Aging & Health A to Z

Arthritis

Care & Treatment

To help you control your pain, maximize your joint movements, prevent or slow down joint damage, and stay as healthy and active as possible, your healthcare professional will use a multi-pronged treatment approach. This will include:

• Medications to control pain and joint swelling
• Exercise
• Rest and joint care
• Complementary (alternative) therapies in some cases
• Surgery (for severe damage that severely impacts your daily life).

Medicines for Pain and Inflammation

The following are the most commonly used medications for osteoarthritis:

Acetaminophen
This is an effective medication and available over-the-counter (Tylenol). In older people, the maximum dosage is lower than for younger people, and overdoses are not uncommon, resulting in liver damage. Follow your healthcare professional’s instructions carefully.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDS are used for pain relief and to reduce swelling and inflammation (some are by prescription only). NSAIDS include:

•  Aspirin
• Ibuprofen (Advil, Motrin, and others)
• Ketoprofen (Orudis)
• Naproxen (Aleve). 

Narcotic pain relievers (opioids)
Opioids are prescription drugs that contain controlled substances like codeine, hydrocodone, or morphine. There may be a danger of addiction with these medications, so they are usually prescribed very carefully, and using the lowest effective dose you can get by with.  However, when used for pain control, the risk of addiction is slight.

Steroids
Steroids are used to reduce pain, inflammation, and joint damage. Commonly used steroids are prednisone and methylprednisone (Medrol). They may be taken as pills, or by injection into the affected joint not more than three or four times per year. Serious side effects such as bone thinning (osteoporosis), cataracts, and weight gain may occur. Therefore, long-term use is usually avoided.

Hyaluronic Acid-type Preparations
These are products that are injected into knee joints to help lubricate and protect the bone.

Creams or sprays
These are pain-relieving products that have various ingredients that soothe or distract the nerves.

Additional Types of Drugs for Rheumatoid Arthritis

Patients with rheumatoid arthritis may take some of the medications mentioned above. Additional types of drugs are also used to control the malfunctioning immune system and minimize the resulting damage to joints. Although these drugs are often very helpful, they must be used carefully and your healthcare professional has to monitor your progress closely. These types of medicines are known as:

DMARDs (disease-modifying antirheumatic drugs)
DMARDS can reduce joint damage by slowing down the disease. Your healthcare team must monitor you regularly for side effects such as liver damage, or lung infections. They include drugs like:

• methotrexate (Rheumatrex, Trexall)
• leflunomide (Arava)
• sulfasalazine (Azulfidine)
• minocycline (Dynacin, Minocin).

Immunosuppressants
These drugs work by slowing down your immune system. Your doctor will find a delicate balance between reducing damage to your joints while keeping your immune system healthy enough to fight off infections. Careful monitoring is key. Immunosuppressants include:

• azathioprine (Imuran, Azasan)
• cyclophosphamide (Cytoxan)
• cyclosporine (Neoral, Sandimmune, Gengraf)

TNF-alpha Inhibitors (tumor necrosis factor-alpha inhibitors)
TNF-alpha is one of your immune system’s molecules that contributes to swelling and inflammation in your joints. TNF-alpha inhibitors help reduce pain, tenderness, and swelling. Some examples of TNF-alpha inhibitors are:

• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• Other drugs have been developed that can slow down different components of your malfunctioning immune system. Some examples of these drugs are:
• anakinra (Kineret)
• rituximab (Rituxan)
• abatacept (Orencia)

Surgery

If your healthcare professional feels that exercise and medications have not adequately controlled your symptoms, he or she may suggest surgery to clear debris out of the joint (arthroscopy), reposition the bones, or smooth out the surfaces of the affected structures.

If the joint damage is severe, your healthcare professional may suggest a joint replacement.

For patients with rheumatoid arthritis, specialized surgeries may be considered to help you regain use of a damaged joint. These include:

• Joint fusion, for stabilizing the joint, and to reduce pain
• Tendon repair, if your disease has severely damaged tendons in the joint
• Removal of the lining of the joint.

After surgery, you will probably need a few weeks of rehabilitation, which may require moving to a specialized short-term residence. Here you will get physiotherapy and occupational therapy, and learn to care for yourself once you return home.

