Julian E Girod, MD

Arthritis

 

Introduction
According to the National Institute on Aging, half of all people age 65 or older have arthritis. There are over 100 different forms of arthritis, according to the Arthritis Foundation. They vary in symptoms and treatment methods. Although some forms of arthritis are better understood than others, the causes of most are unknown.

Arthritis causes pain and loss of movement. It can affect joints in any part of the body. Arthritis is usually chronic, meaning it can last for years. The more serious forms generally involve inflammation, with swelling, warmth, redness, and pain. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis, and gout.

Most Common Forms of Arthritis
Osteoarthritis (OA): Sometimes called degenerative joint disease, osteoarthritis is the most common type of arthritis in older people. It can range from a mild problem with only occasional stiffness and joint pain to a serious condition with much pain and disability.

OA most often affects the hands and the large weight-bearing joints of the body: the knees, ankles, and hips. Early in the disease, pain occurs after activity and rest brings relief; later on, pain can occur with even minimal movement or while at rest.

Scientists think that several factors may produce OA in different joints. For example, OA in the hands or hips may run in families. Being overweight has been linked to OA in the knees. Injuries or overuse may relate to OA in joints such as knees, hips, and elbows.

Rheumatoid arthritis: Rheumatoid arthritis (RA) can be one of the more disabling forms of arthritis but varies in severity. Signs of RA often include morning stiffness, swelling in three or more joints, swelling of the hands and wrists, swelling of the same joints on both sides of the body (for instance, both feet), and bumps (or nodules) under the skin. RA can occur at any age and affects women about three times more often than men.

While the cause of RA is unknown, scientists believe it may result from a breakdown in the immune system, which is the body's defense against disease. It is also likely that people who get RA have certain inherited traits (genes) that cause this process to go awry.

Gout: Gout occurs most often in older men. It affects the toes, ankles, knees, elbows, wrists, and hands. An acute attack of gout is very painful. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender. Medicines can now stop gout attacks, as well as prevent future attacks and damage to the joints. Although these medicines allow people with gout to eat a normal diet, alcoholic drinks should be limited.

The Treatment of Arthritis
Treatments for arthritis work to reduce pain and inflammation, keep joints moving safely, and avoid further damage to joints. Treatment options include medicines, special exercises, use of heat or cold, weight control, and surgery.

Medicines help relieve pain and reduce inflammation. The medications used most often are aspirin and nonsteroidal anti- inflammatory drugs, such as ibuprofen.

Exercise is also basic to treatment. Certain activities, such as a daily walk or swim, help keep joints moving and reduce pain. They also strengthen muscles around the joints. But rest is also important; it is good for the whole body and for the joints affected by arthritis. Also, the advice of a physical therapist can be helpful in developing a personal program that balances exercise and rest.

Many people find that heat or cold helps to temporarily relieve pain. For example, soaking in a warm bath, swimming in a heated pool, or applying heat or ice packs can be helpful. Weight control helps keep unnecessary stress off joints so that they don't become further damaged.

Surgery is sometimes helpful in OA or RA. It is used when joints are so badly damaged that activity is severely limited and other treatments fail to reduce pain. Surgery may involve repairing or replacing damaged joints with artificial ones. Hip and knee joints are replaced most often.

Unproven Remedies
Arthritis symptoms may go away by themselves but then come back weeks, months, or years later. This may be one reason why many people with arthritis try quack cures or unproven remedies. Some of these remedies, such as snake venom, are harmful while others, such as copper bracelets, are not. Still, the safety of many is unknown.

Look for tip-offs that point to which remedies are unproven. For example, claims that a lotion works for all types of arthritis and other diseases, too; scientific support coming from only one research study; or labels that have no directions for use or warnings about side effects.

Arthritis Warning Signs
There are a number of common warning signs to look for:
bulletSwelling in one or more joints
bulletEarly morning stiffness
bulletRecurring pain or tenderness in any joint
bulletInability to move a joint normally
bulletObvious redness or warmth in a joint
bulletUnexplained weight loss, fever, or weakness combined with joint pain.
If any of these symptoms lasts longer than 2 weeks, you may want to call or visit your doctor or one who specializes in arthritis (a rheumatologist). He or she will ask questions about the history of symptoms, will do a physical exam, may take X-rays or do lab tests, and can recommend a program plan for your treatment.

Arthritis Medications
According to research conducted by the Food and Drug Administration, the medicines taken most by people over age 45 are those used to relieve the discomfort of arthritis. This is hardly news to older Americans who know only too well the pain and discomfort caused by this condition.

