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Treatments for Arthritis

Treatments for Arthritis:

Treatment of arthritis varies depending on the type of arthritis and other factors.

Septic arthritis is often curable with antibiotics if it is caused by a bacterial infection. Treatment may also include surgically opening up the affected joint to drain the infected synovial fluid.

There is no cure for osteoarthritis or rheumatoid arthritis, but with early recognition and treatment, it is possible to minimize or delay joint damage and complications of the diseases, such as chronic pain and disability.

Commonly used medications for all forms of arthritis include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and aspirin, and the supplements glucosamine and chondroitin. Glucosamine and chondroitin can help to strengthen damaged joint cartilage.

Medications commonly used to treat rheumatoid arthritis include disease modifying anti-rheumatic drugs (DMARDs), which appear to reduce inflammation and slow down the destruction of joints. Corticosteroids may also be used to reduce inflammation. Other medications that are used to treat rheumatoid arthritis include tumor necrosis factor (TNF) inhibitors, and the human interleukin-1 receptor antagonist Anakinra (Kineret).

Physical therapy is also often recommended for all form of arthritis. Physical therapy includes range-of-motion exercises that can help to strengthen joints and delay the loss of joint function. Occupational therapy, heat and cold therapies may also be helpful.

For osteoarthritis the injection of a synovial fluid substitute into the joint may be prescribed.

For severe cases of osteoarthritis and rheumatoid arthritis, surgery may be recommended to help improve joint pain, correct deformities, and help increase function in seriously affected joints.

Treatment List for Arthritis

The list of treatments mentioned in various sources for Arthritis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

  • Treatment for arthritis depends on the specific type of arthritis, the severity of the symptoms, and the patients' age, general health and other medical conditions. Treatment is aimed at symptom control and modification of disease progression. Treatments include:
    • Explanation - Education plays an important role in arthritis management
    • Rest - during bouts of active inflammation
    • Exercise - graduated exercise program recommended to maintain good joint function, especially in osteoarthritis
    • Heat - may provide relief in non-inflammatory arthritis such as osteoarthritis
    • Weight loss - will assist with symptom control in patients who are overweight, and have arthritis in weight bearing joints
    • Physiotherapy - can assist with regaining and maintaining joint function
    • Occupational therapy - can assist with management at home and mobility aids
    • Simple analgesics (used regularly) - can be effective in control of pain either alone or in combination with other agents. Regular paracetamol is an effective first line agent
    • NSAIDs, aspirin and COX-2's - used for more persistent pain or where there is evidence of an inflammatory component. Need to be wary of gastrointestinal and cardiovascular side effects
    • Stronger analgesics - tramadol, buprenorphine, opioid analgesics, used when pain is not adequately controlled with other measures, but not first line
    • Intra-articular steroids - not routinely recommended but can be effective for acute flare ups of arthritis
    • Intra-articular hylans - for osteoarthritis of the knee
    • Glucosamine - found in some studies to be as effective as NSAIDs in osteoarthritis
    • Surgery - arthroscopy and joint replacement have a role when other measures do not provide adequate symptom control, especially in osteoarthritis
    • Oral steroids - used in treatment of inflammatory arthritis such as rheumatoid arthritis, ideally for short periods of time only
    • Disease Modifying Antirheumatic Agents (DMARDS) - used in treatment of inflammatory arthritis such as rheumatoid arthritis and arthritis associated with connective tissue disorders
      • Immunosuppressants - Azathioprine, Cyclosporin, Leflunomide, Methotrexate
      • Other agents - Gold Salts, Hydroxychloroquine, Penicillamine, Sulfasalazine
    • Cytokine blockers - Adalimumab, Anakinra, Entanercept, Infliximab for inflammatory arthropathies
    • Colchicine and allopurinol for gout
    • Antibiotics - for septic arthritis

Alternative Treatments for Arthritis

Alternative treatments or home remedies that have been listed as possibly helpful for Arthritis may include:

Arthritis: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Arthritis may include:

Hidden causes of Arthritis may be incorrectly diagnosed:

Arthritis: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Arthritis:

Curable Types of Arthritis

Possibly curable types of Arthritis may include:

Arthritis: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Arthritis:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Arthritis include:

