What Is Arthritis?
Arthritis is a generic term for joint inflammation. Pain, stiffness,
swelling, or a decreased range of motion may result, sometimes progressing
to deterioration of the affected joint. Cracking or popping noises
may occur when moving, though this may not be indicative of the
level of pain or discomfort in the joint. Different symptoms may
present themselves depending on the cause.
A healthy joint is contained within a thin, smooth synovial membrane.
This membrane produces a lubricating synovial fluid to assist the
motion of the slick layer of cartilage cushioning the end of the
bones. An inflammation, infection, improper growth, or deterioration
in any of these tissues can cause pain and stiffness.
There are several different conditions that may cause pain or deterioration
in a joint. The most common types are osteoarthritis, rheumatoid
arthritis, and gout.
Osteoarthritis involves degeneration of the smooth cartilage,
and is more commonly a result of environment and lifestyle,
rather than inherited factors. This condition may affect some
joints more than others, sometimes depending on wear and tear.
It may sometimes start in only one place, but individuals
over sixty years of age are likely to have at least mild osteoarthritis
in one or more joints. It's very uncommon to get osteoarthritis
before the age of forty.
The primary component of treatment for this condition is
physical therapy, but pain relievers are often necessary.
Long term use of pain relievers may have other side effects,
and if you use them regularly, alcohol should be avoided to
minimize the risk of liver damage.
Rheumatoid arthritis is an autoimmune condition, where
the body's protective mechanism attacks its own joints. This
disorder may have an inherited component, but there is no
reliable way to predict who will have the disorder. It can
be triggered by bacterial, fungal, or viral infection in the
joints, and may start an accidental process of dysfunctional
immune reactions.
Rheumatoid arthritis will affect all of the body's joints,
and often presents symptoms of system wide infection. Inflammation
and tissue degeneration begin in the synovial tissue, spreading
to affect all parts of the joint. This creates scar tissue,
and sometimes progressing to the fusion of the bones when
the body tries to repair the damage. Removal of the synovial
tissue or joint replacement may be necessary in advanced stages.
Rheumatoid arthritis primarily strikes women, commonly beginning
in individuals under forty years of age. When rheumatoid arthritis
begins before the age of sixteen, it is referred to as juvenile
rheumatoid arthritis. Remissions have occasionally occured in individuals
who have received high doses of chemotherapy for other reasons,
but the mechanism is not yet clear. Chemotherapy has not been developed
as a treatment for this condition, and is too toxic to invite common
use.
Spondyloarthropathies, including ankylosing spondylitis, are rheumatic
conditions which involved the spine. This subtype of the disorder
seems to affect men more often than women, and may result in spinal
rigidity, deformed posture, and difficulty breathing.
Gout is caused by lifestyle factors, most frequently occuring
in overweight individuals, and those who consume high levels of
fatty foods and alcohol. This condition is most frequent in men,
and involves the buildup of uric acid crystals in the joints. The
presence of these gritty deposits can cause extreme pain and stiffness
in the affected joints, most commonly the feet and hands.
Medical science is unsure why arthritis occurs, but the condition
has been found even in the fossil remains of other ancient mammals.
Painful, achy joints have been around for millions of years, though
we are better equipped to treat their discomfort now than at any
time in the past. While there is still no cure, there are things
that can be done to keep your joints in better shape for as long
as possible.
Standard Treatments
Not all of these medications mix well with each other, or with
other prescription or over the counter treatments. Effectiveness
varies with each individual, and between conditions. The following
list is by no means complete, but covers many of the more common
treatments.
- Anti-Gout Medications: Zyloprim
(allopurinol), Probenecid, and Sulfinpyrazone may be
used to reduce uric acid concentrations in the body. These
should not be combined with aspirin, but can safely be used
with acetaminophen or an NSAID treatment. Individuals with
immune disorders, kidney or liver disease, or pre-existing
skin conditions should discuss the merits of treatment with
their doctor. All patients are advised that these medications
may carry significant risk of serious side effects, and
should be accompanied by the intake of around 3 quarts of
water daily. For this class of medication, generic prescriptions
may not be appropriate replacements.
