Treating Arthritis With Medications
Meds are usually very effective in helping to ease joint pain and other arthritis symptoms. That’s because most of them help reduce inflammation — the source of all that aching. Some types of medications may be used simply to ease joint pain, without doing much to combat inflammation. Over-the-counter pain-relievers. These include Tylenol (acetaminophen), and nonsteroidal anti-inflammatory drugs (NSAIDs) like Aspirin, Aleve (naproxen), and Advil or Motrin (ibuprofen). Acetaminophen may be best used in conjunction with some prescription medications and is generally safe for long-term use, according to 2012 research in The Open Rheumatology Journal. But the researchers also noted that, while NSAIDs can ease an arthritis flare-up, high doses and long-term use may also be harmful; the Food and Drug Administration (FDA) cautions that NSAIDs can cause stomach bleeding and kidney damage in some people. Acetaminophen is the first line of defense against osteoarthritis, says Robert T. Keenan, MD, a rheumatologist at Duke University Hospital in Raleigh, North Carolina. He considers the medicine to be very safe if you don’t have significant liver damage or other contraindications and don’t take more than the maximum dosage (3 grams per day). “It seems to work best before the pain starts and [for] preventing the pain associated with increased activity,” Dr. Keenan says. In July 2015, the FDA reported that non-aspirin NSAIDs can also increase a person’s risk for a heart attack and stroke — and that these risks were higher than experts originally believed. According to the agency, the increased risk can begin within the first week of using the medications, and risk also appears to rise with the strength of the dose and increased length of use. (People who already have heart disease or are likely to develop it in the future may have a higher risk.) The FDA ordered manufacturers to strengthen the medications’ warning labels. Supplements like glucosamine and chondroitin. People who take chondroitin — either alone or with glucosamine — may have fewer adverse events than those who take a placebo, according to one January 2015 review in the Cochrane Database of Systematic Reviews. Topical pain-relieving creams, gels, and ointments. Topical NSAIDs, which you rub into the skin over an aching joint, can be another pain-relieving option. Plus, they don’t trigger the gastrointestinal side effects caused by the oral NSAIDs, according to 2012 research in the Cochrane Database of Systemic Reviews. The research suggested that topical diclofenac might be the most effective treatment option they reviewed. Disease modifying anti-rheumatic drugs (DMARDs). Both older versions and the newer tumor necrosis factor (TNF) inhibitors can reduce your symptoms and the progression of the disease. The TNF inhibitors block a joint-destoying substance in the body, according to the Johns Hopkins Arthritis Center, and while they help protect against joint damage, side effects include an increased risk for serious infections and liver damage. Prescription NSAIDs. These pain-relieving agents — including Naprelan (naproxen), Indocin (indomethacin), and COX-2 inhibitors like Celebrex (celecoxib) — can enhance control of inflammation, pain, and other symptoms of arthritis in people taking DMARDs and/or corticosteroids, according to research published in the February 2015 issue of BMC Musculoskeletal Disorders. Keep in mind that the July 2015 FDA warning about heart attack and stroke risk applies to prescription NSAIDs as well. Corticosteroid medications. These prescription medications, which include prednisone and cortisone shots, are often given in conjunction with other therapies, such as NSAIDs and DMARDs, to control symptoms and inflammation, according to the Johns Hopkins Arthritis Center. Prescription pain relievers. Easing pain is essential in managing rheumatoid arthritis, but since these pain relievers can also cause side effects and even greater sensitivity to pain — as was shown in a 2013 study in Current Rheumatology Reports — they should only be used in the short-term and carefully monitored. How well these medications work varies from person to person. “[They] can be very helpful for some and unhelpful or only partially effective for others,” says Matthew Husa, MD, a rheumatologist and assistant professor in the division of rheumatology and immunology at the Ohio State University Wexner Medical Center in Columbus. Also keep in mind that while NSAIDs and acetaminophen relieve pain, they don’t stop the progression of the disease.
Physical Therapy for Arthritis Treatment
Physical therapy is often recommended to help ease arthritis pain. It can strengthen the muscles that support your damaged joints, help reduce joint stiffness, and improve your range of motion. “It’s also a good first non-surgical and non-medicating start to improve mobility,” says Keenan. According to 2014 research in the Cochrane Database of Systemic Reviews, people with osteoarthritis of the hip can feel less pain and have more physical function after engaging in physical therapy exercises. And by going to sessions, you’ll learn how to properly perform the moves and stretches. You may also see an improvement in your ability to:
WalkSit and stand comfortablyClimb stairsClimb in and out of the bathtub
If you’re looking for a physical therapist, it’s important to consult with your doctor first. And to find a specialist in your area, you can also check out the “resource finder” tool from the Arthritis Foundation and the “find a PT” tool from the American Physical Therapy Association. While physical therapy can offer significant benefits for many people with arthritis, it’s not effective for everyone. If it’s recommended as part of your treatment, give it a try for at least three to six months. If you don’t see any improvement in that time, physical therapy simply may not be useful for your individual case of arthritis.
More Approaches to Fight the Joint Pain of Arthritis
Taking medication isn’t the only way to treat arthritis pain. Other options include:
Hot and cold therapy. Although it’s only a temporary fix, applying heat and ice packs to arthritic joints can ease inflammation and pain.Weight loss. Being overweight adds extra stress to your damaged joints. Losing weight can help relieve some of that pressure, which lessens the pain. “In many ways, diet, exercise, physical therapy, weight loss, and other non-pharmaceutical therapeutics for OA may be more effective over the long-term than medication alone,” says Dr. Husa. Ask your health care team if it’s safe for you to start a new exercise or diet routine, and the best ways to get started, he says.Braces. Supporting your arthritic joint with a brace or splint can give it the extra strength it needs to work properly. But these assistive devices offer temporary support and relief — they shouldn’t be used all the time.Chiropractic adjustments. Though not always recommended or found to be effective, manipulating some joints affected by osteoarthritis can help some people feel less pain and stiffness.Exercise. This is an extremely effective pain management method for people with osteoarthritis. It’s perfectly safe to exercise with arthritis, and as an added benefit, it can improve joint health and function. Keenan suggests people try non- or low-impact activities like swimming, yoga, and light strength-training.TENS. Known as transcutaneous electrical nerve stimulation, TENS is a procedure that uses light electrical pulses to change the way pain is felt.Surgery. While often an effective remedy, surgery is typically recommended for severe cases of arthritis in which damaged joints don’t respond to other treatments.Newer arthritis treatments. Biologic medications, which normally are given by injection or infusion, are great advances in rheumatoid arthritis treatment (though they’re not for osteoarthritis). Now the first oral biologic drug for rheumatoid arthritis, Xeljanz (tofacitinib citrate), is available. According to one study published in a 2014 issue of The New England Journal of Medicine, tofacitinib was better at slowing joint damage and lessening RA symptoms than the current mainstay treatment, methotrexate.
There are many arthritis treatment options available to you to help manage your pain, so don’t despair — you don’t have to muddle through without relief. Just keep in mind that you may need to try a few different therapies before you figure out which arthritis treatments work best for you.
