14 May Conventional medication for treating arthritis
When you are diagnosed with a chronic disease like arthritis, the best thing you can do is research the disease as much as you can, and a vital part of this research is investigating the types of medication used to treat it.
Take into account that you can also complement your treatment with alternative therapies to help with the side effects produced by traditional medication.
For the medical treatment of arthritis, 6 different types of medicines may be prescribed:
1. Analgesics for arthritis
These drugs were developed with multiple chemical ingredients to reduce the patient’s sensitivity to pain.
Products available at the pharmacy:
Acetaminophen with codeine – Hydrocodone with acetaminophen – Methadone – Morphine – Oxycodone – Oxycodone with acetaminophen – Oxycodone with aspirin – Oxymorphone – Propoxyphene – Propoxifeno with acetaminophen – Tramadol
Important: most of these drugs require a medical prescription and, depending on the country you are in, may require close supervision, as they can be used as narcotics.
How do analgesics help treat arthritis?
Analgesics have a biological effect on the body, focusing particularly on eliminating the feeling of pain in a particular area.
Do you know how feelings of pain are produced? Prostaglandins are substances that stimulate nerve endings and that is what causes pain. Analgesics intervene with the prostaglandins, either stopping them from being released and producing pain, or at least making it more difficult for the body to produce these substances.
Side effects of analgesics for arthritis
Side effects can occur depending on the type of analgesic and the length of time it is taken for. They include constipation, fatigue, dizziness, stomach ache, ringing in the ears, itching, rash and dry mouth, among others.
2. NSAIDs (non-steroidal anti-inflammatory drugs)
These drugs are used to alleviate inflammation in the affected tissue, ease pain and reduce fever produced by inflammation. They work by slowing down the cyclooxygenase, which facilitates the production of prostaglandins, the substances responsible for producing pain.
These drugs are perhaps the most widely used for controlling cases of inflammation in arthritis (high dose) and relieving pain (low dose). It is very likely that you have taken some type of NSAID in your life.
Products available at the pharmacy:
Aspirin – ibuprofen – naproxen – diclofenac – diflunisal – etodolac – fenoprofen – flurbiprofen – indomethacin – ketoprofen – meclophenamate – meloxicam – nabumetone – oxaprozin – piroxicam – sulindac – tolmetin.
How do NSAIDs work?
This type of medication is a class of analgesic, so they also block prostaglandins, natural enzymes in the body related to pain and inflammation.
These drugs also fight against general pain, particularly muscle and joint pain [ Mayo Clinic. 2018].
NSAIDs that are available without a prescription, such as ibuprofen, naproxen and aspirin, should not be used for more than 10 days, due to the possible damage they can do to the kidneys. If the pain and discomfort continues for over a week, you should talk to your doctor.
Side effects of NSAIDs
Why should you not use over-the-counter NSAIDs for that long? Because although they help with pain, they are designed for short-term use. According to Dr. Mark S. Allen of the Mayo Clinic (Phoenix, USA.), when you take NSAIDs over long periods of time, you increase your chances of experiencing:
- Gastrointestinal bleeding
- Renal failure
In addition, NSAIDs increase your chances of heart attack or stroke, regardless of whether you suffer from heart disease or not [Rekha Mandkad, M.D. Mayo Clinic. 2018], which is why it is extremely important not to self-medicate. If you suffer from heart disease, talk to your doctor about whether this type of medication is safe for you.
The use of hot or cold compresses and physical therapy can help improve muscle and joint pain, both of which should be considered before using NSAIDs [Rekha Mandkad, M.D. Clínica Mayo. 2018]. If the pain persists, talk to your doctor first about the best treatment for you.
New considerations for taking NSAIDs
A new generation of more selective NSAIDs (celecoxib, etoricoxib, etc.) has been developed, which act almost exclusively to reduce inflammation and are, therefore, more effective and produce fewer side effects.
You should try taking the maximum recommended dose of NSAIDs before deciding whether or not the medication has had a positive effect, as the maximum recommended dose will enhance the anti-inflammatory effects, whilst low doses only reduce pain.
It is not recommended to take multiple types of NSAIDs at once, as this will not increase their positive effects, but increase their toxicity. It is recommended to take gastroprotective medication such as omeprazol, esomeprazol, lansoprazol, pantoprazol, etc, to protect your stomach lining and reduce your risk of gastrointestinal bleeding.
