Medical Therapy — How Is It Used to Treat Arthritis?

Posted on 14 September 2010

There are many components to a treatment program for arthritis. Some of them include self-help, exercise, joint protection and a positive attitude. Another common treatment is medical therapy. When is this appropriate? What is most often prescribed? What is the function of that specific medicine?

There are many different kinds of medicine used. They are used for a specific purpose and for a certain kind of arthritis. Some medications are used for several different kinds of arthritis.

One of the first widely used medications for the treatment of arthritis was over-the-counter aspirin. It was and still is available without prescription, at a reasonable cost and is conveniently located. For many years this was the bulk of the medical therapy for arthritis. Aspirin is an anti-inflammatory. It has the ability to reduce or get rid of unwanted inflammation that is common with many forms of arthritis. At first it was just thought to be a symptom reliever. As the years went by and more research was done, they found that reducing the inflammation also helped slow the destruction of the joint components. Aspirin became valuable because it reduced swelling, therefore relieving the symptom, but in the process it also decreased pain and slowed the joint deterioration. It was like a miracle pill. But, as with most great things, it had one big side effect. When aspirin was used in large enough doses to keep inflammation in check, it could cause irritation to the stomach lining and increase the risk and occurrence of stomach ulcers. This was not discovered right away because, even when taken in fairly high doses, it took a while for the problem to develop in the stomach lining. Because scientists didn’t know the dangers of continual, high-dose aspirin intake, years went by before they made the connection between taking aspirin and stomach ulcers. Today it is a documented fact that aspirin can cause stomach-lining irritation and ulcers, but is it still widely used as an arthritis medication?

In the last two years, two new anti-inflammatory medications have been developed. They are considered the “new age” version of the anti-inflammatory. They are referred to as Cox-2 inhibitors. Basically, these medications are a “smarter” version of the old anti-inflammatory medications. These medications inhibit the production of prostaglandins (hormone-like substances that contribute to inflammation but also protect the stomach lining), but somehow recognize the protective ones lining the stomach. So, by taking a Cox-2 inhibitor, one can get the benefits of an anti-inflammatory and hopefully experience less stomach irritation.

People who have osteoarthritis with inflammation as one of the symptoms are usually prescribed an anti-inflammatory medication. If these same people don’t have inflammation, but do have stiffness, pain and loss of function, then they are most often prescribed Tylenol.

Early on, another common medicine called prednisone was used for the treatment of rheumatoid arthritis and other inflammatory forms of arthritis. It came in various forms: pills, in topical creams and by injection. Sometimes people were given the pills and the injections at the same time. The injection was used for more immediate relief, and the pills were to sustain the relief for a longer period of time.

In the late 1940s and the early 1950s, prednisone was also considered a miracle drug. It was not only used for the treatment of arthritis, but for other conditions such as asthma. But, as time went by and more research was done, scientists found that prednisone also had some devastating side effects over the long haul. The most common of these side effects is bone wasting. Prednisone, taken over a long period of time, can highly increase a person’s chances of developing osteoporosis. In addition to that side effect, it can also cause the early formation of cataracts and weight gain. Despite these troublesome effects, prednisone still is used widely today, in low doses for maintenance and in higher doses for a short period of time for an acute flare-up. Since prednisone is prescribed for reducing inflammation, it is only used in the treatment of the inflammatory forms of arthritis.

Medical therapy began to change in the late 1960s and early 1970s when scientists’ theories about what caused arthritis changed. Early on, scientists thought it was mostly due to hereditary factors. So, they just focused on treating the symptoms. But as time traveled on, a new theory developed about what caused arthritis. They thought possibly a virus could be the culprit. So, with a new focus came a different kind of medication. Now they wanted to target the virus and develop a medication to kill it. A new class of drugs were developed called disease modifying drugs. These drugs were designed to slow the progression or eliminate the disease altogether. Disease-modifying drugs were used extensively for many years, but eventual destruction of the joint still occurred. It seemed at best that these new drugs were only slowing the devastating effects of the arthritis.

In the late 1970s and early 1980s, another theory was born. Now the scientists were focusing on the immune system as the possible target. It seemed that the immune system played an important role in the inflammatory process. For some reason, the body identified itself as the enemy and sent inflammatory cells to kill off the intruders. This over-production of inflammatory cells to the joint site caused the swelling and eventual destruction of the joint. So now the challenge was to develop a medicine to interrupt that immune system response. A number of new disease-modifying drugs were developed or discovered to be useful to doing just that. Some of these drugs had been used for the treatment of other conditions such as cancer and malaria. While being used to treat these other conditions, they also helped with controlling the inflammation caused by the arthritis. As with the other medications, these new disease-modifying drugs also had some worrisome side-effects.

Since these drugs were designed to suppress the immune system, they also decreased a person’s ability to fight off common ailments such as the flu and other viruses. Despite the risks involved in taking these medications, they have been very helpful in slowing the progression of the disease process for many people with inflammatory forms of arthritis. There are a number of these disease-modifying drugs being used today.

Scientists have known for many years that attacking the whole immune system was not the best answer. In the last couple of years, another new line of medications has been developed. These are called “biologic response modifiers.” They are referred to as the “smart bombs” because they target only the part of the immune system that contributes to disease. Since these medications only target part of the immune system, the side effects are minimal, but the disease-modifying benefit is still present. Like all the other medications developed before these, time will tell the real story in how effective they are and whether long-term problems develop.

Fibromyalgia is a form of arthritis that does not affect the joints. It is characterized by muscle pain, fatigue, achiness and a host of other symptoms. Medication used to treat this form of arthritis is very different from those used in osteoarthrtitis and other inflammatory forms of arthritis.

One of the most common complaints of people who have fibromyalgia is sleep disturbance. Doctors often prescribe low doses of antidepressant medication and selective serotonin re-uptake inhibitors to restore a normal sleep pattern. When the sleep cycle is restored, many of the other symptoms start to improve. Pain in the muscle is reduced with the help of muscle relaxants and pain medication. The main objective in medical therapy for people with fibromyalgia is to restore their function, which enables them to help themselves get better.

There are many other medications taken for the treatment of other forms of arthritis. In treating inflammatory forms of arthritis, medications are used in combination. This is also true with fibromyalgia. In the case of osteoarthritis, usually only one medication is used to control the symptoms. Controlling symptoms and slowing the disease process through the use of medical therapy is a life-long task. Occasionally, each person’s medical therapy program has to be re-evaluated and adjusted to stay effective. Most medications taken for arthritis need to be taken constantly and without lapses to have the best outcome.

If you are taking medication for the treatment of any form of arthritis, discuss the effectiveness and the side effects of each medication with your doctor or pharmacist before you consent to take it. Usually, a pharmacist is the best source for information concerning medication. Educate yourself and weigh the risks against the benefits over the short term and the long haul before starting a medication. Don’t give up on a medication too early in the start-up process. Many of the anti-inflammatory medications have to be taken up three to six weeks before they reach their maximum benefit to you. Don’t stop taking your medication unless you talk it over with your doctor first. In the case of glucocorticoid-type medications, stopping suddenly can have some unwanted health consequences. Report any usual symptoms or reactions to the medication to your doctor. It is also very important to inform your physician of any “natural” remedies or other over-the-counter medication you are taking. This will avoid a possible unwanted drug interaction that could be very harmful to your general health.

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