Arthritis medications have 2 functions:
- Immediate pain relief
- anti-inflammatory properties
The pain relief is present every time you give a pill but the anti-inflammatory part will not work if the medication is only given on an “as needed basis”. For longer lasting and better pain relief, you should give arthritis drugs on a daily basis.
Just as there are over a hundred different types of arthritis, so are there over a hundred different kinds of treatment for arthritis. Each of them treat arthritis and related conditions in a specific way – treat the pain, halt disease progression, reduce inflammation, etc. The response, side effects and adverse reactions to these arthritis medicines vary between individuals.
It is important for the patient to be knowledgeable about arthritis medication for determining what their options are and to make informed decisions with the help of their doctors.
These medications are available in the form of injections, pills and creams.Most patients will be on both pain medications and anti-inflammatory medications to help to manage their condition.
- 1 Types of Arthritis Medications
- 1.1 DMARDs (Disease Modifying Anti Rheumatic Drugs)
- 1.2 Steroids in Arthritis
- 1.3 Corticosteroids
- 1.4 Cortisone Injections for Arthritis
- 1.5 Prolotherapy Injections for Arthritis
- 1.6 nonsteroidal anti-inflammatory drugs (NSAIDS)
- 1.7 BRMs(Biologic Response Modifiers)
- 1.8 Analgesics
- 1.9 Topical Pain Relievers
- 1.10 Hyaluronan Injections or viscosupplementation
- 1.11 Chemotherapy Medications
- 1.12 Counter irritants
Types of Arthritis Medications
Medications used for treating arthritis vary, based on the arthritis type. Following are some of the most commonly used medications for arthritis:
DMARDs (Disease Modifying Anti Rheumatic Drugs)
Otherwise known as Disease Modifying Anti Rheumatic Drugs, DMARDs are actually immunosuppressants – that is, they suppress the response of a defective immune system as is the case of patients suffering from rheumatic arthritis. These medications stop or slow the immune system from attacking the joints.They are used as second line arthritis medications specifically for rheumatic arthritis if NSAIDs and aspirin fail. One common DMARD is hydroxychloroquine like Planquenil and methotrexate like Trexall.
Although these arthritis medications have been used to decrease inflammation, they are not categorized under anti inflammatory drugs. They do not affect prostaglandin production, unlike NSAIDs, however, they do relieve pain and inflammation by “modifying” the immune system in some way. As such, these arthritis medications thus help in slowing the disease process though they seldom lead to a complete remission.
How do Biological Anti-Rheumatic Drugs Work?
Our immune system consists of small protein molecules known as cytokines which help in intercellular communication. While some forms of cytokines promote inflammation (especially TNF or tumor necrosis factor) some forms block inflammation. A balance between these cytokine forms exists in people with a normal immune response. But in those suffering from rheumatoid arthritis, the balance is disturbed, as there is an overproduction of cytokines that promote inflammation. There are certain anti-rheumatic drugs that work against this biological phenomenon and help slow down the progression of rheumatoid arthritis (RA).
These anti-rheumatic drugs work against the over production of TNF (cytokines that promote inflammation) and that is how the progress of the disease is slowed down. Let us look at some drugs that have been developed to inhibit the production of TNF.
These biological anti-rheumatic drugs work the best when used in the early stages of RA. This is because the remission of the disease is much faster when these drugs are used during the initial stages of the disease. These drugs are also used in treating ankylosing spondylitis, reactive arthritis and psoriatic arthritis.
Why Early and Aggressive Use of Dmards is Essential
Disease-modifying antirheumatic drugs or dmards are used to reduce the progression of rheumatoid arthritis. Researchers from Tampere University Hospital, Finland have found that early and agreessive use of these drugs with other combinations, in the very initial stage of the disease, can be helpful in the long run.
The results of their 11 years of study published in BioMed Central’s open access journal Arthritis Research & Therapy in June 2010. This article tries to gain further insight on this topic.
Knowledge Gained from Research on the Early Use of Dmards:
- It was already known that early treatment of rheumatoid arthritis with these drugs reduced the progression up to five years.
