Arthritis Treatments

ASPIRIN
Advantages. Aspirin functions as both a painkiller (analgesic) and an anti-inflammatory, depending on dosage. Maximum analgesic effect is achieved with 2 regular (5-grain) aspirin tablets taken about every 4 hours. A much higher dose—usually 16 to 24 5-grain tablets per day—is required to control joint inflammation.

Most Common Side Effects. Ringing in the ears, nausea, abdominal pain, stomach or duodenal ulcers, and gastrointestinal bleeding. Aspirin also reduces the blood's clotting ability, which may cause bleeding problems.

To Minimize Adverse Reaction. Reducing the dosage and taking aspirin with food (for example, milk and bread) or antacids helps protect the stomach.

Most Effective Form. Ordinary, generic aspirin. Although pharmaceutical companies spend millions promoting time-release, arthritis-strength, and other "special" aspirin formulations for the treatment of arthritis, many experts feel these forms are only slightly better or more protective than ordinary aspirin. Extra-strength aspirin simply contains more acetylsalicylic acid, the active ingre- dient in the drug. The same medicinal effect can be achieved by taking an equivalent amount of regular 5-grain or 325-milligram tablets. While some doctors recommend buffered aspirin, which contains an antacid, the same effect can be achieved at a lower cost by using regular aspirin and an antacid or milk to protect the stomach.

ACETAMINOPHEN
Tylenol is one of the branded forms of acetaminophen, the major over-the-counter non aspirin painkiller. They are analgesics with virtually no anti-inflammatory effects even at very high dosages. Recent adverse publicity about the side effects of long-term acetaminophen use on the kidneys was not based on adequate studies. The drug is remarkably safe.

Advantages. Relieves minor arthritis pain without aspirin's side effects of hindering clotting and gastric upset.

Disadvantages. Not as effective as high-dose aspirin in controlling inflammation.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

Advantages. NSAIDs are as effective as, or more effective than, aspirin, and they are less likely to cause gastrointestinal irritation and bleeding. They may therefore be tolerated by people who cannot take aspirin in the required dosage.

Side Effects. Gastrointestinal bleeding, nausea, heartburn, ulcers of the GI tract, rash, itching, disturbance of kidney function, sedation, headache, and mood changes. If you suffer any of these side effects report them promptly to your doctor, who may change the dosage or the drug.

NSAIDs interfere with the production of prostaglandins, substances like hormones thought to play a role in the inflammatory process (among many other functions).

Most Effective Form. All drugs in this category are believed to be similar in their mechanism of action, but individuals differ unpredictably in their response to each. Trial and error is usually needed to arrive at the most effective drug and dosage. NSAIDs act fairly rapidly, and after 7 to 10 days of administration it is usually apparent if a particular drug is of value. After prolonged use, these drugs may lose their effectiveness and others may have to be substituted.

Warning: One of the oldest nonsteroidal anti-inflammatory drugs, phenylbutazone (Butazoli-din), should rarely be used in the treatment of chronic rheumatoid arthritis because of its potential for serious toxic effects, particularly suppression of the bone marrow. It is not marketed in the United States at this time.

CORTICOSTEROIDS
Advantages. These powerful drugs suppress inflammation and are used to treat inflammatory types of arthritis, such as rheumatoid arthritis and lupus. Steroids may produce dramatic initial relief of the pain, swelling, and inflammation of arthritis.

Disadvantages. Originally thought to offer a cure for arthritis, the beneficial effects tend to be temporary; long-term use produces a host of serious adverse effects including puffing or rounding of the face, acne, increase in facial hair and weight gain, lowered resistance to infection, a thinning of the bones (osteoporosis) and skin, gastrointestinal ulcers and bleeding, mental changes (nervousness, insomnia, depression, and psychosis), diabetes, and cataracts.

To Minimize Adverse Reaction. Take the drugs on alternate days (not always possible, depending on the individual and the particular disease).

Inject small amounts of a steroid directly into the inflamed joint to avoid systemic administration, but the number of injections tolerated by a particular joint in a given time period is limited.

Note: Systemic steroids should be used cautiously and under careful medical supervision. The adrenal glands undergo a temporary loss of function during (and after) prolonged steroid therapy, and supplementary or additional steroids must be taken in the event of stressful situations, such as surgery, infection, or injury.

In addition to a special exercise regimen designed by a physical therapist, many people find physical and psychological benefits in recreational exercise that does not stress the joints, such as walking, swimming, and t'ai chi.

Cold alleviates acute pain, particularly after injury to a joint or its surrounding ligaments and tendons. Apply a plastic bag filled with ice directly to the inflamed area for a short period of time.

"Contrast baths"—applying first heat and then cold to a joint or taking a hot bath followed by a cold shower— are often more effective than heat or cold alone in dealing with pain.

Other operations effective in reducing deformity and restoring function include synovectomy (removal of the diseased synovial membrane) and orthopedic procedures to realign deformed toes or fingers.

One of the most promising new approaches involves a group of compounds called "biologicals." They are so named because they are made biologically from living cells, rather than through chemical synthesis. They are designed to neutralize biological mediators of the immune process, including naturally occurring inflammatory substances in the joint.

