Coping with Arthritis in Its Many Forms
Ups and Downs continued...
The drugs used for treating most types of arthritis are
drawn from many categories, but can be thought of in a few broad groups, such
as anti-inflammatory drugs and disease-modifying drugs. For treating gout,
there are also drugs that reduce the amount of uric acid in the blood. More
than one medication may be required for treating arthritis.
Anti-inflammatory agents generally work by slowing the
body's production of prostaglandins, substances that play a role in
inflammation. Many have an analgesic, or painkilling, effect at low doses.
Usually, higher, sustained doses are required to see sufficient
anti-inflammatory activity for treating arthritis. The most familiar
anti-inflammatory agent is aspirin, often a good arthritis treatment. Like
aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) fight pain and
inflammation. More than a dozen NSAIDs are available, most by prescription
only. At press time, FDA was considering whether labeling changes to
prescription-strength NSAIDs are necessary, due to gastrointestinal side
FDA has approved three NSAIDs for over-the-counter (OTC)
marketing: ibuprofen (marketed as Advil, Nuprin, Motrin, and others), naproxen
sodium (sold as Aleve), and ketoprofen (marketed as Actron and Orudis).
Although these drugs are available OTC, a doctor should be consulted before
taking any medication for arthritis symptoms.
"People shouldn't be mixing these medications," says
Linda Katz, M.D., of FDA's Center for Drug Evaluation and Research, and anyone
regularly taking NSAIDs should carefully read the labels of OTC products to
make sure they don't contain similar drugs. For example, many cough and cold
preparations contain analgesics such as aspirin, acetaminophen or
The most potent anti-inflammatories are corticosteroids,
synthetic versions of the hormone cortisone. Like prednisone and dexamethasone,
the generic names often end in "-one." They're usually reserved for
short periods of use during intense flares or when other drugs don't control
unrelenting disease. Relief can be dramatic, but long-term use causes side
effects, such as weight gain, high blood pressure, and thinning of bones and
skin. Usually given orally, they can also be injected directly into a joint to
reduce side effects.
Disease modifiers slow the disease process in autoimmune
diseases such as rheumatoid arthritis or systemic lupus erythematosus. Patients
taking these drugs are closely monitored. It may take weeks or months to learn
if a drug works. During that wait, it's important to keep taking other
medications such as NSAIDs. Gold salts have been used to treat rheumatoid
arthritis for 60 years, although nobody knows why this treatment works.
Penicillamine, methotrexate, and antimalarials such as hydroxychloroquine are
also used. Doctors usually reserve other powerful drugs that suppress the
immune system for extremely serious disease.
Most people with arthritis never need surgery, but when all
else fails, it can dramatically improve independence and quality of life by
reducing pain and improving mobility. The surgeon may remove damaged or
chronically inflamed tissue, or replace the joint entirely. Artificial
replacements are available for all of the most commonly affected joints.