Non-Drug Therapies

Many non-drug approaches can be very beneficial for older people with arthritis. Not only can they reduce pain, but they also keep you more flexible and in control of your life. Your healthcare professional can refer you to a physical therapist or occupational therapist who will devise the right programs for you. These will include techniques to help you get through your daily routine with the least stress to your tender joints.

These are some of the approaches, which should be tailored to your own needs and lifestyle.

Exercise
Researchers have found that exercise not only reduces pain of osteoarthritis and increases flexibility and general fitness, but it also helps you to keep a positive outlook and lowers the risk of depression. For older adults with knee osteoarthritis, a moderate exercise routine at least 3 times per week can reduce arthritis-related disability by almost half.

 Make sure to start your exercise session slowly and with a proper warm-up, and to take regular breaks. You may be advised to take a pain medicine before you begin. Your healthcare professional will choose the most appropriate routines for your body and fitness level.

A good exercise program will combine:

• Strength exercises to build strong muscles that will protect and support joints. Resistance training using elastic bands or weights are effective.
• Aerobic exercises for cardiovascular health and to aid in weight control. This can include simple walking or more defined exercises. Research shows that the more you walk, the more you can walk.
• Range-of-motion exercises to loosen up stiff joints and increase flexibility. Gentle yoga classes are often excellent.
• Balance exercises to help you get around and carry out your daily activities more easily and safely. Tai chi can be effective for improving balance and reducing the risk of falls.

Many people particularly enjoy using swimming pools or doing water aerobics, since the water supports damaged joints and adds resistance while you exercise.

Weight Reduction
Your healthcare professional may recommend that you lose weight if you are overweight to help take the stress off of your joints. Ask your healthcare professional to recommend a dietitian who can help.

Rest and Relaxation
Though you may feel stiff and sore when you exercise, it should not be very painful. If activity hurts a lot, your joints may be telling you you've overdone it. This is especially true if your joints are red, hot, and very swollen. Find the right balance for your own body.

Many stress reduction programs are available that teach relaxation techniques including releasing muscle tension and even meditation. These can increase well-being.

Regular, adequate sleep will help reduce the pain and inflammation. Being well-rested also allows you to cope with your arthritis more effectively. If you are having trouble sleeping, tell your healthcare professional.

Physical Aids
Walkers, canes, special footwear, splints, or individually fitted insoles (such as orthotics) may make a big difference in your pain levels and your ability to get out and about. Your healthcare provider can refer you to a specialist such as an occupational therapist or podiatrist who can suggest aids for your specific needs and teach you their proper use.

Heat or cold, applied at the right times, can be very soothing and help reduce inflammation. Heat can be provided by heating pads, a warm bath, or inexpensive heating packets available in drug stores that stay warm for many hours. Reusable cold packs—even packages of frozen vegetables— kept in the freezer between uses are also handy.   In general, heat is most useful in soothing sore or tense muscles and cold helps with swollen or hot joints.

Alternative Approaches

Researchers have found that some complementary therapies may also be beneficial for controlling pain and improving your quality of life, including:

• Acupuncture (with a properly licensed acupuncturist).
• Massage helps many people to feel more relaxed and may reduce pain. It must be done carefully in arthritis patients to avoid irritating already inflamed joints.
• Nutritional supplements such as glucosamine sulphate and chondroitin, vitamins, green tea.
• Fish oil and flax seed oil or other natural oils may be helpful in rheumatoid arthritis, but check with your healthcare professional before starting to take them. They may interfere with other medications or have unwelcome side effects.
• TENS (transcutaneous electrical nerve stimulation) is a technique in which very mild electrical pulses are applied to your skin. This appears to block pain reactions and helps reduce the sensation of pain for many people. However, it is usually applied by a professional in a physiotherapy or pain clinic.

Monitoring

Once you know your diagnosis, your healthcare professional will schedule regular appointments depending on the seriousness of your condition. This is especially important if you have been diagnosed with rheumatoid arthritis. Some of the drugs you may need regular monitoring with blood tests.  

Updated: March 2012
Posted: March 2012