Joint pain is the most common symptom of osteoarthritis and rheumatoid arthritis, both of which are chronic diseases that can affect the person afflicted over a long period of time. Arthritis cannot be cured, but the symptoms can be treated through a variety of products and methods. Sports-related activities as well as falls and other trauma can injure the cartilage within a joint and, if it is not provided sufficient time to heal, chronic pain and persistent disability can follow. Additionally, damage to the bone surface can start a biological process that results in joint degeneration. This, in turn, often leads to rheumatoid arthritis and osteoarthritis. This is a brief overview of some of the products currently available, through both prescription and over-the-counter, to treat the symptoms of arthritis, specifically Joint Pain.
Acetaminophen is a pain reliever but does not reduce swelling, which is a common symptom associated with some types of arthritis, specifically rheumatoid arthritis. As such acetaminophen, the best known of which is Tylenol, may be effective for people afflicted with osteoarthritis which often times have very little inflammation. In addition, acetaminophen does not cause stomach irritation and is less likely than nonsteroidal anti-inflammatory drugs (NSAIDs), described later, to cause long-term side effects. Research has shown that acetaminophen relieves pain as effectively as NSAIDs for many patients with osteoarthritis. People with liver disease, people who drink alcohol heavily, and those taking blood – thinning medicines or NSAIDs should use acetaminophen with caution.
Ibuprofen is a pain reliever that combines anti-inflammatory properties with pain relief. People afflicted with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or ibuprofen, the best know of which are Motrin and Advil. Unfortunately, ibuprofen products and aspirin typically cause some stomach discomfort if taken without food and have been linked to ulcers with long-term use.
What Causes Rheumatoid Arthritis?
Scientists are studying risk factors that increase the likelihood of developing a rheumatic disease. Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. In rheumatoid arthritis, the combination of genetic factors that determine susceptibility and environmental triggers are believed to be important.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
This class of drugs includes aspirin and ibuprofen as well as ioxx (rofecoxib), Celebrex (celecoxib), and Bextra (valdecoxib), which are classified as COX-2 inhibitors. Aspirin and ibuprofen are used to reduce pain and inflammation, as noted above, and may be used for both short-term and long-term relief in people with osteoarthritis but are more commonly used to treat symptoms of rheumatoid arthritis. The other drugs under NSAIDs are COX-2 inhibitors that work by blocking an enzyme known to cause an inflammatory response. COX-2 inhibitors had been approved for short-term use in the treatment of pain, and for longer-term use to treat the signs and symptoms of osteoarthritis and rheumatoid arthritis.
**Please see latest FDA Alerts regarding Vioxx, Celebrex, and Bextra recall.**
Side effects associated with NSAIDs include stomach irritation, negative impact on kidney functions, and are often associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. As such, people over age 65 and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution. As with most medications, the longer a person uses NSAIDs, the more likely he or she is to have side effects. In addition, because of the way NSAIDs alter the way the body uses or eliminates other drugs, many other drugs cannot be taken when a patient is being treated with NSAIDs. It is important to check with your health care provider or pharmacist before you take NSAIDs in addition to other medications.
Glucosamine and Chondroitin
Both glucosamine and chondroitin are synthesized by the body and are components of natural joint cartilage. Studies indicate that glucosamine and chondroitin can help alleviate joint pain related to osteoarthritis and rheumatoid arthritis through improvements to the general joint function including greater joint flexibility. It appears that together they help offset joint space narrowing, which is the loss of cartilage within the joint, seen with osteoarthritis by stimulating production of new cartilage. Researchers theorize that glucosamine assists in the creation of new cartilage, while chondroitin slows cartilage destruction.
Some studies indicate that glucosamine may help as much as nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and tolmetin in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects.
Biological Response Modifiers
This class of drugs includes Enbrel and Remicade, and is often used for the treatment of joint pain associated with rheumatoid arthritis by reducing the inflammation in the joints. Biological response modifiers theoretically block the reaction of an immune system protein involved in immune system response called tumor necrosis factor.
Disease-Modifying Antirheumatic Drugs (DMARDs)
This class of drugs includes Arava, methotrexate, hydroxychloroquine, penicillamine, and gold injections. Because of the likelihood of side effects, these drugs are used to treat people with rheumatoid arthritis who have not responded to NSAIDs or are no longer taking NSAIDs because of the FDA recall of Vioxx, Celebrex, and Bextra (COX-2 inhibitors). It is theorized that these drugs influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis and other rheumatic diseases. Due to the likelihood of adverse side effects, treatment with these medications requires careful monitoring by the physician.
Corticosteroids are hormones that can be taken by mouth or given by injection directly into the affected joint. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. These hormones are very effective in treating arthritis but cause many side effects, including damage to the cartilage. In fact, frequent injections may cause damage to the cartilage, and as such, they should only be done once or twice a year.
Hyaluronic Acid Products
These drugs include Hyalgan and Synvisc. It is theorized that these drugs mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain.
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