Of the more than 100 forms of arthritis, osteoarthritis, rheumatoid arthritis, and gout are the most common. According to the Arthritis Foundation, more than 9 million Americans over 65 have some symptoms of osteoarthritis. This condition strikes the joints of the hands, feet, knees, hips, neck, and back. Pain may come and go and can vary from mild to severe.

Although rheumatoid arthritis often begins during middle age, it can develop at any age. This type of arthritis, which tends to occur more often in women than men, most commonly affects the joints of the wrists, hands, and feet, but can affect any movable joint. Gout causes sudden swelling and extreme pain, usually in only one joint, often the big toe.

Most forms of arthritis cannot be prevented or cured, so the goals of treatment are to relieve pain and maintain or restore the function of the arthritic joint. A treatment program may include rest, weight control, heat therapy, exercise, and drug therapy. Appropriate treatment depends on the type of arthritis, the stage of the disease, and the general health of the patient.

The Benefits And Risks Of Arthritis Medications
Nonsteroidal Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve arthritis pain. These drugs block the production of prostaglandins, chemicals in the body that cause pain and inflammation, which is the stiffness, swelling, and warmth felt by people with arthritis. Although some NSAIDs are available without a prescription, most are prescription drugs.

It often takes a few days to a week before NSAIDs start to work and 2 to 3 weeks before the full benefits of treatment are felt. Some of the most frequently used NSAIDs are listed below. These drugs are divided into two groups--salicylates and non- salicylates. Although both groups of drugs have similar pain-relieving effects, they may have somewhat different side effects.

 
bulletSalicylates
bulletAspirin: Bayer, Bufferin, Ecotrin, and others
bulletCholine magnesium trisalicylate: Trilisate
bulletCholine salicylate: Arthropan
bulletDiflunisal: Dolobid
bulletMagnesium salicylate: Magan
bulletSalicylsalicylic acid: Disalcid, Mono-Gesic

 

bulletNonsalicylates
bulletDiclofenac: Voltaren
bulletFenoprofen: Nalfon
bulletFlurbiprofen: Ansaid
bulletIbuprofen: Motrin, Rufen, Advil and Nuprin
bulletIndomethacin: Indocin
bulletKetoprofen: Orudis
bulletMeclofenamate: Meclomen
bulletMefenamic acid: Ponstel
bulletNaproxen: Naprosyn
bulletNaproxen sodium: Anaprox
bulletPiroxicam: Feldene
bulletSulindac: Clinoril
bulletTolmetin: Tolectin

Along with much-needed pain relief, NSAIDs may cause unwanted side effects in some people. However, side effects do not occur in everyone. They are listed here so that you will know they are possible and so that you can recognize them early and report them to your doctor. In some cases, it may be necessary to adjust treatment to keep side effects to a minimum. As with all medications and treatment options, it is important to weigh the benefits, risks and costs of each alternative.

 

 


 


 

bulletStomach ulcers: NSAIDs can cause stomach ulcers. Because ulcers sometimes don't cause symptoms, it's important for people taking NSAIDs to see their doctor for regular checkups.
bulletOther stomach problems: Other stomach problems caused by these drugs include heartburn, nausea, stomach pain, vomiting, diarrhea, and occasionally gastrointestinal (GI) bleeding. GI bleeding, which can be especially serious for older people, is signaled by black or very dark stools or blood in the stool.
bulletNSAIDs also can cause headaches, dizziness, and blurred vision.
According to the National Institutes of Health (NIH), coated aspirin tablets and long-acting aspirin products may lessen stomach irritation. NSAIDs should be taken with a full glass of water (or milk), food, or antacids to reduce stomach upset.

In addition, an antiulcer drug -- misoprostol (brand name Cytotec) -- is approved for preventing stomach ulcers which can be brought on by NSAIDs in people at high risk of ulcer complications (for example, older people or those who have had ulcers in the past), reports NIH.

Ulcers and other serious stomach problems are more common in smokers and people who drink alcohol while taking these drugs. When persons using NSAIDS over a long period of time at high doses fail to follow directions carefully, they may be at increased risk of developing liver or kidney damage. People who have stomach or other problems should see their doctor as soon as possible.

Corticosteroid Medications: Corticosteroids also may reduce arthritis inflammation. These drugs closely resemble cortisone, a natural hormone produced by the body. They can be taken by mouth or by injection directly into a stiff, swollen joint.

