Treatment for Arthritis
Primary care physicians can generally treat routine symptoms of osteoarthritis, but may refer patients to specialists (e.g., orthopedic surgeons) to address specific issues. Patients who have rheumatoid arthritis, lupus, fibromyalgia, or another form of arthritis are usually referred to a rheumatologist for diagnosis and treatment.
Treatment goals for both OA and RA are to control pain and inflammation, to maintain or regain mobility, and to control and monitor the progression of disease. In general, there is not one treatment plan that will fit every patient and treatment is designed to meet the specific needs of the patient.
For most types of arthritis, prescription and over-the-counter (OTC) pain relievers are the most common medications used. However, there are many types, with varying effectiveness and side effects. Always check with your doctor before using or combining any pain relief medication, even if it is OTC medication.
Analgesics are medications that relieve pain only—they have no impact on inflammation. The most common non-prescription analgesic is acetaminophen (e.g., Tylenol®). For pain that does not respond to acetaminophen, doctors may prescribe opioid analgesics such as Percoset®, Darvocet®, or codeine. Note: In November 2010, the U.S. Food and Drug Administration (FDA) removed Darvocet from the market in the United States and urged doctors to stop prescribing the medication.
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation in addition to relieving pain. There are three types of NSAIDs:
- Traditional NSAIDs include non-prescription ibuprofen (e.g., Advil®) and about 20 different prescription forms. These medications relieve pain and reduce inflammation, but may cause gastrointestinal bleeding and stomach upset.
- COX-2 inhibitors (e.g., Celebrex® and generic versions approved by the FDA in May 2014) are relatively new to the market and studies continue on their safety and side effects. In general, these drugs are considered to produce fewer gastrointestinal side effects.
- Salicylates include aspirin and non-acetylated salicylates. These medications relieve pain and reduce inflammation. Possible side effects include kidney problems and intestinal bleeding.
In cases where inflammation seriously threatens joints and other tissues, corticosteroids may be prescribed. In low doses, these drugs can work quickly and effectively to prevent inflammation from harming the eyes and internal organs in advanced cases of rheumatoid arthritis. Taken in high doses for long periods of time, corticosteroids have caused brittle bones, high blood sugar, and cataracts. However, these drugs currently are prescribed in lower doses and for shorter periods of time to reduce the risks of these side effects.
Other Medications for RA
Two types of medications that may be used to treat RA are disease modifying anti-rheumatic drugs (DMARDs) and biologic response modifiers (BRMs). Because the inflammation of rheumatoid arthritis can cause irreparable joint damage, DMARDs may be used to help prevent inflammation and reduce the damage to the joints.
BRMs can inhibit a protein that contributes to inflammation. They may be used to treat patients when other treatments have been ineffective. BRMs can slow the progression of RA and can even bring about long periods of remission. However, both of these drugs suppress the immune system and can make the patient more vulnerable to infection. Patients receiving these treatments should be under the close supervision of a healthcare provider.