Treatment and Prevention
Unfortunately, there's no cure for most forms of arthritis. The goal of treatment is to reduce symptoms of pain and inflammation with the help of exercise programs, physiotherapy, and medications.
There are things everyone can do today to prevent the possibility of OA later in life. The most important change you can make is to maintain a healthy weight to limit stress on the joints. Recent studies have shown that a weight gain of only 10 to 20 extra pounds in early adulthood increases wear and tear on the shock-absorbing cartilage in joints and can lead to serious joint damage in the long run. Avoiding repetitive movements over long periods of time can help, but if repetitive motions are part of a job or leisure activities, proper training is important.
If someone has a traumatic injury to a joint, they need medical care and rehabilitation to avoid further damage. Talk to a doctor about the proper use of ice, rest, heating pads, hot water bottles, and hot baths for treating any injury.
Exercise programs to maintain muscle tone are useful for managing OA and other kinds of arthritis. These may include special exercises prescribed by your physician. A physical therapist can help you do exercises that strengthen muscles and improve range of motion. Walking is an excellent form of therapy for arthritis in the knees, but only to the point that it does not cause pain. In some cases, joint pain due to OA is often relieved with heat and rest. Cold packs are good short-term pain relievers, but they can temporarily increase stiffness.
Medications for OA include a wide range of pain relievers and anti-inflammatory medications. Acetaminophen* is generally a good choice for long-term use, but it's important to not exceed the recommended amount. Even though it is sold over-the-counter, it can cause serious liver or kidney injury if used incorrectly. If acetaminophen is not effective or if inflammation is present, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be recommended.
Acetaminophen and some forms of aspirin and other NSAIDs are available without a prescription, but always check with a doctor or pharmacist before taking any of these medications. They can also have serious side effects and drug interactions if used incorrectly.
Prescription narcotic pain relievers (such as various codeine derivatives) can help people who experience acute periods of pain, but they also can be harmful if not used correctly and may be habit-forming. Constipation is a common side effect of these medications and needs prevention if they are used regularly.
If other options have failed, local injections of corticosteroid medication into the affected joints are another treatment option. These injections should not be used too often and should not be given to certain people, such as people with infection or blood problems. For severe cases, surgery such as a hip or knee replacement may be needed.
Therapy for RA and other inflammatory types of arthritis includes specially tailored exercises and medication, such as anti-inflammatory medications including aspirin and other NSAIDs.
The group of medications called disease-modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine and methotrexate can be helpful for RA, but they require time (weeks to months) before they start working. DMARDs can help to prevent joint destruction. Another group of medications called biologics (e.g., abatacept, adalimumab, anakinra, etanercept, infliximab, rituximab, and others) can also help improve RA symptoms and slow down joint destruction.
Corticosteroids (e.g., prednisone, methylprednisolone) may also be used sparingly to control inflammation. Many of these medications are combined with other medications to treat RA (e.g., a biologic is often combined with a DMARD). Relieving stress on joints is important to avoid further damage. Canes, walkers, splints, or crutches are sometimes needed to reduce the amount of body weight placed on certain joints.
NSAIDs are also used to treat the acute symptoms of gout, but low-dose aspirin should be avoided as it affects the manner in which the kidneys handle uric acid and may lead to kidney stones. Corticosteroids may also be used to treat acute gout. Regular use of colchicine may reduce frequency of attacks. In some cases, people are prescribed medications (e.g., allopurinol, febuxostat, pegloticase, probenecid, or sulfinpyrazone) to help prevent acute gout attacks.
All of these medications pose serious risk and should be carefully considered and monitored by your doctor. Make sure you understand all the risks and benefits of taking these medications before you start them. Rheumatologists are the doctors most experienced in the diagnosis, treatment, and management of RA (and all other kinds of arthritis).
Living and coping with arthritis, as with any chronic disease, can be difficult. It may affect daily activities slightly, or it can be more severe and extremely debilitating. Some people may benefit from counseling or support groups to deal with the challenges of living with arthritis. There are many resources available - it's important to take advantage of them. The Arthritis Foundation and the American College of Rheumatology provide valuable resources.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.