  • Aspirin
  • Acetylsalicylic acid
  • ASA
  • Added Strength Analgesic Pain Reliever
  • Adult Strength Pain Reliever
  • Aggrenox
  • Alka-Seltzer Effervescent Pain Reliever and Antacid
  • Alka-Seltzer Night Time
  • Alka-Seltzer Plus
  • Alka-Seltzer Plus Cold
  • Anacin
  • Anacin Maximum Strength
  • Anacin w/Codeine
  • Ancasal
  • APC
  • APC w/Codeine
  • APO-ASA
  • Arthritis Pain Formula
  • Arthritis Strength Bufferin
  • A.S.A. Enseals
  • Asasantine
  • Ascriptin
  • Ascriptin A/D
  • Aspergum
  • Aspirin PROTECT
  • Asprimox
  • Astrin
  • Axotal
  • Azdone
  • Bayer Aspirin
  • Bayer Children's Chewable Aspirin
  • Bayer Enteric Aspirin
  • Bayer Plus
  • BC Powder
  • Buffaprin
  • Bufferin
  • Bufferin Arthritis Strength
  • Bufferin Extra Strength
  • Bufferin w/Codeine
  • Cama Arthritis Pain Reliever
  • Cardioprin
  • Carisoprodol Compound
  • Cope
  • Coricidin
  • Coryphen
  • Coryphen-Codeine
  • C2 Buffered
  • Darvon Compound
  • Dorect Fpr,I;aru As[orom
  • Dristan
  • Easprin
  • Ecotrin
  • 8-Hour Bayer
  • Empirin
  • Empirin w/Codeine No. 2,4
  • Entrophen
  • Excedrin
  • Excedrin Extra Strength Geltabs
  • Excedrin Migraine
  • Fiorinal
  • Firoinal-C
  • Firoinal w/Codeine
  • Genacote
  • Genprin
  • Goody's Headache Powder
  • Halprin
  • Hepto
  • Lortab ASA
  • Low Dose Adult Chewable Aspirin
  • Marnal
  • Maximum Bayer Aspirin
  • Measurin
  • Midol Caplets
  • Momentum
  • Norgesic
  • Norgesic Forte
  • Norwich Aspirin
  • Mpvasem
  • Orphenadrine
  • PAP w/Codeine
  • Percodan
  • Percodan-Demi
  • Phenaphen
  • Phenaphen No. 2, 3, 4
  • Propoxyphene Compound
  • Riphen-10
  • Robaxisal
  • Robaxisal-C
  • Roxiprin
  • 692
  • SK-65 Compound
  • Soma Compound
  • St. Joseph Children's Aspirin
  • Supasa
  • Synalgos
  • Synalgos-DC Tablet
  • Triaphen-10
  • 217
  • 217 Strong
  • 292
  • Vanquish
  • Verin
  • Wesprin
  • Zorprin
  • Dexamethasone
  • Aeroseb-Dex
  • Ak-Dex
  • Ak-Trol
  • Baldex
  • Dalalone
  • Dalalone DP
  • Dalalone LA
  • Decaderm
  • Decadron
  • Decadron Nasal Spray
  • Decadron-LA
  • Decadron Phosphate Ophthalmic
  • Decadron Phosphate Respihaler
  • Decadron Phosphate Turbinaire
  • Decadron w/Xylocaine
  • Decadron dose pack
  • Decaject
  • Decaject LA
  • Decaspray
  • Deenar
  • Deone-LA
  • Deronil
  • Dex-4
  • Dexacen-4
  • Dexacen LA-8
  • Dexacidin
  • Dexacort
  • Dexameth
  • Dexasone
  • Dexasone-LA
  • Dexo-LA
  • Dexon
  • Dexone-E
  • Dexone-4
  • Dexone-LA
  • Dexsone
  • Dexsone-E
  • Dexsone-LA
  • Dezone
  • Duo-dezone
  • Gammacorten
  • Hexadrol
  • Maxidex
  • Mymethasone
  • Neodecadron Eye-Ear
  • Neodexair
  • Neomycin-Dex
  • Ocu-Trol
  • Oradexon
  • PMS-Dexamethasone
  • SKDexamethasone
  • Sofracort
  • Solurex
  • Solurex-LA
  • Spersadex
  • Tobradex
  • Turbinaire
  • Methylprednisolone
  • A-Methapred
  • Depmedalone-40
  • Depmedalone-80
  • Depo-Medrol
  • Enpak Refill
  • Mar-Pred 40
  • Medrol
  • Medrol Acne Lotion
  • Medrol Enpak
  • Medrol Veriderm Cream
  • Meprolone
  • Neo-Medrol Acne Lotion
  • Neo-Medrol Veriderm
  • Rep-Pred 80
  • Solu-Medrol
  • Prednisolone
  • A&D w/Prednisolone
  • Cortalone
  • Delta-Cortef
  • Duapred
  • Fernisonone-P
  • Hydelta-TBA
  • Hydeltrasol
  • Inflamase
  • Inflamase Forte
  • Key-Pred
  • Meticortelone
  • Meti-Derm
  • Metreton
  • Minims Prednisolone
  • Mydrapred
  • Niscort
  • Nor-Pred
  • Nova-Pred
  • Novoprednisolone
  • Optimyd
  • Otobione
  • Peidaject
  • Pediapred
  • Polypred
  • Predcor
  • Pred Forte
  • Pred-G
  • Pred Mild
  • Prelone
  • PSP-IV
  • Savacort
  • Sterane
  • TBA Pred
  • Prednisone
  • Apo-Prednisone
  • Aspred-C
  • Deltasone
  • Liquid Pred
  • Meticorten
  • Novoprednisone
  • Orasone
  • Panasol-S
  • Paracort
  • Prednicen-M
  • Prednisone Intensol
  • SK-Prednisone
  • Sterapred
  • Sterapred-DS
  • Winpred
  • Direct Formulary Aspirin
  • Halfprin
  • Novasen
  • Choline Magnesium Trisalicylate
  • Trilisate
  • SalsalateAmigesic
  • Mono-Gesic
  • Salflex
  • Amigesic
  • Sodium Salicylate
  • Triethanolamine Salicylate
  • Mobisyl
  • Myoflex
  • Sportscreme
  • Antiphlogistine Rub A-535 No Odour
  • Rubesal
  • Diethylamine Salicylate
  • Tilcotil
  • Tenoxicam

