Treatment of arthritis depends on its particular cause, where the joints are affected, their severity, and how the disease affects their daily activities. Your age and profession will also be taken into account when the doctor works with you to create a treatment plan.
If possible, the treatment will focus on eliminating the underlying cause of the arthritis. However, the cause can NOT necessarily be cured, as is the case with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims to reduce pain and discomfort and prevent further disability.
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It is possible to vastly improve the symptoms of osteoarthritis and other long-term types of arthritis without medication. In fact, making lifestyle changes without medication is preferable for osteoarthritis and other forms of joint inflammation. If necessary, medications should be used in addition to lifestyle changes.
Exercise for arthritis is necessary to maintain joint health, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should adapt to you as an individual. Work with a physiotherapist to design an individualized program, which should include:
- Low impact aerobic activity (also called resistance exercises)
- Mobility exercises for flexibility
- Resistance training for muscle tone
A physiotherapist can apply heat and cold as needed and measure braces or devices of orthosis (straightening) to support and align the joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation (TENS).
Rest is as important as exercise. Sleeping 8 to 10 hours at night and taking naps during the day can help you recover from an outbreak more quickly and may even help prevent exacerbations. Should also:
- Avoid holding a position for too long.
- Avoid positions or movements that exert additional stress on the affected joints.
- Modify your home to make activities easier. For example, have support bars in the shower, tub, and near the toilet.
- Reduce stress, which can aggravate the symptoms. Try meditation or guided visualization. And check with your physical therapist about yoga or tai chi.
Other measures may include:
- Apply capsaicin cream (derived from chili) on the skin over the joints that hurt. You can feel improvement after applying the cream for 3-7 days.
- Eat a diet rich in vitamins and minerals, especially antioxidants such as vitamin E. They are found in fruits and vegetables. The selenium sources of brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds and Brazil nuts. Obtain omega-3 fatty acids from cold-water fish (such as salmon, mackerel and herring), flax seed, rapeseed (canola), oil, soy, soybean oil, pumpkin seeds and nuts.
- Take glucosamine and chondroitin - these form the building blocks of cartilage, the substance that lines the joints. These supplements are available in health food stores or supermarkets. While some studies show that these supplements can reduce the symptoms of osteoarthritis, others show no benefit. However, since these products are considered safe, they are reasonable to try and many patients find that their symptoms improve.
MEDICINES
Your doctor will choose from a variety of medications when necessary. In general, the first drugs that are tested are available without a prescription. These include:
- Acetaminophen (Tylenol) - recommended by the American College of Rheumatology and the American Geriatrics Association as a first-line treatment for osteoarthritis. Take up to 4 grams a day (two Tylenol for Arthritis every 8 hours). This can provide significant relief from arthritis pain without many of the side effects of prescription medications. Do not exceed the recommended dose of acetaminophen or take the drug in combination with large amounts of alcohol. These actions can damage the liver.
- Aspirin, ibuprofen or naproxen - these nonsteroidal anti-inflammatory drugs (NSAIDs) are often effective in the fight against arthritis pain. However, they have many potential risks, especially if used for a long time. They should not be taken in any amount without consulting your doctor. Possible side effects include myocardial infarction, stroke, stomach ulcers, bleeding from the digestive tract and kidney damage. In 2005, the US Food and Drug Administration. (FDA) asked NSAID drug manufacturers to include a warning label on their product that alerts users of an increased risk of heart attack, stroke and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medications unless your doctor recommends it.
Prescribed medications include:
- Biological These are the most recent advances for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are given by injection and can greatly improve your quality of life. Most recent biologics include Orencia (abatacept) and Rituxan (rituximab).
- Corticosteroids ("steroids") - These are medications that suppress the immune system and the symptoms of inflammation. It is often injected into joint pain with osteoarthritis. Steroids are used to treat autoimmune forms of arthritis, but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, high blood pressure, thinning bones, cataracts and increased infections. The risks are more pronounced when steroids are taken for long periods of time or in high doses. Close supervision of a doctor is essential.
- The inhibitors of cyclooxygenase-2 (COX-2) . These drugs block an inflammation-promoting enzyme called COX-2. This class of medicines Initially it was believed that they worked the same as the traditional ones, but with less stomach problems. However, numerous reports of heart attacks and strokes have led the FDA to reassess the risks and benefits of COX-2. Celecoxib (Celebrex) is still available, but with strong warning labels and a recommendation that it be prescribed at the lowest possible dose for the shortest possible time. Talk to your doctor about whether COX-2 is recommended for you.
- Disease modifiers antirheumatic drugs - these have traditionally been used to treat rheumatoid arthritis and other autoimmune causes of arthritis. These medications include gold salts, penicillamine, sulfasalazine and hydroxychloroquine. More recently, methotrexate has been shown to decrease the progression of rheumatoid arthritis and improve their quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on medication.
Immunosuppressants These medications, such as azathioprine or cyclophosphamide, are used for severe cases of rheumatoid arthritis when other medications have failed.
It is very important that you take your medications as directed by your doctor. If you are having difficulty doing so (for example, due to intolerable side effects), you should talk to your doctor.
SURGERY AND OTHER APPROACHES
In some cases, surgery to rebuild the joint (arthroplasty) or replace the joint (such as a total joint knee replacement) can help maintain a more normal lifestyle. The decision to perform joint replacement surgery is usually made when other alternatives, such as lifestyle changes and medications, are no longer effective.
Normal joints contain a lubricant called synovial fluid. In joints with arthritis, this fluid is not produced in adequate amounts. In some cases, the doctor may inject the arthritic joint with an artificial version of the joint fluid. Synthetic fluid may postpone the need for surgery, at least temporarily, and improve the quality of life of people with arthritis.