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:
 | Swelling in one or more joints |
| Early morning stiffness |
| Recurring pain or tenderness in any joint |
| Inability to move a joint normally |
| Obvious redness or warmth in a joint |
| Unexplained weight loss, fever, or weakness combined with joint pain. |
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.
| Salicylates |
 | Aspirin: Bayer, Bufferin, Ecotrin, and others |
| Choline magnesium trisalicylate: Trilisate |
| Choline salicylate: Arthropan |
| Diflunisal: Dolobid |
| Magnesium salicylate: Magan |
| Salicylsalicylic acid: Disalcid, Mono-Gesic |
| Diclofenac: Voltaren |
| Fenoprofen: Nalfon |
| Flurbiprofen: Ansaid |
| Ibuprofen: Motrin, Rufen, Advil and Nuprin |
| Indomethacin: Indocin |
| Ketoprofen: Orudis |
| Meclofenamate: Meclomen |
| Mefenamic acid: Ponstel |
| Naproxen: Naprosyn |
| Naproxen sodium: Anaprox |
| Piroxicam: Feldene |
| Sulindac: Clinoril |
| Tolmetin: 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.
| Stomach 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. |
| Other 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. |
| NSAIDs also can cause headaches, dizziness, and blurred vision. |
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:
| Lowered resistance to infection |
| Indigestion |
| Weight gain |
| Loss of muscle mass and strength |
| Mood changes |
| Blurred vision |
| Cataracts |
| Diabetes |
| Thinning of bones (osteoporosis) |
| Increased blood pressure |
Commonly Prescribed Corticosteroids
| Betamethasone: Celestone |
| Cortisone: Cortone |
| Dexamethasone: Decadron |
| Hydrocortisone: Hydrocortone |
| Methylprednisolone: Medrol |
| Prednisolone: Hydeltrasol |
| Prednisone: Deltasone |
| Triamcinolone: 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.
| Gold 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. |
| Penicillamine: 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. |
| Hydroxychloroquine: 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.