Arthritis is a chronic disease and requires long-term management and follow-up.
Although your primary care physician is well qualified to handle this, s/he
may recommend consultation or follow-up with a rheumatologist. Arthritis therapy
focuses on reducing the symptoms (especially pain and decreased mobility) as
well as slowing the progression of the inflammation of arthritis. Certain medications
do both.
- Drugs:
Over-the-Counter (Non-prescription) Medications:
First line medications include analgesics (painkillers) such as acetaminophen
(e.g. Tylenol) or one of the many non-steroidal anti-inflammatory agents (NSAIDs,
e.g. Motrin™ or Advil™ or Aleve). Most drug stores also carry generic ibuprofen
or acetaminophen, which are just as effective and much less costly.
Studies have not shown any one of these medications to be more effective
than another in general; individual patients may find better results
or fewer side effects with one or another preparation. This can only be determined
by trial and error. There are enteric coated versions of most of the NSAIDs
and aspirins (acetaminophen is not irritating to the stomach); these may reduce
the incidence of gastrointestinal complications.
NSAIDs are used by apr. 13 million Americans regularly for various types
of arthritis pain. As a result, there are an estimated 107,000 hospitalizations
per year for gastrointestinal complications from this therapy. It is estimated
that there are 16,500 NSAID-related deaths per year in the US.
Prescription Medications:
COX-2 Inhibitors: This is an entirely new class of medicines launched
just this year.
- Celebrex: (Celecoxib Capsules) Celebrex was recently approved
as the first COX-2 inhibitor for the relief of the signs and symptoms of
OA, and of RA in adults. It treats both the pain and inflammation of arthritis.
It is prescribed orally, once or twice per day (generally once/day for OA;
twice/day for RA). It has become a blockbuster drug since its launch this
year, attesting to the large number of previously unsatisfied arthritis
patients.
The most common side effects for Celebrex are indigestion, diarrhea and
abdominal pain; in rare cases, problems such as bleeding can occur without
warning. This medicine should not be taken by patients with asthma or allergic
reactions to aspirin, arthritis medications or certain sulfa drugs.
- Enbrel™ (etanercept): This breakthrough new drug was approved
a year ago and has already improved the quality of life for millions of
RA sufferers. It is the first in a new class of drugs for the treatment
of moderate to severe RA in adults and children called "biologic response
modifiers". It has been shown to greatly reduce pain and duration of morning
stiffness as well as to reduce the number of swollen and tender joints,
thus enabling patients to resume their normal daily activities.
Enbrel acts by supplementing the body's natural process of regulating levels
of tumor necrosis factor (TNF), a protein know to be integrally involved
in the RA disease process. Enbrel effectively prevents the TNF from working,
making it inactive, and thereby reducing the inflammatory process. Enbrel
can be given alone or in conjunction with other medicines such as methotrexate.
It is given twice weekly as a subcutaneous injection (similar to insulin).
The most frequently reported side effects were mild to moderate skin reactions
at the injection site; long-term effects are still unknown. Patients with
any serious infections (e.g. sepsis) should not take this medication. Patients
who develop infections while taking Enbrel should inform their physicians
immediately. Side effects of Enbrel are more common in children than in
adults, including infections, headache, nausea, abdominal pain and vomiting.
- Corticosteroids: Reserved for most severe cases of RA. These
are the most potent anti-inflammatory agents, but they also have the highest
incidence of serious side effects, especially if used chronically so discuss
these with your physician carefully.
- Methotrexate: this has traditionally been used as second line
therapy by many rheumatologists for RA because of its relatively rapid onset
of action (4-6 weeks) and oral administration. Patients must be monitored
for liver and bone marrow complications however. If you are taking this
medication for RA, ask your doctor if you might be better suited for Embrel.
- Immunosuppressants: Also used as second line therapy for RA,
these medicines (e.g. Sandimmune™, Neoral™) can effectively reduce the autoimmune
destruction of the joints.
Arthritis is the major cause of disability and chronic pain in Americans. 
