There is no cure for arthritis. However, many different treatment options can help relieve the painful symptoms. The most common treatments include analgesic (pain relieving) and anti-inflammatory drugs, natural remedies such as glucosamine and chondroitin, and topical pain relievers placed on the skin. Intra-articular injections (injections into the joint) and acupuncture may also be used to help reduce the pain and stiffness of arthritic joints.

Glucosamine and chondroitin

Glucosamine is a major part of joint cartilage. Taking glucosamine supplements may help slow the progression of arthritis while also reducing joint pain. However, the benefit of glucosamine supplements is still being investigated. The body needs glucosamine to properly maintain healthy joints. Providing the body with this medication may restore some elasticity and resilience to the joint. In other words, it may help slow degeneration (breakdown) by making cartilage in joints stronger again. According to some studies, glucosamine can significantly decrease pain. However, whether it is able to help stop the breakdown of joints is questionable.

Glucosamine is often used in combination with chondroitin, another building block found in joint cartilage. As
with glucosamine, chondroitin comes from natural sources, most commonly shellfish and shark cartilage. Researchers are investigating whether chondroitin can help to relieve pain and slow breakdown of joint tissue. Using glucosamine and chondroitin together may be more effective in treating arthritis than using either alone. Unfortunately, there is a lot of conflicting information about the effectiveness of glucosamine and chondroitin in treatment. It does appear that both of these natural treatments have a short-term pain-relieving effect on mild arthritis.

Anti-inflammatory and pain-relieving medication

The most common medication used to treat pain associated with arthritis is acetaminophen (such as Tylenolª). Acetaminophen does not reduce joint inflammation but helps reduce pain. This medication is considered safe and effective in treating mild pain caused by arthritis.

When arthritis is first diagnosed, a trial of acetaminophen is often recommended to determine if it is effective in reducing pain. This should be combined with non-drug measures such as exercise, heat, and weight loss for best possible results.

If sufficient pain relief is not found after two to three weeks of using acetaminophen, then an anti-inflammatory medication is often added. For instance, acetylsalicylic acid (ASA, e.g. Aspirinª) or naproxen may be suggested. Anti-inflammatory drugs, also known as NSAIDs, help relieve pain in joints by reducing inflammation. They do not slow down the progression of arthritis but rather help relieve discomfort and allow increased movement. It is often inflammation that causes swelling, tenderness and pain in joints. By reducing inflammation, pain is also reduced.

Since the anti-inflammatory medication known as Vioxxª was withdrawn from the market in September 2004, there have been many concerns raised about Celebrexª. These two anti-inflammatory medications are from a family of drugs called COX-2 inhibitors. In February 2005 the FDA reported that Celebrexª may increase the risk for heart problems (heart attacks and strokes) but allowed it to remain on the market as they believed that the benefits of Celebrexª outweigh the risks of use. Although the incidence of heart problems caused by Celebrexª appear with higher than normal doses, this medication should only be considered after other treatment options have been investigated. If an alternative to Celebrexª cannot be found, then the lowest effective dose of this medication should be used.

Many factors are involved in choosing the right anti-inflammatory medication. Since everyone is different, the anti-inflammatory medication that works for one may not work for another. When anti-inflammatory medications are prescribed, a trial of about two to three weeks is usually suggested. Talk to your health care team before trying any anti-inflammatory medication to treat your arthritis.

Topical pain reliever

For some, acetaminophen and anti-inflammatory medications do not offer enough pain relief. Others cannot tolerate oral anti-inflammatory medications. Instead, topical preparations such as creams and ointments may help reduce arthritis pain. Topical medications often contain anti-inflammatory drugs or capsaicin. Capsaicin is a naturally-occurring substance found in chili peppers. It helps reduce pain by acting as a counter-irritant and creating a sensation of warmth. Little research has been done on the effectiveness of capsaicin cream in treating osteoarthritis. However, studies suggest that it may help reduce pain associated with arthritis, especially arthritis of the knee.