- The latest study found that when they were used early, the disease progression can be retarded up to 11 years.
- In the study, 97 patients were given a combination of these drugs and 98 patients received a simple drug of this category.
- After two years, both the groups had unrestricted treatment available for rheumatoid arthritis.
- It was learnt from the study that group 1 had excellent results of remission of the disease upto nearly an year’s time than group two patients.
- The study is a classic example and stresses on the need of early initiation of rheumatoid arthritis treatment through combination of these drugs for achieving remission.
Significance of the Research on Early Use of Dmards:
The American College of Rheumatology is the body in the United States which frames the diagnostic criteria for this auto-immune disease. Owning to the nature of the disease, unfortunately, symptoms of rheumatoid arthritis remain asymptomatic (no apparent signs) in the early stages.
There is no cure for this condition and the available treatment options primarily aim at keeping the signs of this ailment under check. This makes awareness about the symptoms of the disease, the significance of early diagnosis and commencement of the treatment be of vital importance in addressing it.
Steroids in Arthritis
Arthritis patients use steroids, which are synthetic drugs, to control inflammation and pain. The kind of steroids used depends on the severity and location of the arthritic condition.The actual name of steroids used in the treatment of arthritis is corticosteroids. It is closely linked to the hormone called cortisol which is naturally produced in our body.
How Do Steroids Work?
Steroids help in decreasing inflammation and in reducing immune system activity. In certain conditions, the body’s immune system becomes overactive and does not function properly. This leads to inflammation working against tissues, causing tissue damage. Steroids help in reducing the production of inflammatory chemicals, thereby minimizing tissue damage.
Oral Steroids and Their Effects
Steroids such as prednisone may be taken in pill or liquid form to control inflammation and pain. Prednisone is particularly effective for patients suffering from arthritis in multiple joints. The side effects include eye diseases, osteoporosis, weight gain and high blood pressure. Healing after injuries and infections may slow down.
Topical Steroids and their Effects
These steroids like hydrocortisone are rubbed into the skin enveloping the affected joint, to reduce inflammation, swelling and pain. Side effects include thinning of the skin, redness or acne at the point of contact.
Injected Steroids and their Effects
These steroids like cortisone are injected into the arthritic part, such as ankles or knees. Side effects include changes in skin appearance, skin infections and pain in the injected portion.
Do not stop using prednisone suddenly. This can lead to withdrawal symptoms such as vomiting, nausea, extreme fatigue, head and body aches and low blood pressure.
These steroids in the long run caused, irregularities in menstrual cycle, cataracts, infection and weakened the muscles. Patients who were diabetic, this steroid worsened the situation. It also caused a problem of moon face which made them sensitive towards bruises.
When are Steroids to be Avoided?
When an infection is there around the area to be targeted or in any part of the body. Also it must not be used when the joint is already seriously damaged. And even if someone has a possibility of bleeding problem.
What are the Defects of using Steroids in the Treatment of Arthritis?
A high dosage of steroids could lead to irregular heartbeats which is called as Atrial Fibrillation(AF). It means blood is not being pumped effectively to heart which could cause weakness and slowness of breath. Other side effects could be weight gain, high blood pressure, heart diseases and high blood sugar to name a few. Hence they should not be taken in high dosages.
It is for these reasons the frequency and the quantity of steroids should be put in check as most of the side effects are reversible by stopping the usage of them but some of them could be permanent.
Corticosteroids(cortisone and prednisone) make up for some of the oldest and most effective arthritis medication. It is also one of the fastest working. Corticosteroids like cortisone decrease inflammation and suppress the immune system. Joints, eyes, and internal organs that have been damaged due to arthritic inflammation can be spared with the use of steroids.
However, this arthritis medication needs to be used properly and sparingly. Because while steroids have the potential to help arthritic patients, they also have the potential to do great harm by causing bones to become brittle, cataracts to occur, blood sugar levels to elevate and other side effects.
