Arthritis Treatment Options

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You can probably remember a time when stairs weren’t your enemy and you could bound up them without any painful protest from your joints. Back then, you didn’t have to give a second thought to whether you could open a jar or turn a doorknob. Then arthritis intervened, leaving your joints swollen, painful, and stubbornly unwilling to let you do even the simplest everyday tasks.

Regardless of whether you’ve developed osteoarthritis with age or you have rheumatoid arthritis or a painful case of gout, you don’t have to let joint discomfort and stiffness prevent you from living. Your doctor has a whole range of medications and recommendations to relieve your pain and protect your joints from further damage.

Here is a rundown of the top arthritis treatment options.

Simple Ways to Protect Your Joints

Arthritis relief doesn’t always have to come from a bottle. Maintaining a healthy weight, exercising, and using special devices to help you get around can also have a big impact on your symptoms.

Losing weight if you are overweight or obese can help take pressure off your joints.

People with gout should avoid alcohol and foods that are high in purines, and that includes organ meats (liver, kidney), dried beans, sardines, anchovies, asparagus, and mushrooms. When the body breaks down purines, it produces uric acid, and excess uric acid causes painful crystals to deposit in the joints. Making these changes may reduce flare-ups, but they almost never cure the condition.

Relieving Stiff Joints With Exercise

When you’re in pain, the last thing you may want to do is exercise, but it’s actually one of the best things you can do for your joints. Aerobic, strength-training, and stretching exercises can all be helpful. Work with your doctor to learn what exercises are safe for you to do. Physical therapy is also a common part of treatment in people with OA. Regular exercise can also help you maintain a healthy weight.

Medications

Pain Relievers

You’re probably familiar with a group of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs interfere with chemicals called prostaglandins in the body, which trigger pain, inflammation, and fever. Some NSAIDs are available without a prescription for relief of pain and fever at your local drugstore, including ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. There are also many other prescription NSAIDs available, such as celecoxib (Celebrex), ketoprofen, naproxen (Naprosyn, Anaprox), piroxicam (Feldene), and sulindac. Prescription doses of NSAIDs also curb inflammation.

NSAIDs can be very helpful for relieving pain and swelling in all types of arthritis, including gout. Just be careful when you use these drugs, because they can have side effects such as stomach bleeding and an increased risk for heart attack, stroke and other cardiovascular problems, especially with use in higher doses. Read the package label and talk to your doctor to make sure you’re using the lowest effective dose for the shortest possible period of time.

Acetaminophen (Tylenol) is another option for easing arthritis pain. In the past, doctors thought acetaminophen was only good for pain relief and that it did little, if anything, to reduce inflammation. Now some research suggests that acetaminophen may have some anti-inflammatory properties.

For some people, acetaminophen can relieve pain as well as NSAIDs can, and it doesn’t come with the gastrointestinal and heart risks. Acetaminophen isn’t entirely free from side effects, though. Because it can harm the liver and kidneys, make sure to stick with the recommended dosage and talk to your doctor if you need longer-term pain relief.

An alternative or addition to pain relievers you take by mouth, are creams or gels that you rub on your affected joints. These topical pain relief options include:

  • Capsaicin, the ingredient that gives cayenne peppers their kick, may help curb arthritis pain.
  • Counterirritants distract your brain away from the pain in your joints by irritating nerve endings and contain ingredients like menthol, camphor, and eucalyptus oil. NSAIDs also come in topical formulations, some of which are only available by prescription. The FDA has issued a warning that the topical form of the NSAID diclofenac can be harmful to the liver. If you’re using this drug, your doctor will need to check your liver function four to eight weeks after you start treatment.

If you’ve already tried a variety of pain relievers and your joints are still throbbing, or you just can’t tolerate NSAIDs or acetaminophen, your doctor may recommend stronger opioid or narcotic pain relievers. These drugs can become habit-forming, so it’s important that you keep in close touch with your doctor while taking them.

Disease-Modifying Drugs

Pain relievers can make you feel better, but they’re not going to change the course of your arthritis. Disease-modifying anti-rheumatic drugs (DMARDs) can actually slow joint damage in people with arthritis from an overactive immune system such as rheumatoid arthritis and psoriatic arthritis. These drugs can’t reverse damage that’s already been done to your joints, however, and they can cause side effects such as in increased risk of serious infection.

