Arthritis is a chronic condition characterised by painful, stiff and swollen joints. If you have severe arthritis you are likely to have reduced mobility, disturbed sleep, impaired quality of life, and even depression.

There is no ‘standard’ arthritis treatment. The choice of treatment depends on the type and severity of the arthritis you have. Arthritis treatments range from lifestyle adjustments (diet, exercise, mobility assistance) to medicines that treat the symptoms and that target the cause of the disease.

This article on arthritis treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Who needs arthritis treatment?

Arthritis usually occurs in people over the age of 40 and is more common in women than in men; however, it can affect both men and women of any age. Children can also be affected by a condition known as juvenile idiopathic arthritis’. In adults, there are several types of arthritis, the most common being osteoarthritis and rheumatoid arthritis.

  • Osteoarthritis is usually the result of the cartilage within the joints wearing out and becoming thin and rough. This causes the bones themselves to develop growths at the ends in an attempt to compensate and to protect the bone tissue from further destruction. However, these growths are ‘knobbly’ and cause even more pain and swelling as the bones in the joints grate on each other. Osteoarthritis usually affects the joints in the legs, mostly the knees and hips, but it can also affect the hands, feet and back.
  • Rheumatoid arthritis is thought to be an autoimmune disorder. It develops when the body’s immune system mistakenly attacks its own joint tissue as it would attack a foreign invader. Immune complexes collect in the synovial fluid, the joints’ natural lubricant, and start to attack the joint itself. The joints most commonly affected by rheumatoid arthritis are those of the hands and feet. Rheumatoid arthritis symptoms are usually symmetrical – they occur in the same joints on both sides of the body. In very severe cases, rheumatoid arthritis can affect other tissues, including the heart, lungs and eyes.

What treatments are available?

Medical arthritis treatments fall into two categories: those that treat the symptoms and those that address the cause of the joint damage. Most people with arthritis usually get a combination of both types of arthritis treatment.

Symptom relief

Arthritis treatments that relieve symptoms include painkillers (such as paracetamol or codeine), non-steroidal anti-inflammatories (NSAIDs, such as ibuprofen) or steroids. Steroids are given as a short course of tablets or injection directly into the joint. These arthritis treatments are the mainstay of drug therapy for osteoarthritis, but may also be used for rheumatoid arthritis treatment.

Targeting joint damage

Rheumatoid arthritis treatments that are designed to alter the course of the disease are known as ‘disease-modifying anti-rheumatic drugs’, or DMARDs. These drugs work by blocking inflammatory pathways, reducing both the symptoms and the joint damage caused by the inflammation. Traditional disease-modifying arthritis treatments include gold injections or tablets, penicillamine, leflunomide, hydroxychloroquine, sulfasalazine, and the most commonly used – methotrexate. In more severe or resistant cases, other DMARDs such as cyclophosphamide, azathioprine or cyclosporine may be used.

Biological arthritis treatments

Traditional DMARDs and steroid treatments are fraught with side-effects if used long term, and so newer DMARDs – also known as ‘biologic response modifiers’ or ‘biological DMARDs’ – that target the causes of the damage without having such a wide-spread impact on the rest of the body are being developed all the time. These include etanercept, infliximab and adalimumab, which block the action of tumour necrosis factor alpha. This is a chemical mediator that causes inflammation to flare up. Blocking its action soothes the inflammation very dramatically.

Newer arthritis treatments

More recently, two newer biological DMARDs have been developed: abatacept and rituximab. These arthritis treatments block the activity of specific immune cells. Abatacept blocks T cells and rituximab blocks B cells. They both work to damp down the immune response in rheumatoid arthritis. By acting on such specific targets, these new rheumatoid arthritis treatments can significantly reduce the symptoms and damage that occurs in rheumatoid arthritis without causing as many side-effects as traditional DMARDs. However, you might not be offered these two treatments as are not yet widely available in the UK.

Are there any other types of treatment?

At one end of the spectrum in very severe cases, surgery may be the most appropriate arthritis treatment. This is particularly true of osteoarthritis. When the joints become very damaged, the best option is to replace them – hip and knee joints are replaced in standard operations and many thousands of people benefit from them every year in the UK.

Complementary therapies such as acupuncture or yoga may help to manage the symptoms of arthritis. Staying mobile and eating a healthy diet can help to maintain a healthy weight and reduce pressure on the joints, as well as improving well-being and quality of life.

Are there any risks with the treatment?

Painkillers or anti-inflammatories can cause stomach problems in some people. Arthritis treatments given as an injection or an intravenous infusion carry the risk of injection-site reactions. Long-term use of steroids is associated with side-effects including thinning of the bones and skin and changes in body weight. Arthritis treatments that suppress the immune system (such as DMARDs) can make you more open to infection.

Each arthritis treatment may cause different effects, good and bad, in different people, so it is important to discuss any new symptoms with your doctor and report anything unusual or worrying.

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