Arthritis treatments

Your primary care physician will take a medical history and confirm the diagnosis of arthritis usually through an X-ray. Rheumatoid arthritis is confirmed through blood tests, biopsy and joint aspiration as well as through X-ray.

For mild arthritis, primary care physicians may recommend over-the-counter and prescription medication, nutritional supplements, modifications to activity, weight loss where applicable, and physical therapy or any combination of these treatments.

Over-the-counter medication

Both painkillers and anti-inflammatory drugs help relieve joint swelling and pain. The Academy of Rheumatology says that Tylenol® is the best medication for minor pain. It does not, however, reduce the inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin®, Advil® and Aleve® are all recommended for reducing inflammation. These drugs are blood thinners and can increase your risk for developing stomach ulcers so they are not for everyone. If you are taking these medications regularly, tell your physician.

Prescription medication

When over-the-counter medications fail to reduce pain, physicians may prescribe one of four medications: stronger NSAIDs, non-narcotics, narcotics and a different type of medication for those with RA.

With newer NSAIDs called COX-2 inhibitors, there is less chance of developing stomach ulcers and they do not increase bleeding. These new medications block the harmful prostaglandins that produce pain while preserving the good prostaglandins that are a normal product of human cells and are necessary for cell function and integrity. For patients who can’t tolerate NSAIDs, medications are available that reduce the brain’s recognition of pain. These narcotics generally are prescribed for more intense pain and only for a short period because of the drug’s addictive side effects.

Rheumatologist Jack Lichtenstein said some new drugs are getting high marks from rheumatoid arthritis (RA) patients. He said, “RA is not the crippling disease it once was, as long as you are diagnosed early. We have some powerful agents that in conjunction with other treatments can have a tremendous impact. RA is very treatable, and you can lead a normal life.” He said RA patients also benefit remarkably from prednisone, but it can’t be used continuously because of the side effects.

Injections

Cortisone injected directly into joints is often used to relieve pain and swelling, but the outcome for patients varies and the long-term effect is controversial, so physicians limit its use. Hyaluronate injections have been approved for use in arthritis of the knee and can offer relief for 6 to 12 months when effective.

Surgery

The majority of arthritis patients will never have surgery. Surgery is always the last resort. Because of the risks involved, physicians always look to non-surgical treatments first. Also, some procedures, such as knee and hip replacements are generally good for only 15 to 20 years, so younger patients may want to wait until they are older before having replacements.

Lumbar Fusion

Dr. Richard Kortizer, 76, Glen Burnie dentist, suffered from arthritis for years without knowing it. The symptoms of the disease didn’t materialize until about 8 years ago, when bone spurs from an arthritic spine caused spinal stenosis in his lower back. Spinal stenosis is narrowing of the spinal column due to deterioration of the cartilage in the spine. “I fell down one day crossing the street. I thought I was having a heart attack at first, but I had pain in my legs. The truth is, I’d fallen a number of times, but hadn’t thought much about it.”

He tried steroid injections and COX-2 inhibitors, but the pain returned. Finally, he turned to surgery. Dr. Roy Bands, an orthopedic surgeon who specializes in spine surgery, performed lower back fusion for three cervical discs, grafting bones at all three levels. “I spent six days in the Spine Center at AAMC and was treated like the King of England,” he said. “Now I have lots of screws and rods and a foot-long incision but I also have no pain and I’m on no medication. I lost a little range of motion, but I’ve not lost the ability to do anything I did before. I’ve got 100 percent capabilities.”

• Surgical Options

• Back to Pain Management home

• Ask your physician or call askAAMC at 443-481-4000

• Fibromyalgia Pain Helped with Parkinson's Medication
• Vitamin D May Help Protect Against Rheumatoid Arthritis
• 'Tis the Season to Have a Migraine

• Fibromyalgia Better Understood, Experts Say
• Migraine Headache Link To Menstruation Studied

• Novalis® Team Cures Intense Facial Pain
• Finding The Root of The Pain
• AAMC Neurosurgeon Conducts FDA Trials for Neck Pain
• Pain: A Measure of a Patient's Well-Being
• Implantable Devices Offer Hope for Chronic Pain Patients
• Laparoscopic First at AAMC
• Fibromyalgia: Elusive But Not Illusive