Arthritis 3-LEWAC

Arthritis – Part III
by Glen R. Smith, M.D., Ph.D. Internal Medicine/Endocrinology
Email: hwellness@aol.com
135 Grant Street, Buffalo, New York 14213, Telephone: 881-4300, Fax: 881-5300
Office hours Monday – Friday 9 AM – 5 PM

The two most common and destructive forms of arthritis, i.e. Rheumatoid and Osteoarthritis, usually become chronic once they develop. Several of the over 100 different forms of arthritis are curable or are highly controllable, e.g. gouty arthritis and some forms of infectious arthritis. This greatly underlies the importance of seeking early medical advice, having accurate diagnosis and early therapeutic intervention.

Many individuals suffer irreparable joint and connective tissue destruction because they allow themselves to minimize the seriousness of the complications, accept unfounded myths, e.g. “arthritis is just a part of getting old” or “because arthritis is so widespread and often chronic, there is no need to take it seriously or go to the doctor and get proper treatment as indicated by their diagnosis.” In my previous article I tried to dispel some of these myths.

There are very few diseases the treatment of which has been subjected to such quackery, unfounded and unproven treatments and attempted cures as arthritis. Because this disease can be so debilitating and chronic, affected individuals are often willing to try anything at any cost. Unfortunately, there are more than enough individuals out there who readily capitalize on the “any cost,” although they may be aware that their therapy is unlikely to be effective or even help. As I pointed out in my last article, once the specific form of arthritis has been accurately diagnosed, there are many forms of treatment that can delay further joint damage, relieve pain and suffering, and help in mobility.

I pointed out that there are three main approaches in the treatment of arthritis:

non-medical prevention/intervention
medical intervention and treatment
surgical intervention and treatment

I addressed the non-medical prevention/intervention and emphasized that whatever therapeutic modality your health care provider recommends for you, nothing will work effectively unless you are willing to work with him or her as a team and be compliant in taking your medications.

I will now address medical and surgical interventions and treatments. It is imperative that you realize that there is no universal treatment for everyone. “One size does not fit all.” What may work well for one individual may not work for you, or may even be detrimental to you. Therefore, all diagnoses and treatments are to be made by, and discussed with, your health care provider.

Medical Intervention/Treatment
Over-the-counter medications: These are available without a prescription. These may be taken to relieve minor arthritis pains. These include medications such as Aspirin or Tylenol, Alleve, etc. There are also topical medications which are usually applied as rubs to the skin over the painful joints. Again, I must emphasize that it is imperative that you tell your doctor whatever over-the-counter medications you are taking, because many of these can have serious side effects and may react negatively with other medications you are taking.

Prescription medications: There is a large group of prescription medications, and the list keeps growing every day. The most common ones are the traditional non-steriodal anti-inflammatories (NSAIDS). These include Naproten, Relafen, Aspirin, etc. The NSAIDS are very effective in controlling pain. Their main drawback has been their tendency to cause bleeding and ulcers, especially in the gastrointestinal tract. Thousands of people die each year as a result of such complications.

Cox-2 inhibitors: These are the latest form of NSAIDS. They have the advantage of being as effective in controlling pain as the traditional NSAIDS, but are less likely to cause bleeding. These include Celebrex, Bextra and Vioxx.

Cortisteroids: These are available both as pills and as injections which are given in the joint to relieve pain and inflammation. Again, I emphasize that because of the potential side effects of these medications, decisions on taking them should be made only by your health care provider, and you should be monitored closely to detect and prevent complications.

There are several other medications that your doctor can choose from.

Surgical Intervention/Treatment
Surgery is usually a treatment of last resort. There are three main types of surgery.

Synovectomy: the process of removing the little pieces of bone and tissue that may be floating around in the joint space and causing pain and inflammation, as well as furthering joint damage
Bone fusion and correcting bone deformity
Joint replacement surgery: replaces a badly damaged joint with an artificial one; most often done as replacement to knees and hips

Always remember that “patients manage their illness, health care providers merely show you how – therefore you must work together as a team.

Take charge of your health, be in partnership with your doctor, and be well in Body, Mind and Spirit.