3. DMARDs (disease-modifying antirheumatic drugs)
If you have been diagnosed with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, idiopathic juvenile arthritis or lupus, it is very likely that your doctor has prescribed you some type of DMARD.
What do these drugs do? They delay the onset of arthritis by blocking inflammation in the tissues of the joints, but they do not stop it completely. Remember that this is a condition that cannot be cured, but it is possible to improve its symptoms.
DMARDs are slow-acting drugs, which means that they take several months before they bring about any results. Before your doctor prescribes you this type of medication, you should undergo an X-ray and a blood test.
Products available at the pharmacy:
Auranofin – ridaura – azathioprine – imuran – azasan – chlorambucil – leukeran – cyclophosphamide – cytoxan – cyclosporine – neoral -thiomalate – myochrysine – plaquenil
– leflunomide – arava – methotrexate – rheumatrex – trexall – tofacitinib – xeljanz – minocyclin.
How do DMARDs work? [
To delay the onset of arthritis, DMARDs help to stop or reduce the cells in the immune system (the body’s defense system) that cause inflammation in the joints. Each DMARD acts differently within the body.
- Traditional DMARDs – restrict the immune system broadly
- Targeted DMARDs– block precise pathways inside immune cells.
Side effects of DMARDs
They weaken the immune system, increase the possibility of infections and can trigger or aggravate problems in organs such as the heart, liver, kidneys, gastrointestinal tract, eyes and skin.
Other possible side effects of DMARDs can include nausea, vomiting, hair loss, pain, difficulty urinating, fever, chills or sore throat. DMARDs can take months before they take effect, and usually your doctor will prescribe you NSAIDs first.
Treatment should start no more than one month following the diagnosis. When coming off DMARDs, patients may show signs of relapse and new symptoms of rheumatoid arthritis may appear.
DMARDs are particularly recommended for patients with poor prognostic factors and who require intensive treatment as soon as possible. A combination of DMARDs is recommended to enhance their effect on the body.
Also known as glucocorticoids or steroids. These are hormones produced by the body by the adrenal glands located in the kidneys. Their synthetic and semi-synthetic forms are used for their anti-inflammatory effect.
They have been used to treat arthritis since 1949. Corticosteroids are often confused with drugs taken by some athletes take to enhance their performance, but they are not the same.
Products available at the pharmacy:
Cortisone – dexamethasone – hydrocortisone – methylprednisolone – prednisolone – prednisolone sodium phosphate – prednisone.
How do corticosteroids work? [
They imitate the anti-inflammatories that your body produces naturally (cortisol). At high doses, corticosteroids reduce inflammation because they act directly on the affected area, and provide immediate relief.
Inflammation is a natural reaction in the body in which the white blood cells and other enzymes in the body defend themselves against an infection, the problem occurs when diseases like arthritis cause the immune system to stop working properly.
Corticosteroids reduce the activity of the immune system and prevent inflammation from damaging the tissues in the body and affecting the joints.
Side effects of corticosteroids
Like all medication, corticosteroids present some side effects in the body. When taken at high doses over a prolonged period, and depending on the type of corticosteroid, the most common side effects are as follows:
- Increased appetite
- Sudden mood swings
- Muscle weakness
- Blurry vision
- Increased body hair
- Easy bruising
- Low resistance to infection
- Inflammation of the face
- Osteoporosis (disease that weakens the bones)
- Worsening of diabetes
- High blood pressure
- Stomach ache
- Difficulty sleeping
- Cataracts or glaucoma
- Water retention
Low doses of corticosteroids (cortisone, hydrocortisone and prednisone) reduce bone density, which increases one’s risk of osteoporosis. A dose of more than 10 mg a day increases the risk of fracture.
The use of low doses of glucocorticoids in rheumatoid arthritis delays the appearance of radiographic lesions, as long as it is recent (less than 2 years since it first appeared). It is recommended to take Vitamin D supplement to reduce the harmful effects these drugs can have on bone density.
5. Biologic drugs or biopharmaceuticals
Therapeutic substances derived from living organisms or extracts (bacteria, fungi or cells), like vaccines, which interact with human or animal proteins. They reduce inflammation, death of cells and joint destruction. They are produced by means of molecular biotechnology.
