Treatment

The treatment for arthritis has the purpose to maintain the articulations and to help them function normally. Some of the ways in which treatment works are:

• - By determining the inflammation to back off
• - By relieving pain and giving back the mobility of the articulations

In addition heat or cold therapy may be recommended by the doctor. In some of the cases, to protect the articulations, a splint is required.

The pain caused by the different kinds of arthritis may be reduced or eliminated by transcutaneous electrical nerve stimulation, also known TENS, which drives more electrical impulses to the painful area's nerves. Other pain relievers are drugs like ibuprofen and naproxen, which are anti-inflammatory non-steroids (NSAIDs). And so are COX-2 inhibitors. Although they are effective in dealing with arthritis, the last ones increase the risk of heart attack and strokes.

NSAIDs may sometimes fail. For this kind of situations, there are other types of medications:

• - Disease – modifying anti rheumatic drugs (DMARDs) in case of rheumatoid arthritis
• - Corticosteroids, as pills or injections into the articulations.
• - The inflammation may be reduced by means of biological response modifiers

These medications have strong side effects, so medical supervision is required.

To help the knee to move without pain, sometimes the injection of hyaluronic acid is necessary. In case of extremely serious of RA the harmful antibiotics are filtered from the blood. There is a series of exercises that help the persons affected by arthritis.

• - Strengthening exercises, maintain the strength of muscles, so the joints may be protected and supported.
• - The aerobic activities help a person not to gain extra pounds, keep cardiovascular function normal and sometimes also reduce the inflammations.
• - Range of motion preserves the normal motion of the articulations.

 

A healthy life and a good equilibrated nutrition are very helpful. The normal weight is maintained so the articulations are not pressured by the extra pounds.

For very severe cases, surgical intervention is required. There are three types of surgery:

• - Osteotomy, which puts the articulation back in its place
• - Synovectomy, that removes the swollen tissue of the articulation
• - The replacement of the affected joint by a prothesis

Arthritis is a burden that will be carried by a person for the rest of his or her life. Depending on the type of arthritis, the symptoms can occur more or less often. There are also periods when the symptoms are absent and they are called remissions. And there are times of frequent attacks.

Means to take care of your arthritis

• - Control your arthritis by means of the prescribed treatment.
• - Don't forget the recommended exercises
• - Control your weight
• - Have a healthy diet

There is no known way to prevent arthritis, but it can be controlled by proper treatment, protection of the articulations and maintenance of their mobility

 

What are the effective treatments?

Different methods of treatment for arthritis are being used and are still proving themselves more or less effective. Some of these methods are: local steroid injection, medicines and joint replacement. But only a few times do they manage to eliminate or reduce the damage produced by arthritis to the articulation.

Patients that have tried any kind of available treatment consider every day a frustrating battle. But new methods appeared and the doctor can figure the most appropriate.

Osteoarthritis

Traditional medication, based on non – steroidal anti-inflammatory drugs was proved to generate ulcers and gastrointestinal bleeding. The newly discovered alternative, also a NSAID, COX – 2 inhibitors, help to relieve the pain caused by arthritis without damaging the stomach.

Cyclooxygenases synthesizes substances similar to the hormones, the prostaglandins and are divided into COX – 2 enzyme which deals with the pain and inflammation and COX – 1 that keeps the normal level of the physiological functions. In the past, both enzymes were inhibited by NSAIDs but the new type focuses the most on the blockage of COX – 2 enzyme. Maria Villalba says, in the name of FDA's Center for Drug Evaluation and Research that “ COX – 2 inhibitors are just as effective in treating osteoarthritis as other NSAIDs.

The first COX – 2 inhibitor, Celebrex, was approved by the FDA in 1998 for the treatment for osteoarthritis and rheumatoid arthritis. The second, Vioxx (refecoxib) received the approval one year later to treat acute osteoarthritis, dysmenorrhea and to relief acute pain in adults.

During the trials performed in clinics, the two medicines seemed to diminish the risks of stomach and intestinal ulcer. But long – term studies have shown that during a year, the results were not even close to these indicated by trials. Vioxx and Celebrex, both orally taken medications, haven's proved themselves superior to the other NSAIDs. The deaths, the severe side effects, hospitalization have not decreased in number.