Unlabeled Drugs and Medications to treat Arthritis:

Unlabelled alternative drug treatments for Arthritis include:

  • Hydroxychloroquine - mainly used to treat refractory arthritis associated with Lyme disease
  • Plaquenil - mainly used to treat refractory arthritis associated with Lyme disease

Latest treatments for Arthritis:

The following are some of the latest treatments for Arthritis:

Hospital statistics for Arthritis:

These medical statistics relate to hospitals, hospitalization and Arthritis:

  • 0.05% (6,633) of hospital consultant episodes were for seropositive rheumatoid arthritis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 95% of hospital consultant episodes for seropositive rheumatoid arthritis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 27% of hospital consultant episodes for seropositive rheumatoid arthritis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 73% of hospital consultant episodes for seropositive rheumatoid arthritis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Medical news summaries about treatments for Arthritis:

The following medical news items are relevant to treatment of Arthritis:

Discussion of treatments for Arthritis:

Do I have Arthritis: NIAMS (Excerpt)

Sometimes you might still have pain after using your medicine. Here are some things to try:

  • Take a warm shower.

  • Do some gentle stretching exercises.

  • Use an ice pack on the sore area.

  • Rest the sore joint.

If you still hurt after using your medicine correctly and doing one or more of these things, call your doctor. Another kind of medicine might work better for you. Some people can also benefit from surgery, such as joint replacement. (Source: excerpt from Do I have Arthritis: NIAMS)

Questions and Answers About Knee Problems: NIAMS (Excerpt)

Most often osteoarthritis of the knee is treated with pain-reducing medicines, such as aspirin or acetaminophen (Tylenol*); nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Nuprin, Advil); and exercises to restore joint movement and strengthen the knee. Losing excess weight can also help people with osteoarthritis. (Source: excerpt from Questions and Answers About Knee Problems: NIAMS)

Questions and Answers about Arthritis and Exercise: NIAMS (Excerpt)

What Are Some Pain Relief Methods for People With Arthritis?

There are known methods to help stop pain for short periods of time. This temporary relief can make it easier for people who have arthritis to exercise. The doctor or physical therapist can suggest a method that is best for each patient. The following methods have worked for many people:

  • Moist heat supplied by warm towels, hot packs, a bath, or a shower can be used at home for 15 to 20 minutes three times a day to relieve symptoms. A health professional can use short waves, microwaves, and ultrasound to deliver deep heat to noninflamed joint areas. Deep heat is not recommended for patients with acutely inflamed joints. Deep heat is often used around the shoulder to relax tight tendons prior to stretching exercises.