In the pharmaceutical industry, biologic drugs and biopharmaceuticals are seen as an innovative product of groundbreaking research into specialized drugs. However, their high price point means that they are not as popular for treating rheumatic diseases as other medicines.
Products available at the pharmacy:
Infliximab – certolizumab – pegol – adalimumab – etanercept – golimumab – tocilizumab.
How do biopharmaceuticals work?
They are a special type of DMARD, some of which take effect by joining to the defective proteins of a particular disease and destroying them, whilst others interrupt certain processes of the disease, as is the case for rheumatoid arthritis, in which they block the cause of inflammation and thus, reduce the feeling of pain.
Side effects of biopharmaceuticals
Biopharmaceuticals weaken the ability of the immune system to combat germs, so they increase your possibility of contracting an infection while you are taking them. However, they generally produce fewer side effects than other conventional medicines.
Biologic drugs are prescribed for patients with active or very progressive rheumatoid arthritis. These drugs have been shown to produce the best results in terms of relieving symptoms and delaying the onset of the disease when combined with methotrexate.
The combination of infliximab and methotrexate can reduce the radiological evolution and improve functional ability. This therapy requires special monitoring and supervision by a rheumatologist.
These drugs are considered a first choice for patients that experience adverse side effects when taking DMARDs. They are not suitable for women who are pregnant or breastfeeding, or people with a known sensitivity to this type of medication.
Natural complementary therapies to arthritis medication
Anything you take alongside conventional arthritis medicine, be it some kind of treatment or home remedy, should first be approved by a doctor. Although natural medicine is inoffensive, it is best to speak to a professional before trying any complementary therapies.
To eliminate pain, inflammation, stiffness and fatigue caused by arthritis and other associated diseases, it is common to turn to natural remedies to help alleviate symptoms of arthritis and improve overall health. Bear in mind that the effectiveness of these natural remedies has not been scientifically proven:
It has been used to alleviate pain caused by osteoarthritis (OA), a type of arthritis that wears away at the joints. It is believed to be able to delay the onset of the disease and you can add it to your food. Avocado oil is rich in monounsaturated (healthy) fats and it increases your levels of HDL or good cholesterol in the body. Additionally, it helps reduce C-reactive protein, a marker of inflammation in the blood.
A 2017 study published in Arthritis Care & Research, showed that participants who ate healthy fats like avocado oil showed fewer signs of progression of osteoarthritis.
The benefits of flaxseed oil are that it helps to lubricate the joints to minimize wear, as well as reduce stiffness and pain. Flaxseed is rich in fatty acids and omega 3. You can also add the seeds to your food or add milled flaxseed to smoothies.
Calendula creams or ointments
Calendula helps to reduce inflammation in the joints and facilitates range of motion.
The eucalyptus leaf has properties that reduce inflammation and relieve pain in the joints. A 2013 study examined the effects of aromatherapy and concluded that inhaling eucalyptus oil can significantly reduce inflammation, pain and tension. You could also massage eucalyptus oil into the affected joint.
This root has a number of medicinal uses. In order to benefit from its many anti-inflammatory and analgesic properties, just grate a small amount onto your food or add it to your smoothie. One study of over 200 patients, showed that a specialized ginger extract, known as Eurovita Extract 77, improved osteoarthritis pain after standing and walking.
Cannabidiol Oil (CBD)
Some studies that are currently underway suggest that the oil extracted from the cannabis plant, with high concentrations of one of its components (CBD), can help with arthritic pain.
It has been found that the activation of cannabinoid receptors in the body can eliminate inflammation of the synovial membrane, reduce joint damage and prevent additional inflammation from being produced.
You should avoid self-medicating, either with the medications that we mentioned at the beginning of this article or the natural complementary therapies. Talk to your doctor and see what they recommend. Personalized treatment is safe treatment.
- Mayo Clinic Minute: What are NSAIDs? [Clínica Mayo. 2018]
- NSAIDs: Do they increase my risk of heart attack and stroke? [Mayo Clinic. 2018]
- DMARDs Overview [Arthritis Foundation]
- Corticosteroid Overview [Arthritis Foundation]
- Diagnóstico y tratamiento de artritis reumatoide del adulto [Secretaría de Salud de los Estados Unidos Mexicanos. 2010]