Therapies

Medical Essentials with Diagnosis and Treatment: 
The absolutely essential first step is a medical diagnosis of which arthritic condition you are suffering from. If possible, treatment will then focus on eliminating the underlying cause of the arthritis. Osteoarthritis, Rheumatoid Arthritis and other chronic forms cannot be cured. Medical treatment for these is nevertheless vital and effective. Pain and discomfort can be much reduced. Unnecessary damage and disability can be prevented.

Drug Treatments 
Medication advice: Always write down what you take and when you take it. In our experience it’s amazingly easy to get this wrong – and taking the wrong amounts or combinations of medications can be very dangerous. Pain is best controlled if you take painkillers before it gets too bad. Talk to your doctor or chemist about having enough of the right drugs to keep pain safely controlled.

Most people with arthritis will be prescribed some kind of pain relieving or disease controlling drug. Drug treatments include:

• Analgesic Painkillers like paracetamol, co-dydramol and codeine are for reducing pain. Stronger, sometimes narcotic painkillers may also be prescribed for severe pain. Handled properly, these can be important. The over-the-counter analgesics can be very effective for the milder forms of arthritis pain. Analgesics are specifically for pain, not for inflammation.

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to reduce pain, stiffness and swelling caused by inflammation. Common NSAIDs are aspirin, ibuprofen, paracetamol, naproxyn and diclofenac (Voltarol). NSAIDs can cause a number of side effects, especially stomach problems. The same mechanism that reduces inflammation also reduces your stomach’s ability to protect itself from its own digestive juices. Talk to your doctor and chemist about doing the best you can with these very helpful medications. It can be protective to take them with or just after food.

NB. Some NSAIDs are now sold in a gel form to rub into arthritic joints. BE CAREFUL about using these if you are also taking an oral NSAID. While not much of the medication gets through the skin into your system, it can actually be enough to cause an excessive dose reaction in some people.

• Steroids (oral or injected) – Corticosteroids are powerful drugs to reduce inflammation and suppress immune reactions. They can be very effective in severe cases of osteoarthritis. They are also used to treat autoimmune forms like rheumatoid arthritis. They are avoided in treating infectious arthritis. Steroids can have many side effects if used for long periods of time. They require careful medical supervision.

• Disease Modifying Anti-Rheumatic Drugs (DMARDs) and anti-TNFs slow down the progress of rheumatic diseases like Rheumatoid Athritis. Studies show that they may even stop the disease progressing if given early. In any case they can be extremely effective. See the Medline Plus website in our First Resources to learn all about them. Their side effects need to be considered carefully. Medline Plus describes these drugs as “including gold salts, penicillamine, sulfasalazine, and droxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate can be highly toxic and requires frequent blood tests for patients on the medication”.

• Cyclo-Oxygenase-2 (COX-2) Inhibitors. These drugs block an inflammation-promoting enzyme called COX-2. Medline Plus reports that: “This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s”. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. and UK markets following reports of heart attacks in patients taking the drugs. Celecoxib (Celebrex) is still available, but labelled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you.

• Biologics are the most recent breakthrough for the treatment of rheumatoid and other forms of arthritis. These medications may dramatically improve your quality of life. Biologic response modifiers – drugs that target specific products of the immune system – have very recently gained momentum as treatment for inflammatory arthritis. Much discussed in US sites. Availability in the UK is unclear. Ask your doctor about availability and appropriateness for you. Results with biologics can be very good, but they aren’t a cure.

• Immunosuppressants are drugs which can suppress the overactive immune system. They are used for serious cases of rheumatoid arthritis when other medications have failed. Side affects must be carefully monitored.

Physiotherapy: Physiotherapy, physiotherapy, physiotherapy. For almost all forms of arthritis this cannot be emphasised often enough. Exercise, help with posture, learning to protect affected joints… Your physiotherapist will treat your painful joints, but physiotherapy is not just treatment. It’s also education. A physiotherapist will help you gain strength, become more functional and suffer less damage. By strengthening, stretching and learning good body mechanics you can improve many aspects of your life. It doesn’t matter what state you’re in, physiotherapy can help.

The only downside with physiotherapy is there can be a dreadfully long wait for it on the NHS. See our Health Information we Trust list for alternatives if or while you are waiting.

Nurse Specialists: If you are referred for hospital outpatient treatment, you may have the good fortune to find you are being helped by a Rheumatology Nurse Specialist. The RNS should be the easy one to contact and talk to on your medical team. Problems from the various forms of arthritis can be hard to cope with. The RNS is there to help with anything from your medication to emotional counselling. You can get help with physical coping, relaxation techniques, a good physiotherapy programme, occupational therapy and ways to keep working… When you need to get help, advice, or just to talk, the RNS is likely to be there for you.

Surgery and other approaches: In some cases, including advanced Osteoarthritis, surgery to replace the joint may hugely improve quality of life. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Knee and hip replacement surgery can be extremely effective. Other joint replacement procedures are currently less advanced and may be less durable or practical. Some joints do not need flexibility for ordinary daily life. The knuckle of the big toe or a single joint in the spine are examples. When joints like these degenerate beyond use they can be “fused”. The operation stops them from moving. Some flexibility is lost, but you can eventually function again without pain.

Normal joints contain a lubricant called synovial fluid. In joints with arthritis, this fluid may not be produced in adequate amounts. Medline Plus advises that “another treatment approach is to inject arthritic joints with a man-made version of joint fluid such as hylan G-F 20 (Synvisc) or other hyaluronic acid preparations. This synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for arthritis patients. Many studies are evaluating the effectiveness of this type of therapy.” Many of us have wished we could simply oil our joints like rusty hinges. Man-made joint fluids are an attempt to do just that.

Complementary Therapies / Alternative Medicine 
One or more complementary therapies may be a great help to you. They may help relieve symptoms. They may help you do more to take charge of your own condition and life. They may offer a level of support, empowerment and care which you aren’t finding in conventional medicine. If you find a complementary therapy which works for you, it can very much improve your whole quality of life.

Never use a complementary therapy or medication instead of seeing your doctor. They are what they say they are; complementary. They are useful in addition to medical diagnosis and treatment, not instead of. Never stop taking a steroid or other prescription drug because you’re substituting an alternative therapy. Always check with your doctor first to be sure it’s safe to stop.

Many complementary techniques and therapies have been found very helpful by arthritis sufferers. Look in our For Arthritis Help and Health Information we Trust lists and our Complementary Techniques for more on this. When it comes to arthritis, they are most definitely worthwhile.

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