These medications are usually more powerful than NSAIDs and have options in how they are administered. Steroids can be taken orally or injected into the body. Certain ones, such as hydrocortisone can be injected directly into affected joints. Many sports stars perform with cortisone injections when they are carrying injuries and sometimes cause more damage as a result.
Edward Kendall and Dr. Phillip Hench were two therapists who first introduced costicosteroids in 1940 which helped in taming inflammation. This drug was also known as glucocorticoids and was used to cure patients suffering from rheumatoid arthritis. They were recognized for their work in 1950 and received the Nobel prize.
Uses and side-effects
Though costicosteroids relieved patients suffering from pain but this had a serious side-effects especially when taken in high doses. Steroids took a toll on patients and that didn’t seem to help them. Even physicians hesitated to prescribe steroids. Though steroids are still being used to treat rheumatoid arthritis but physicians are being more cautious. This drug is used when arthritis cannot be controlled by DMARD or NSAIDs. It can also happen when a patient experiences side-effects, therefore he/she may not prefer medications.
These days steroids are given for a small period of time and in small doses. Bridge therapy is the period for which the steroid is prescribed for inflammation, which waits for DMARDs to gradually take effect. Only only the inflammation is reduced in the patient, that’s when the steroid is taken off.
Steroids are injected in some patients to reduce warmth, swelling and pain for about six to seven weeks.
Side-effects included acne, nervousness, insomnia, depression, weight-gain and increase in appetite.
Cortisone Injections for Arthritis
Cortisone is a steroid that reduces joint swelling, redness, heat and pain. Specific preparations are utilised to lengthen its effect at the injected point. Cortisone takes 24 to 36 hours to act and its benefits may sometimes last for months.
Cortisone injections are recommended when:
- Other medicines cannot be used
- Specific joints prevent activity
- A few joints only are impacted
- There is severe pain and inflammation in a joint or surrounding tissues
Frequency of cortisone injections:
- Once every two or three weeks in the surrounding tissues.
- Once a month in a joint, with a maximum of four in one year.
- May be combined with physiotherapy or other forms of treatment
- As the pain lessens, other medicines can be reduced
- Increases mobility
- Reduces pain and swelling
The Injection Procedure
The administration method is akin to soft tissue injections. Prior to the injection, any excessive fluid in the joint is removed. This reduces pressure in the joint, relieving the pain and helping the joint to heal.
After the cortisone injection:
To maximise the impact of cortisone, it is important to:
- Rest the injected joint for 24 hours.
- Avoid too much moving of the joint and decrease stress on it. This should be done for about a week. In some cases, the pain increases after the injection, but subsides within 24 hours.
- To minimize pain, if any, take rest, apply ice and take paracetamol or aspirin.
- If the pain continues for over 48 hours, contact your doctor.
Injected cortisone does not enter the bloodstream as much as cortisone taken in tablet form. Therefore, side effects are minimal and very uncommon. They include:
- swelling of face or fingers
- increased blood pressure
- mood changes
Prolotherapy Injections for Arthritis
Usually, corticosteroid injections are injected straight into the arthritis affected joints in the body to alleviate the pain. But, they come with their share of side-effects. Prolotherapy injections are being preferred over the corticosteroid ones of late, to heal arthritis pain. What exactly are these injections and how effective are they when it comes to treating arthritis and soft tissue damages?
The science of growth factor comes into play very effectively as far as these injections are concerned.
- In this therapy, soft tissue injuries related to arthritis are healed by using medications that trigger a local inflammation. When a local inflammation is triggered at a particular tissue, the growth process (process of healing) starts happening automatically repairing the damaged tissues.
- This growth process is most common in our day-to-day lives. Like, a cut in the finger or a sprained ankle, a broken bone, a surgery wound, all heal upon themselves due to the triggering of this process in the body.
- In arthritis related tissue damage, prolotherapy, triggers this healing process.
Soft tissue damage in arthritic conditions can be attributed to the degenerated bones which automatically affect the joints. The affected ligaments and joints when stretched, they tend to grow weak. The weakened joints add pressure on the other muscles and tendons causing the cartilage to replenish.