  • Cold supplied by a bag of ice or frozen vegetables wrapped in a towel helps to stop pain and reduce swelling when used for 10 to 15 minutes at a time. It is often used for acutely inflamed joints. People who have Raynaud's phenomenon should not use this method.

  • Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising in a large pool may be easier because water takes some weight off painful joints. Community centers, YMCAs, and YWCAs have water exercise classes developed for people with arthritis. Some patients also find relief from the heat and movement provided by a whirlpool.

  • Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation (using the hands to restore normal movement to stiff joints). When done by a trained professional, these methods can help control pain and increase joint motion and muscle and tendon flexibility.

  • TENS (transcutaneous electrical nerve stimulation) and biofeedback are two additional methods that may provide some pain relief, but many patients find that they cost too much money and take too much time. In TENS, an electrical shock is transmitted through electrodes placed on the skin's surface. TENS machines cost between $80 and $800. The inexpensive units are fine. Patients can wear them during the day and turn them off and on as needed for pain control.

  • Relaxation therapy also helps reduce pain. Patients can learn to release the tension in their muscles to relieve pain. Physical therapists may be able to teach relaxation techniques. The Arthritis Foundation has a self-help course that includes relaxation therapy. Health spas and vacation resorts sometimes have special relaxation courses.

  • Acupuncture is a traditional Chinese method of pain relief. A medically qualified acupuncturist places needles in certain sites. Researchers believe that the needles stimulate deep sensory nerves that tell the brain to release natural painkillers (endorphins). Acupressure is similar to acupuncture, but pressure is applied to the acupuncture sites instead of using needles.
(Source: excerpt from Questions and Answers about Arthritis and Exercise: NIAMS)

Questions and Answers About Arthritis and Rheumatic Diseases: NIAMS (Excerpt)

Treatments for arthritis include rest and relaxation, exercise, proper diet, medication, and instruction about the proper use of joints and ways to conserve energy. Other treatments include the use of pain relief methods and assistive devices, such as splints or braces. In severe cases, surgery may be necessary. The doctor and the patient work together to develop a treatment plan that helps the patient maintain or improve his or her lifestyle. Treatment plans usually combine several types of treatment and vary depending on the rheumatic condition and the patient.

Rest, Exercise, and Diet

People who have a rheumatic disease should develop a comfortable balance between rest and activity. One sign of many rheumatic conditions is fatigue. Patients must pay attention to signals from their bodies. For example, when experiencing pain or fatigue, it is important to take a break and rest. Too much rest, however, may cause muscles and joints to become stiff.

Physical exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being. Before starting any exercise program, people with arthritis should talk with their doctor. People with arthritis can participate in a variety of sports and exercise programs. Exercises that doctors often recommend include

  • Range-of-motion exercises to help maintain normal joint movement, maintain or increase flexibility, and relieve stiffness.
  • Strengthening exercisesto maintain or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
  • Aerobic or endurance exercises to improve cardiovascular fitness, help control weight, and improve overall well-being. Studies show that aerobic exercise can also reduce inflammation in some joints.

Another important part of a treatment program is a well-balanced diet. Along with exercise, a well-balanced diet helps people manage their body weight and stay healthy. Weight control is important to people who have arthritis because extra weight puts extra pressure on some joints and can aggravate many types of arthritis. Diet is especially important for people who have gout. People with gout should avoid alcohol and foods that are high in purines, such as organ meats (liver, kidney), sardines, anchovies, and gravy.

Medications

A variety of medications are used to treat rheumatic diseases. The type of medication depends on the rheumatic disease and on the individual patient. At this time, the medications used to treat most rheumatic diseases do not provide a cure, but rather limit the symptoms of the disease. The one exception is treatments for infectious arthritis. If caught early enough, arthritis associated with an infection (such as Lyme disease) can usually be cured with antibiotics.

Medications commonly used to treat rheumatic diseases provide relief from pain and inflammation. In some cases, the medication may slow the course of the disease and prevent further damage to joints or other parts of the body. This fact sheet describes the medications most commonly used to treat pain and inflammation.

