly as prescribed by their healthcare providers. Patients should also tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter) because they may interfere with treatment. Abatacept (Orencia®): Abatacept (Orencia®) is a type of drug called a costimulation modulator. Abatacept reduces inflammation and joint damaged caused by rheumatoid arthritis. The drug prevents white blood cells, called T-cells, from attacking the joints. Patients receive a monthly injection through a vein in the arms. Side effects may include headache, nausea, and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, may develop. Antidepressants: Some patients with arthritis may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline, nortriptyline (Aventyl®, Pamelor®), and trazodone (Desyrel®). Arthroscopic lavage and/or debridement: In some cases, patients with osteoarthritis may suffer from severe joint damage. In such cases, surgical procedures called arthroscopic lavage and/or arthroscopic debridement may be recommended. During the surgery, a small incision is made near the joint. A small tubular instrument called an arthroscope is then inserted. The arthroscope has a small light and camera attached to it, allowing the surgeon to see inside the joint. During arthroscopic lavage, the surgeon squirts saline into the joint to remove any blood, fluid, or loose debris inside the joint. During arthroscopic debridement, loose fragments of bone or cartilage are removed from the joint. In some cases, built up scar tissue may also be removed. Both of these procedures may provide temporary pain relief and improved joint function. However, recent studies suggest that they may not be effective in some patients with osteoarthritis. Therefore, patients should discuss the potential risks and health benefits of the procedure with their healthcare providers. Corticosteroids: Corticosteroids, such as prednisone (e.g. Deltasone®) and methylprednisolone (Medrol®), have been used to reduce inflammation and pain and slow joint damage caused by rheumatoid arthritis. These drugs are generally very effective when used short-term. However, if these drugs are used for many months to years, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes. Occasionally, corticosteroids are used to treat patients with severe osteoarthritis. The medication is injected into the affected joints to reduce pain and inflammation. Patients with periarthritis typically receive corticosteroid injections into affected joints to reduce pain and inflammation. Corticosteroids are usually prescribed for a certain amount of time and then the patient is gradually tapered off the medication. Patients should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers. Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain. Disease-modifying antirheumatic drugs (DMARDs): During the early stages of rheumatoid arthritis, patients typically receive disease-modifying antirheumatic drugs (DMARDs) to limit the amount of permanent joint damage. These drugs may take weeks to months before they begin to take effect. Therefore, they are often used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Commonly prescribed DMARDs include the gold compound auranofin (Ridaura®), hydroxychloroquine (Plaquenil®), minocycline (Dynacin® or Minocin®), sulfasalazine (Azulfidine®), and methotrexate (Rheumatrex®). Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, patients may take a hot shower or bath before exercise to help reduce pain. Immunosuppressants: Patients with rheumatoid arthritis may take prescription drugs called immunosuppressants. These medications weaken the body's immune system, which limits the amount of joint damage. Commonly prescribed immunosuppressants include leflunomide (Arava®), azathioprine (Imuran®), cyclosporine (Neoral®, Sandimmune®), and cyclophosphamide (Cytoxan®). These medications may have serious side effects, including increased risk of infections, kidney problems, high blood pressure, and decreased levels of red blood cells. Other side effects may include increased hair growth, loss of appetite, vomiting, and upset stomach. Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused to together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. However, the joint no longer has any flexibility and cannot bend or move. Joint replacement surgery: In some cases, patients with osteoarthritis or rheumatoid arthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints, can be replaced. Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. Researchers estimate that hip or knee replacements last at least 20 years in 80% of patients. After a successful surgery and several months of rehabilitation, patients are able to use their new joints without pain. As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers. Lifestyle: Many lifestyle changes, including regular exercise, weight management, and healthy diet may help reduce symptoms of osteoarthritis. A healthcare provider may recommend a physical therapist or nutritionist to help a patient determine the best treatment plan for him/her. Individuals with osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking. Patients with osteoarthritis or rheumatoid arthritis may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Patients should talk to their healthcare providers about assistive devices that are available. Individuals with osteoarthritis or rheumatoid arthritis should maintain good posture. This allows the body's weight to be evenly distributed among joints. Non-selective Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by osteoarthritis, rheumatoid arthritis, and periarthritis. Commonly used over-the-counter NSAIDs include ibuprofen (Advil® or Motrin®) and naproxen sodium (Aleve®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam® or Voltaren®), nabumetone (Relafen®), and ketoprofen (Orudis®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms. The frequency and severity of side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum. Pain relievers: Prescription pain relievers, including tramadol (Ultram®), have been used to reduce pain caused by osteoarthritis or rheumatoid arthritis. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups. Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®), hydrocodone/acetaminophen (Lorcet®, Lortab®, or Vicodin®), or oxycodone (OxyContin® or Roxicodone®), may be prescribed to treat severe arthritis pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because patients may become addicted to them. Rituximab (Rituxan®): A medication called rituximab (Rituxan®) has been used to treat patients with rheumatoid arthritis. This medication, which is injected into the patient's vein, reduces the number of B-cells in the body. This medication helps reduce swelling because the B-cells are involved in inflammation. Side effects may include flu-like symptoms, such as fever, chills, and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems. Selective COX-2 inhibitors: Celecoxib (Celebrex®) has been taken by mouth to reduce pain and inflammation caused by osteoarthritis, rheumatoid arthritis, or periarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long term to manage symptoms. COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea. Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. Many over-the-counter pain relievers may temporarily help reduce the pain caused by osteoarthritis. Products such as Aspercreme®, Sportscreme®, Icy Hot®, and Ben-Gay® may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows. Copyright© 2007 Natural Standard Inc.
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