- Replenished bone cartilage, thus, is a result of an arthritic attack. Prolotherapy makes sure that the weakened muscles and joints are strengthened, thus putting a stop to the degenerative process.
- These injections or medications contain saline or glucose which add strength to the tissue there by resolving the root cause that leads to an arthritic attack.
- Various degenerative conditions causing arthritic problems in knee, hip, neck, shoulder, lower back, hands/fingers and ankle/feet can be healed, thanks to these injections.
Prolotherapy injections act as a catalyst and assist the natural process of healing within the body. Where most anti-inflammatory drugs look to only alleviate the pain, this therapy addresses the root cause of the pain and resolves that issue. Regular medication for 5-7 months resolves the issue of pain.
nonsteroidal anti-inflammatory drugs (NSAIDS)
Among the first line of treatments for arthritis are nonsteroidal anti-inflammatory drugs (NSAIDS). Drugs in this class include ibuprofen, naproxen, celebrex, and others. These medications provide temporary relief by reducing swelling in the joints and by acting as anti-pyretics (fever reducers). Many individuals who suffer from arthritis in any form take NSAID drugs daily in order to function at anything approaching a normal level. This is a serious matter, as these drugs can have life-threatening or even fatal side effects.
NSAIDs are available in three basic categories:
- traditional NSAIDs ( like Advil, Motrin),
- COX-2 inhibitors (Celebrex),
- and salicylates (Aspirin).
How Nonsteroidal Anti-inflammatory Drugs Work?
Enzymes are substances which change the rate of chemical reactions in the body, without getting directly involved in the process. NSAID drugs prevent the functioning of an enzyme called cyclooxygenase, or COX. It has two forms namely the COX-1 and COX-2. The former protects the stomach lining from harsh digestive chemical acids and helps in proper functioning of kidney. The latter is produced in the body when joints are injured or swollen.
As these drugs do not allow both the forms of COX enzyme to function, the pain gets relieved but at the cost of complaints of stomach upset and interference with kidney function.
The drugs’ main target is cyclooxygenase, the enzyme that catalyzes arachidonic acid to prostaglandins and leukotrienes. When the membrane phospholipids of our cells are exposed to inflammatory stimuli, they release arachidonic acid which is then catalyzed by cyclooxygenase into prostaglandins. This creates the biological response of inflammation.
By interfering with the prostaglandin production and inhibiting the release of cycooxygenase, NSAIDs can prevent inflammatory response, a common symptom of arthritis.
Anti-inflammatory drugs decrease both inflammation and pain. Over the counter drugs include naproxen, aspirin and ibuprofen. A few types of anti-inflammatory drugs can be obtained by medical prescription. Oral anti-inflammatory drugs may result in stomach irritation and a few may increase the chances of heart stroke or attack. Some of these drugs are available in the form of gels or creams that can be massaged on the joints.
COX-2 Inhibitors as Nonsteroidal Anti-inflammatory Drugs:
In order to allow the COX-1 enzyme continue its function and reduce the side effects of NSAIDs, a special category of drugs called the COX-2 inhibitors are developed. As the name suggests, the drugs target only the COX-2 enzyme and stop the swelling process of joints. Celecoxib, rofecoxib and valdecoxib are some of these drugs. But rofecoxib and valdecoxib were removed from the market by their manufacturers in 2004 and 2005 respectively.
Patients using these drugs should not use traditional NSAIDS. COX-2 inhibitors do not provide any protection from heart disease by clotting the blood. Prior to commencing its intake, the doctor should be informed if there were any cases of heart attacks, heart pain, blood clotting, stroke or history of high blood pressure.
Unfortunately even COX-2 inhibitors are not immune from side effects. Benefits of these drugs come along with the risks like nausea, abdominal pain, indigestion or bleeding of the abdomen without any warning in severe cases. They should not be taken along with antacids or after a fatty meal as the body cannot absorb them in such a state.
Adverse drug reactions (ADRs) effects of Non-steroidal Anti-inflammatory Drugs
Non-steroidal anti-inflammatory drugs do come with adverse effects that can manifest on different parts of the body. The use of these drugs has become widespread since they can be sold over the counter without prescriptions.