The DMARD that’s often tried first is methotrexate (Rheumatrex, Trexall). Other DMARDs include:

Newer disease-modifying drugs called biologics include abatacept (Orencia), adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Erelzi). a biosimilar to Enbrel, golimumab (Simponi, Simponi Aria), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, rituximab (Rituxan), tocilizumab (Actemra) or tofacitinib (Xeljanz). Downsides to biologic drugs include their high price tag, which can conservatively reach $20,000 a year or more, and an increased risk of infection as well as other side effects.

Corticosteroids

Corticosteroids also dampen the immune response and help reduce inflammation. Some might take a steroid drug if NSAIDs aren’t budging your arthritis symptoms, or when you’ve just started treatment and you’re waiting for your DMARD to take effect. Corticosteroids for arthritis are most often taken by mouth or via an injection directly into the joint. Injections offer speedy pain and inflammation relief, and their effects can last for a few weeks or months. The side effect many people complain about with oral corticosteroids is weight gain, but these drugs can also increase your risk for infection, cataracts, and weak bones (osteoporosis).

Hyaluronic Acid Therapy (Viscosupplementation)
The joints contain a natural lubricant and shock absorber called hyaluronic acid that keeps them moving smoothly, but people with osteoarthritis have less of this substance than normal. Hyaluronic acid injections with products such as hyaluronate sodium (Euflexxa, Hyalgan, Supartz), Orthovisc, and Synvisc. One can help relieve the pain of mild-to-moderate osteoarthritis of the knee and improve mobility. Side effects from viscosupplementation are usually mild and may include pain or swelling at the injection site.

Antidepressants

Some doctors may recommend the use of an antidepressant drug for chronic pain whether you suffer from depression or not. In 2010, the FDA approved the antidepressant duloxetine (Cymbalta) for chronic musculoskeletal pain, including the pain of osteoarthritis. Although not FDA-approved for this use, another class of antidepressants called tricyclics may also help manage chronic pain. These include amitriptyline, desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor). Although it is unclear how they help with chronic pain, antidepressant effects on brain chemicals that cause you to feel pain is believed to play a role. Side effects can range from drowsiness to dry mouth and blurred vision. Rarely, these drugs can also lead to mood changes or suicidal thoughts.

In addition to taking steroids, NSAIDs, or other pain relievers for gout, your doctor may prescribe a medication that reduces the amount of uric acid in your body, such as allopurinol (Aloprim, Zyloprim), febuxostat (Uloric), or probenecid. When drugs like allopurinol or febuxostat are used in combination with lesinurad (Zurampic), the actual level of uric acid in the body may be reduced. Colchicine may also be used in gout treatment to treat or help prevent attacks. If your gout does not respond to other treatments, your doctor may prescribe the drug pegloticase (Krystexxa). Krystexxa is an enzyme that breaks down uric acid so it can be removed in the urine. The enzyme is often used only in cases where large deposits of uric acid are present. Side effects of the drug include allergic reactions, nausea, and bruising at the injection site.

Surgery

If joint pain or damage is so severe that medication isn’t working, your doctor may talk to you about having surgery to replace the joint or improve its alignment.

Arthroscopy

To look inside your joint, the surgeon makes a very small incision and inserts a thin, lighted tube and small surgical instruments. Through this small cut, the doctor can remove floating pieces of bone or cartilage or other debris from the joint, smooth out rough surfaces, or remove swollen tissues.

Joint Replacement (Arthroplasty)

Arthritis can take its toll on your joints, and over time you may have no choice but to replace a worn out hip or knee joint with a man-made plastic or metal version. If osteoarthritis is only in one part of the knee joint, you can have a partial knee or hip replacement, a less invasive procedure that will still help improve function.

When joint replacement fails, the surgeon can try another technique that removes a joint completely from the ends of the two bones that connect it. The bones are then held together with screws, pins, or plates. Over time, the bones should fuse into one piece.

Osteotomy

If you’re still young and active and you’ve got knee or hip osteoarthritis, you may be able to have an osteotomy, or joint-preserving surgery. By cutting and removing a section of the bone, this procedure improves joint alignment and stability, and it could help you delay joint replacement surgery for several years.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on December 06, 2016

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