Although corticosteroids rapidly relieve the pain, swelling, and redness caused by arthritis, these powerful drugs can have serious side effects. According to NIH, the potential side effects include:

 
bulletLowered resistance to infection
bulletIndigestion
bulletWeight gain
bulletLoss of muscle mass and strength
bulletMood changes
bulletBlurred vision
bulletCataracts
bulletDiabetes
bulletThinning of bones (osteoporosis)
bulletIncreased blood pressure

Commonly Prescribed Corticosteroids
bulletBetamethasone: Celestone
bulletCortisone: Cortone
bulletDexamethasone: Decadron
bulletHydrocortisone: Hydrocortone
bulletMethylprednisolone: Medrol
bulletPrednisolone: Hydeltrasol
bulletPrednisone: Deltasone
bulletTriamcinolone: Aristocort

Other side effects may develop and as with all side effects should be discussed with your doctor. Also, serious stomach problems may occur in people who take corticosteroids along with NSAIDs, according to NIH.

Disease-Modifying Medications
Researchers believe that disease-modifying, antirheumatic agents slow the progress of rheumatoid arthritis, but these drugs are not used for osteoarthritis.

These prescription drugs include gold compounds, D-penicillamine, and antimalarial medications as described in the paragraphs below. Individuals receiving these medications should be under the care of a physician who is experienced in using them to treat rheumatoid arthritis.

 

 


 

bulletGold compounds: Gold compounds may help people with mild to moderate rheumatoid arthritis. Auranofin (ridaura) is taken by mouth. Aurothioglucose (Solganol) and gold sodium thiomalate (myochrysine) are available in injection form. It may be 2 to 6 months before relief is felt.

Possible side effects are blood in the urine, easy bruising, sores in the mouth, skin rash, and numbness in the hands and feet. Diarrhea often occurs in those who take gold by mouth, and many people receiving injectable gold notice a metallic taste.

bulletPenicillamine: Penicillamine (Depen and Cuprimine) is also used to treat rheumatoid arthritis. This drug may take 2 to 6 months to work. Side effects include blood in the urine, fever, joint pain, skin rash, sores in the mouth, easy bruising, weight gain, and (rarely) muscle weakness. People taking gold compounds or penicillamine should be checked regularly by their doctor.
bulletHydroxychloroquine: Hydroxychloroquine (Plaquenil) and other drugs originally developed to treat malaria can be used to relieve swelling, stiffness, and joint pain caused by rheumatoid arthritis.

>People taking these drugs should have regular eye exams because these medicines can permanently damage the retina (the light-sensitive tissue at the back of the eye). Diarrhea, headaches, loss of appetite, skin rash, and stomach pain are other possible side effects. Liver problems may develop in people who drink alcohol while taking antimalarial drugs.

Immunosuppressants: Immunosuppressants are drugs that suppress the immune system and can ease symptoms of rheumatoid arthritis. The immune system normally protects the body against foreign invaders such as viruses. Some researchers believe that rheumatoid arthritis is an autoimmune disease, a disease in which the immune system reacts against the body's own tissues.

Azathioprine (Imuran) and methotrexate are immunosuppressants used to treat this form of arthritis. Side effects, which include mouth sores, infection, fever, chills, sore throat, nausea, diarrhea, and unusual tiredness, should be reported to your doctor.

Over-the-counter (OTC): Over-the-counter (OTC) products such as aspirin and low-dose forms of acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil and Nuprin) temporarily relieve minor arthritis pain. "Extra strength" and "arthritis formula" aspirin products contain more aspirin in each tablet than regular aspirin.

As with prescription drugs, these medications can cause side effects, particularly when directions are not followed carefully. For example, long-term, high-dose use of acetaminophen, ibuprofen, or aspirin may cause liver or kidney damage.

Do not take OTC products for long periods without consulting a doctor. Combinations of OTC products, or OTC products and prescription drugs, should not be taken without checking with your doctor first. In addition, some OTC ointments offer short-term relief of minor arthritis pain. However, these ointments, which are rubbed over painful joints, do not reduce swelling and should not be used for long periods of time.

Because arthritis drugs may interact with other types of medicine, it is important to let your doctor know if you are taking any other prescription or OTC medications. Be sure to follow your doctor's instructions exactly when taking your medicine -- take only the amount specified, ask what to do if you miss a dose, and do not suddenly stop taking the medicine without consulting your doctor. It is also important to keep all appointments with your doctor so your progress can be checked regularly.

Again...Use Caution
Americans spend over a billion dollars each year on useless pills, gadgets, and diets hoping to find a cure for arthritis. Because arthritis pain can come and go, many people believe that these phony "cures" really work. Beware of any pill or device that promises miracles. Don't be misled by products that are supposed to cure many different diseases. If you have questions about the safety and usefulness of a treatment, ask your doctor.

Some portions copyright©1996 Health ResponsAbility Systems. Used by permission.

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