The extensive use of NSAIDs has meant that the adverse effects of these drugs have become increasingly prevalent.
The two main adverse drug reactions (ADRs) associated with NSAIDs relate to gastrointestinal effects and renal effects of the agents:
- Gastrointestinal effects have been a problem with NSAIDs, since they have been known to cause ulcers and bleeding. Ulcers can lead to certain complications, such as a perforated ulcer.
perforated ulcer is the result of a chronic use of non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen. Such painkillers hinder mechanisms that protect the gastrointestinal lining from digestive juices that can cause ulcers.
- It’s possible that NSAIDs can become toxic to your kidneys, leaving a large amount of damage. You may begin having problems when trying to urinate, including burning or pain.
Non-steroidal Anti-inflammatory Drugs can also cause:
- your blood pressure to go up, leading to hypertension.
- your heart rate to increase as well.various blood disorders. Excessive bleeding can become problematic after an injury or surgical procedure.
- Erectile dysfunction risk. A 2005 study linked long term (over 3 months) use of NSAIDs, including ibuprofen, with a 1.4 times increased risk of erectile dysfunction.
- inflammatory bowel disease. NSAIDs should be used with caution in individuals with ibd (e.g., Crohn’s disease or ulcerative colitis) due to their tendency to cause gastric bleeding and form ulceration in the gastric lining.
- Other adverse effects related to NSAIDs might include ringing in the ears, a feeling of fatigue, dizziness, mental changes, such as confusion, and problems with vision.
It is important that you discuss any adverse effects with your doctor, so that the necessary changes in your medical regimen can be made.
BRMs(Biologic Response Modifiers)
Unlike NSAIDs, BRMs or Biologic Response Modifiers are arthritis medications that stimulate, not inhibit, the ability of the immune system to fight arthritis and rheumatic diseases. These arthritis medications are based on compounds that are manufactured by the body’s living cells, such as monoclonal antibodies, interferon, interleukin-2, and various types of colony-stimulating factors.
BRMs are slower acting compared to NSAIDs but if applied properly, they could be effective in halting disease progression.
Biologic medications are genetically engineered group of drugs that are derived from human proteins found in our bodies. They are created to counter the immune response to inflammation. Biologic medications are used to treat many types of arthritis and have found to have a level of success.
Typically, these are used in conjunction with disease-modifying anti rheumatic drugs. Genetically, biologic response modifiers engineered drugs which suppress the immune system. For example, infliximab like Remicade and TNF blockers like etanercept (Enbrel).
These help in reducing pain, but don’t have any effect on inflammation. For example, narcotics such as oxycodone, hydrocodone such as Vicodin, tramadol such as Ultram and acetaminophen such as Tylenol.
Analgesics like Tylenol resemble NSAIDs in that they can provide relief for pain. However, that is all that this arthritis medication can do. It cannot reduce inflammation or swelling of the joints. Nevertheless, analgesics are most helpful if, for some reason, the patient cannot take NSAIDs (like if he is allergic to it or suffers stomach problems if he takes that arthritis medication).
Topical Pain Relievers
These are over-the-counter drugs that provide quick pain relief. These are used by patients with relatively mild arthritic condition in just a few joints.
Hyaluronan Injections or viscosupplementation
These are also known as viscosupplementation. They are used for osteoarthritis of the knee. These injections are known to reduce pain and increase mobility and activity.
Chemotherapy is usually used for cancer treatment. These are used as they slow cell reproduction and decrease those products created by cells that cause inflammatory responses. Lower doses are used for autoimmune or rheumatic conditions compared to the doses for cancer treatment.
A few varieties of ointments and creams have a substance like capsaicin or menthol. This is the ingredient which makes hot peppers spicy. Rub these preparations on the skin over the paining joint. This interferes with the transmission of painful signals from the joint.
Talk to your doctor to find out what kind of pain medication that he recommends for your pain. He may give you a stronger pain medication depending on the level of your pain. If not, you could try using over the counter pain relievers.