For the treatment of pain generated by osteoarthritis, 2 medications -approved by FDA's Center for Devices and Radiological Health in 1997-are to be taken into consideration: Hyalgan and Synvisc. They have both the form of viscous solution and, injected into the knee, may relieve the pain. Their composition includes hyaluronan, which represents a natural lubricant of the articulation and, due to this fact, they are believed to improve the quality of synovial fluid. They represent the best solution for people that will not have a surgery but that can't tolerate pills either. The side effects are not serious, consisting only in pain in the injected area and sometimes in temporary inflammations.

Rheumatoid arthritis.

The classic treatments used to control RA consist in the association of NSAIDs (ibuprofen, aspirin) and DMARDs (methotrexate and sulfasalazine), also known as slow acting drugs. The last category that changes frequently the course of the disease was by now used only for the patients that obtained no effects from other medications. Nowadays, their use has significantly increased, covering almost every treatment plan prescribed by the specialist.

The newest approved scheme of treatment for RA uses a combination of methotrexate (which is not always effective when it is used alone) with Remicade, a biological drug obtained by genetic engineering. The last one blocks the action of TNFs, the proteins thought to be involved in the inflammation and damage of the articulations.

Remicade is given intravenously by a doctor and the procedure usually takes 2 hours. It was approved in 1999 by FDA and reduces the signs and symptoms methotrexate fails to control.

The first biologic response modifier, Enbrel, received the FDA approval to treat patients with moderate and severe forms of RA. It is administered twice a week by injection and proved its efficiency in the reduction of pain and rigidity. It is suitable both for children and adults and it seems to manage where other treatments have failed. In addition, it hasn't generated severe side effects in clinical trials.

In short term tests Remicade and Embrer both did an excellent job, but long term effects haven't been studied enough. The side effects associated to these medications are although serious. Even a risk of death is mentioned.

The first approved oral treatment that slows the process of the disease is Arava (leflunomide). The effects are similar to the one generated by Methrotrexate but, in addition, it blocks more then lymphocyte, so that the RA is regressed.

Still, Arava cannot be considered a proper cure, because it increases pregnancy related risks, such as birth defects, it damages the liver and may even cause death. It is also not appropriate for persons affected by immunodeficiency, severe infections and bone marrow dysplasia.

The first non – drug alternative recommended for adult persons with moderate to severe RA is called Prosorba column, and was approved by FDA in 1999. it represents a single – used device with contains a substance capable to bind antibodies and antigen antibody complexes.

In the hospital, the blood of the patient is separated from the plasma, which is then recombined with the blood cells inside the Prosorba column and given back to the patient. This treatment is administered once a week every twelve weeks.

The Prosorba column's side effects are pain and inflammation of the articulations, hypotension, anemia and tiredness.

Sahar M. Davisha, medical officer in the FDA's Center for Devices and Radiological Health says that “for those patients who have failed or are intolerant to DMARDs, including Arava and the anti TNF agents, the Prosorba column may be an additional treatment option”.

 

The role of exercises in arthritis

The Arthritis Foundation considers the exercises as a base for the most appropriate management of arthritis. Until the last 20 years they were considered to worsen the symptoms of arthritis. But nowadays, rheumatologists claim that in absence of the exercises, the muscles become weak, the articulations turn more rigid, the mobility is diminished and the vitality is lost. In order to prevent all these things, exercises don't only represent a recommendation but also a necessity. The National Institutes of Heath, NIH, advice the physicians to collaborate with the physical therapists to develop the suitable exercise program for each patient, depending on the type of arthritis and on how much damage the disease produced to the joints.

There are 3 categories of exercises for people with arthritis:

• - Range – of – motion implies the solicitation of the articulations for as long as it is comfortable. Then, it should be followed by a little stretch, to improve the articulations' mobility and to relieve the pain. They should be performed every day.
• - Strengthening exercises use the muscles, without an additional movement of the articulations, which are stabilized by this type of exercises. They should be daily performed or at least once every two days.
• - Endurance aerobic exercises include activities like bicycling, swimming or even walking and they are very helpful to the heart, the lungs and the increase of stamina. They are recommended three times a week in 20 – 30 minutes sessions.

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