Other topical arthritis medications contain anti-inflammatory medications such as methyl salicylate. These preparations have been shown to reduce chronic pain associated with arthritis with less gastrointestinal (upset stomach) side effects than traditional oral anti-inflammatory medications. As many as one in three people suffering from osteoarthritis may get relief from topical preparations. They are considered an appropriate addition to arthritis treatment.

Intra-articular injections

Intra-articular injections can be used to treat symptoms of arthritis. The most common are corticosteroids and hyaluronic acid. Corticosteroids, very strong anti-inflammatory medication, usually relieve arthritis symptoms anywhere from two weeks to six months. Generally, the effect lasts around four to six weeks.

Intra-articular corticosteroid injections should not be used often in treating arthritis. Injections are recommended at four to six month intervals, with no more than three or four injections per year. Evidence suggests that high doses of corticosteroid injections may actually make arthritis worse, further breaking down joint tissue. However, with low, infrequent doses, injections do more good than harm.

Hyaluronic acid, a substance found in joint fluid, is another component used in intra-articular injections. People with arthritis have less of this fluid, which helps lubricate and protect bones in the joint. Cartilage damage is the result. Studies suggest that intra-articular injections of hyaluronic acid may relieve pain for up to six months. Injections are usually given once a week for a period of three to five weeks.

Intra-articular injections are usually only used for those who have not had success with other types of arthritis treatment. Discuss this option with your doctor to determine if it is the best treatment.

Acupuncture

Acupuncture is an ancient Chinese procedure used to treat a variety of illnesses. It involves placing needles in specific places on the body related to certain medical conditions. A few studies done on the effectiveness of acupuncture suggest it can improve both pain management and movement for those with arthritis. Before considering acupuncture, consult your health care team to determine whether this treatment is suitable for you.

Rheumatoid arthritis

Rheumatoid arthritis causes progressive joint destruction and deformation. Inflammation and deformation are generally caused by the body's immune response. Medications that change the immune (defence) system are usually used to help treat this condition.

In recent years, many new medications have offered hope to those suffering from rheumatoid arthritis.

Leflunomide (Aravaª), is a medication that helps slow the progression of rheumatoid arthritis by suppressing the immune cells causing inflammation. Studies on leflunomide suggest a 60 per cent reduction in pain intensity. The morning stiffness commonly found in those with rheumatoid arthritis is also significantly decreased. This medication not only slows joint damage but also helps increase physical function. The most common side effects are diarrhea, nausea, headache, rash, itching and weight loss. Leflunomide is not recommended for those who are pregnant, have heart conditions such as congestive heart failure, or have liver problems.

Another recently developed medication, etanercept (Enbrelª), helps relieve pain and prevent joint deformation of joints in rheumatoid arthritis. However, this medication works in a slightly different way than leflunomide. Injected under the skin twice a week, it binds to a protein in the body called tumor necrosis factor alpha (TNFalpha). This makes the TNFalpha less active in the body. TNFalpha is made when the body reacts to injury and is involved in the inflammation process. Since rheumatoid arthritis is a highly inflammatory condition, the body makes TNFalpha (associated with fever, pain, tenderness and swelling).

This medication is only used when others used to treat rheumatoid arthritis have not worked. Common side effects include pain, swelling and redness at the site of injection, as well as headache, dizziness and throat irritation. Etanercept is not recommended for pregnant women, those with a history of tuberculosis or nervous system conditions such as multiple sclerosis.

Although arthritis can be painful and disabling, many treatment options can relieve symptoms. Natural remedies such as glucosamine and chondroitin may help milder cases. Oral anti-inflammatory medicine and pain relievers are usually used to treat arthritis. Topical creams may be combined with oral medications to provide more relief. Topical medications seem to be effective and safe. In more severe cases, doctors may recommend steroid injections for short-term relief of pain and stiffness. Non-conventional methods may also be considered in treating arthritis. Several new medications have recently been made available to treat rheumatoid arthritis.

Talk to a health care professional before starting any treatment to ensure the solution is the best one for you. For more information on arthritis and how to treat it, visit The Arthritis Society website at www.arthritis.ca.

Arthritis Medications Available treatment options

There are many different types of arthritis, the two most common being osteoarthritis and rheumatoid arthritis. Although many medications can be used to treat both types, there are differences in the treatment of each.