The doctor may delay using medications until a definite diagnosis is made, because medications can hide important symptoms (such as fever and swelling) and thereby interfere with diagnosis. Patients taking any medication, either prescription or over-the-counter, should always follow the doctorís instructions. The doctor should be notified immediately if the medicine is making the symptoms worse or causing other problems, such as an upset stomach, nausea, or headache. The doctor may be able to change the dosage or medicine to reduce these side effects.

Analgesics (pain relievers) such as aspirin; other nonsteroidal anti-inflammatory drugs (NSAIDís) such as ibuprofen (Motrin,Ļ Advil, Nuprin); and acetaminophen (Tylenol) are used to reduce the pain caused by many rheumatic conditions. Aspirin and NSAIDís have the added benefit of decreasing the inflammation associated with arthritis. Certain analgesics, such as aspirin and NSAIDís, can have side effects, such as stomach irritation, that can be reduced by changing the dosage or the medication. The dosage will vary depending on the particular illness and the overall health of the patient. The doctor and patient must work together to determine which analgesic to use and the appropriate amount. If analgesics do not ease the pain, the doctor may use other medications, depending on the diagnosis.

Ļ Brand names included in this fact sheet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean that the product is unsatisfactory.

Corticosteroids, such as prednisone, cortisone, solumedrol, and hydrocortisone, are used to treat many rheumatic conditions because they decrease inflammation and suppress the immune system. The dosage of these medications will vary depending on the diagnosis and the patient; again, the patient and doctor must work together to determine what dose is best for the patient.

Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Short-term side effects of corticosteroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects generally stop when the drug is stopped. It can be dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together when changing the corticosteroid dose. Side effects that may occur after long-term use of corticosteroids include stretch marks, excessive hair growth, osteoporosis, high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts.

Although some rheumatic diseases respond to analgesics and corticosteroids, others may not. Rheumatoid arthritis, gout, lupus, scleroderma, and fibromyalgia are some of the rheumatic diseases that routinely require other medications; these are prescribed to slow the course of the disease or to treat disease-specific symptoms.

Heat and Cold Therapies

Heat and cold can both be used to reduce the pain and inflammation of arthritis. Both therapies come in different forms, and the patient and doctor can determine which form works best. Studies have shown heat and cold therapies to be equally effective in reducing pain, although they are usually avoided in acute gout.

Heat therapy increases blood flow, tolerance for pain, and flexibility. Heat therapy can involve treatment with paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are needed to apply paraffin wax, or use microwave or ultrasound therapy, but patients can apply moist heat themselves. Some ways to apply moist heat include placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.

Cold therapy numbs the nerves around the joint (which reduces pain) and relieves inflammation and muscle spasms. Cold therapy can involve cold packs, ice massage, soaking in cold water, or over-the-counter sprays and ointments that cool the skin and joints.

Hydrotherapy, Mobilization Therapy, and Relaxation Therapy

Hydrotherapy involves exercising or relaxing in warm water, which helps relax tense muscles and relieve pain. Exercising in a large pool is easier because water takes some weight off painful joints. This type of exercise improves muscle strength and joint movement.

Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation (using the hands to restore normal movement to stiff joints). When done by a trained professional, these methods can help control pain, increase joint motion, and improve muscle and tendon flexibility.

Relaxation therapy helps reduce pain by teaching people various ways to release muscle tension throughout the body. In one method of relaxation therapy, known as progressive relaxation, the patient tightens a muscle group and then slowly releases the tension. Doctors and physical therapists can teach patients progressive relaxation and other relaxation techniques.

Assistive Devices

The most common assistive devices for treating arthritis pain are splints and braces, which are used to support weakened joints or allow them to rest. Some of these devices prevent the joint from moving; others allow some movement. A splint or brace should be used only when recommended by a doctor or therapist, who will show the patient the correct way to put the device on, ensure that it fits properly, and explain when and for how long it should be worn. The incorrect use of a splint or brace can cause joint damage, stiffness, and pain.

A person with arthritis can use other kinds of devices to ease the pain. For example, the use of a cane when walking can reduce some of the weight placed on an arthritic knee or hip. A shoe insert (orthotic) can ease the pain of walking caused by arthritis of the foot or knee.