One such experimental approach is called targeted immunosuppression. Researchers form a protein consisting of interleukin-2 (IL-2) and diphtheria toxin, and inject this substance into the patient. The protein is taken up by the activated lymphocytes believed to be essential in mediating the immune process that leads to rheumatoid arthritis. When the IL-2 is taken up, the diphtheria toxin is liberated within these cells and destroys them.

Another technique involves monoclonal antibodies, which are substances made in the laboratory to destroy particular cells. A monoclonal antibody to the CD-4 lymphocyte, believed to be essential for the development of rheumatoid arthritis and which may also play a role in lupus, is given intravenously over a period of days; CD-4 cell counts in the blood are markedly reduced and improvement may ensue for many months. While this technique sometimes results in severe allergic reactions to the antibody, researchers are trying to reformulate the antibody to prevent such occurrences.

Yet another treatment under study for rheumatoid arthritis is called oral tolerization. It involves the oral administration of an extract of type II collagen, the major protein constituent of articular cartilage (the prime site of rheumatoid arthritis tissue damage). This nontoxic substance is extracted from chicken cartilage and other sources. While its mechanism of action is unclear, investigators believe that it desensitizes the immune mediated inflammatory and destructive attack against the type II collagen present in the diseased joint cartilage. If the results of continued studies support the early observations that this treatment may be effective, it could be available for general use in the near future.

Warning: Do not use commercial preparations of cartilage to treat arthritis. These preparations do not have the same characteristics as the material used by researchers.

One of the newest approaches involves one of the cytokines—chemical messengers that mediate inflammation. One of the main examples is called tumor necrosis factor-alpha (TNF-alpha), which is normally produced by the body as a protective response to infection. But patients with rheumatoid arthritis seem to either make too much TNF-alpha, or lack sufficient amounts of a natural substance to neutralize its actions. Laboratory-made monoclonal antibodies that block the action of TNF-alpha have already proven effective in the treatment of rheumatoid arthritis, and this has been confirmed in controlled clinical trials.

Common arthritis quackery includes the use of copper bracelets, bee venom, flu shots, megavitamins, and a variety of balms or salves. None of these has any beneficial property aside from a possible placebo effect.

People who resort to such obviously worthless remedies often defend their action by saying: "I've tried everything my doctor recommends and I still have arthritis. What do I have to lose?" Aside from the money, time, and energy that could be better spent, people who resort to arthritis quackery run the risk of suffering injury from treatments less harmless than copper bracelets. The arthritis pills and shots offered by clinics on the Mexican border, for example, frequently consist of large doses of steroids, which can have very serious side effects. DMSO, an industrial solvent absorbed through the skin, is widely available as an arthritis remedy without FDA approval. Animal studies have shown DMSO to be potentially harmful and the FDA has rejected it for human use. (When DMSO is applied in a diluted solution on the skin, it is not harmful, but it may be highly toxic when taken internally.) Nevertheless, faddist publications continue to promote it as a "miracle" drug being suppressed by the medical establishment in much the same way that Laetrile is allegedly suppressed for cancer therapy. But researchers have found no evidence supporting claims that either DMSO or Laetrile is of any medical value, and people who resort to treatment with either are victims of an expensive hoax.

Fatty Acid Supplements. Recent research suggests that high doses of an omega-6 essential fatty acid known as gamma linolenic acid (GLA) can help reduce joint inflammation. It is believed GLA replaces arachidonic acid as a building block for prostaglandins, hormones that are important mediators of inflammation. GLA is found in plant seed oils, such as those from evening primrose, borage, black currants, and hemp; capsules are available in health food stores. Studies have found beneficial effects with twice daily doses of 240 mg. of GLA. Research also suggests that these benefits may be enhanced by further supplementation with omega-3 fatty acids, which are plentiful in cold-water fish, and also available in health food stores.

Dietary Modification. Although many fad diets have been promoted for the relief of arthritis, none has been proven to help all sufferers. Nonetheless, individuals have sometimes found that eliminating one or more foods from the diet may decrease arthritis flare-ups. With this in mind, you should keep a daily food diary that correlates your discomfort with your meals. With time, you may find that particular foods apparently contribute to your pain and stiffness, and eliminating those foods may bring some relief.

Relaxation Techniques. Although no one fully understands the physiological mechanisms that trigger flares of inflammatory arthritis, undue excessive physical or emotional stress is believed to play a role in its development. Therefore, the regular use of relaxation techniques-such as progressive relaxation, self-hypnosis, and visualization—may help reduce the frequency and severity of flares.

Acupuncture. Studies have shown this traditional technique of Chinese medicine to be very effective for many types of pain relief. Although researchers do not understand the underlying mechanisms that explain why needles applied to specific points on the body alleviate pain, some patients have experienced significant reduction in arthritis symptoms. Acupuncture does not reduce inflammation.

Self-Help Devices. Devices that conserve energy or protect joints from stress are useful in everyday activities. These include portable telephones to save steps at home, reaching pincers for retrieving objects from high shelves, stools to facilitate sitting in the shower, and writing and eating utensils with special handles easy to grip.