- Aspirin: Salicylate pain medication relieves some
symptoms of pain and swelling. It should not be used by
those with aspirin sensitive asthma, ulcers, or a history
of intestinal bleeding. Individuals with overactive thyroid
conditions, anemia, bleeding problems, heart disease, kidney
or liver disease, allergies, hypertension, or gout should
ask a doctor if this treatment is appropriate. It must not
be combined with blood thinners, Non-Steroidal Anti-Inflammatories
(NSAIDs), or any other type of pain medication. Do not use
more than recommended by a physician or pharmacist, and
never use during pregnancy. Aspirin tablets may be
high in sodium.
- Cox II (cyclooxygenase) Inhibitors: Medications
like Naprosyn (naproxen),
Celebrex (celecoxib)
and Vioxx (rofecoxib) are often
classed with Non-Steroidal Anti-Inflammatories (NSAIDs),
and the recommendations are similar. See below. [Note:
Vioxx was pulled from the marked by the manufacturer after
a study indicated increased risk of heart attack and stroke,
and users of Celebrex should be aware that a similar study
indicated that it also increases the risk of heart attack.]
- Corticosteroids: Cortisone treatments are used
for several types of arthritis, and the skin conditions
that may accompany different forms of lupus. They may aggravate
diabetes, glaucoma, thyroid problems, high blood pressure,
mental illness, seizures, tuberculosis, ulcers, digestive
tract disorders, as well as liver or kidney disease. Used
topically, they may cause thinning of the skin. If you are
allergic to aspirin or yellow dye, have an internal fungal
infection, are undergoing any type of medical treatment,
or taking other medication, speak to your doctor about possible
interactions or alternate treatment. Special dietary instructions
may be required for internal or long-term use.
- Gold Compounds: These treat rheumatoid arthritis,
but have a high risk of undesirable side effects that can
continue for months after treatment has stopped. Typically,
treatment with these compounds requires intense physician
monitoring.
- Immunosuppressives: These treatments are typically
used in cases of rheumatoid arthritis, or other conditions
when an immune disorder causes the body's own defenses to
attack the joints. These potent cancer-fighting medications
can have serious side effects such as damage to the reproductive
system, or increased risk of infection or cancer.
- Non-Steroidal Anti-Inflammatories (NSAIDs):
Clinoril (sulindac),
Diclofenac, Ibuprofen, Tolmetin, Toradol
(ketorolac) - These medications reduce inflammation,
and are prescribed across the spectrum of arthritic pain.
The main side effects are stomach irritation, and they may
cause stomach or intestinal bleeding in some individuals,
or if taken at high doses for prolonged periods. They should
not be combined with alcohol, and individuals who use them
daily should not use alcohol, as the risk of liver damage
goes up significantly. If you have aspirin sensitive asthma,
or ulcers, they should be avoided. Consult a doctor about
safe and effective treatment if you have a major organ disorder,
porphyria, or bone marrow depression.
Other Medications
Some medication you might take for other conditions may not mix
well with your treatment. Be sure to read the list of drug interactions
on your package inserts, and ask your doctor or pharmacist to check
the safety of combining multiple prescription medications you may
need. Be sure to ask questions about unfamiliar treatments, and
understand why they are being prescribed. As always, over the counter
medications or supplements are not beyond question:
- Alcohol - Do not use alcohol if you regularly take pain
medication for any condition. You may severely increase your risk
of acute liver failure, and this risk increases with age. Some
individuals have reported serious adverse effects from mixing
even small amounts of alcohol with recommended doses of pain relievers.
- Blood Thinners - Some pain medications may act
as blood thinners, and can cause bleeding problems when
taken with anticoagulants. Speak to your doctor about adjusting
your dosages if you require both pain medication and blood
thinners on an ongoing basis.
- Pain medication - It is not advisable to mix different
types of pain medication without the explicit advice of a doctor,
even over the counter analgesics like Aspirin, Tylenol, and Motrin.
This may increase your risk of gastrointestinal bleeding, kidney
damage, or liver failure from certain medications. If you have
ever had ulcers or any type of kidney or liver disease, you should
not take or mix any pain medication without the advice of a physician.
The risk of these serious, and potentially life-threatening side
effects increases for all individuals with age.
This list of interactions is by no means complete. If you must
take more than one medication on a regular basis, for any condition,
always give your prescribing doctor an updated list of your current
treatments. Medication interactions may mimic other conditions,
and can cause serious health problems.
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Links:
Medline on Arthritis: A service of the National
Institutes of Health
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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