Surgery

Surgery may be required to repair damage to a joint after trauma (a torn meniscus, for example) or to restore function or relieve pain in a joint damaged by arthritis. The doctor may recommend arthroscopic surgery, bone fusion (surgery in which bones in the joint are fused or joined together), or arthroplasty (also known as total joint replacement, in which the damaged joint is removed and replaced with an artificial one).

Myths About Treating Arthritis

At this time, the only type of arthritis that can be cured is that caused by infections. Although symptoms of other types of arthritis can be effectively managed with rest, exercise, and medication, there are no cures. Some people claim to have been cured by treatment with herbs, oils, chemicals, special diets, radiation, or other products. However, there is no scientific evidence that such treatments are helpful in patients with arthritis and, moreover, they may actually cause harm with the development of side effects. Patients should talk to their doctor before using any therapy that has not been prescribed or recommended by the health care team caring for the patient. (Source: excerpt from Questions and Answers About Arthritis and Rheumatic Diseases: NIAMS)

Questions and Answers about Arthritis Pain: NIAMS (Excerpt)

How Is Arthritis Pain Treated?

There is no single treatment that applies to everyone with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief.

Short-Term Relief

  • Medications--Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (Tylenol*) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil).

  • Heat and cold--The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

  • Joint protection--Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.

  • Transcutaneous electrical nerve stimulation (TENS)--A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.

  • Massage--In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive, so the therapist must be familiar with the problems of the disease.

Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long-term pain relief.

* Brand names included in this booklet are provided as examples only and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Long-Term Relief

  • Medications

    Biological response modifiers--These new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the reaction of a substance called tumor necrosis factor, an immune system protein involved in immune system response. These drugs include Enbrel and Remicade.

    Nonsteroidal anti-inflammatory drugs (NSAIDs)--These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. NSAIDs also include Celebrex and Vioxx, so-called COX-2 inhibitors that block an enzyme known to cause an inflammatory response.

    Disease-modifying antirheumatic drugs (DMARDs)--These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the new drug Arava and methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

    Corticosteroids--These are hormones that are very effective in treating arthritis but cause many side effects. Corticosteroids can be taken by mouth or given by injection. 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. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year.

    Other products--Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain. A blood-filtering device called the Prosorba Column is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis.

  • Weight reduction--Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.

  • Exercise--Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.*

    * The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse has a separate booklet on arthritis and exercise.

  • Surgery--In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
(Source: excerpt from Questions and Answers about Arthritis Pain: NIAMS)

Arthritis: NWHIC (Excerpt)

In the past, doctors often advised arthritis patients to rest and avoid exercise. Rest remains important, especially during flares. But doing nothing results in weak muscles, stiff joints, reduced mobility, and lost vitality. Now, rheumatologists routinely advise a balance of physical activity and rest. Exercise offers physical and psychological benefits that include improved overall fitness and well-being, increased mobility, and better sleep.

Joints require motion to stay healthy. That's why doctors advise arthritis patients to do range-of-motion, or flexibility, exercises every day--even during flares. Painful or swollen joints should be moved gently, however.

Strengthening and endurance activities are also recommended, but should be limited or avoided during flares. Arthritis patients should consult their doctors before starting an exercise program, and begin gradually. (Source: excerpt from Arthritis: NWHIC)

Arthritis Advice -- Age Page -- Health Information: NIA (Excerpt)

Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.

Medicines help relieve pain and reduce swelling. Acetaminophen or ACT should be the first drug used to control pain in patients with osteoarthritis (OA). Patients with OA who donít respond to ACT and patients with RA and gout are most commonly treated with nonsteroidal anti-inflammatory drugs such as ibuprofen. People taking medicine for any form of arthritis should limit the amount of alcohol they drink. (For more information, see the Age Page "Arthritis Medicines.")

Exercise, such as a daily walk or swim, helps keep joints moving, reduces pain, and strengthens muscles around the joints. Rest is also important for the joints affected by arthritis. Physical therapists can develop personal programs that balance exercise and rest.

Many people find that soaking in a warm bath, swimming in a heated pool, or applying heat or cold to the area around the joint helps reduce pain. Controlling or losing weight can reduce the stress on joints and can help avoid further damage.

When damage to the joints becomes disabling or when other treatments fail to reduce pain, your doctor may suggest surgery. Surgeons can repair or replace damaged joints with artificial ones. The most common operations are hip and knee replacements. (Source: excerpt from Arthritis Advice -- Age Page -- Health Information: NIA)

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