treatments

Arthritis Treatments

In the UK approximately 10 million people suffer from arthritis, with the most common forms being osteoarthritis and rheumatoid arthritis.

Arthritis is a general term that covers over 100 different conditions that affect the musculoskeletal system.  These joint-related problems cause symptoms such as stiffness, inflammation, pain, and damage to the cartilage and surrounding tissues.

This can lead to weakened joints, deformities, and instability that can make basic daily tasks changing.

SUMMARY

There are no cures for these conditions. However, If left untreated conditions such as rheumatoid arthritis and osteoarthritis will significantly worsen as the joint degradation accelerates.

There are many ways to manage arthritis to lessen the symptoms and improve the quality of life. Arthritis treatments vary and often include a combination of medications, natural supplements, physical therapy, and lifestyle adjustments.

It is critical to maintain an arthritis-friendly diet, rich in anti-inflammatory foods and antioxidants from the right foods or supplements.

Classification of Arthritic Conditions

The wide range of arthritis conditions can be classified into three main groups:

Inflammatory Arthritis

Inflammatory arthritis is a term used to describe a group of conditions which affect the immune system. The arthritis is caused by the body’s own defence system attacking its own tissues instead of viruses, germs and other foreign substances.  This causes stiffness, pain and joint damage.

The most common type of inflammatory arthritis is Rheumatoid Arthritis (RA). Other common conditions from within this category include gout, ankylosing spondylitis, and psoriatic arthritis.

Rheumatoid Arthritis Treatments

The most common type of inflammatory arthritis rheumatoid arthritis affects approximately 400,000 people in the UK according to the National Health Service (NHS). Adults of any age can be affected by this condition, although it most commonly develops between the ages of 40 and 50.

Women tend to be more prone to rheumatoid arthritis than men, with around three-quarters of diagnosed patients female1.

An auto-immune disease, the immune system attacks the cells around the joints. This causes painful swelling and stiffness. As the disease progresses the affect joint becomes damaged as cartilage and surrounding bone break down.

Treatment Strategies

All experts agree that the earlier rheumatoid arthritis is detected and treatment begins the better the chance of limiting joint damage. Since the majority of joint damage is irreversible, the disability will be greater with persistent damage. The goals of treating rheumatoid arthritis are to try and control the degree of joint degradation, stop disease progression and loss of function, minimise symptoms, and improve quality of life. Most experts encourage aggressive treatment plans as soon as the disease is detected, although there is still some conjecture as to the best treatment strategy2

Results from a range of clinical studies suggest that early therapy should focus on the use disease-modifying anti-rheumatic drugs (DMARDs)3. This may involve monotherapy with a drug such as methotrexate (MTX) or hydroxychloroquine (HCQ), or a step-up combination therapy where a range of DMARDs are used4,5. Non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed. There also evidence to support the use of anti-tumor necrosis factor (anti-TNF) drugs, especially in combination with MTX, in the treatment of rheumatoid arthritis6.

Medical practitioners and researchers acknowledge that there isn’t one single strategy that can be applied to treat rheumatoid arthritis. Everyone responds differently to the disease and treatments must be adapted accordingly. Combining medications with exercise, healthy diet, and supplements is the overarching treatment plan for rheumatoid arthritis. As new advances are made in developing medications, it’s possible that treatment options will be expanded and improved on.

New breakthrough research from the University of Queensland in Australia has developed a vaccine-style treatment for rheumatoid arthritis. This vaccine treats the underlying cause of the disease, rather than the symptoms. This new treatment is in its infancy and needs further testing, but may be a future turning point for sufferers of this disease.

Gout, Ankylosing Spondylitis, and Psoriatic Arthritis Treatments

Gout

One of the most painful forms of arthritis, gout occurs when there is an abnormal build-up of uric acid in the body that deposits as crystals within the joints. Gout is most commonly associated with the big toe, although it can also affect insteps, ankles, knees, heels, wrists, elbows, and fingers.

Acute gout attacks are treated using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. Medications that block uric acid production may also be prescribed.

Ankylosing Spondylitis

A form of spinal arthritis, ankylosing spondylitis typically affects young men and can eventually lead to new bone formation on the spine. It can cause severe, chronic pain and discomfort. Although the spine is primarily affected, ankylosing spondylitis can also cause inflammation, stiffness, and pain in other areas such as the ribs, hips, shoulders, and smaller joints associated with the feet and hands.

NSAIDs (nonsteroidal anti-inflammatory drugs) are the primary treatment for ankylosing spondylitis. If these are not effective, disease-modifying anti-rheumatic drugs (DMARDs) may be used. Exercise, good posture, and diet are important in the management of ankylosing spondylitis. In some cases surgery may be required.

Psoriatic Arthritis

There are several forms of psoriatic arthritis, which affects people with the skin condition psoriasis. It causes stiffness, pain, swelling and discomfort of affected joints, reducing movement.

NSAIDs (nonsteroidal anti-inflammatory drugs) or disease-modifying anti-rheumatic drugs (DMARDs) may be recommended for people with psoriatic arthritis. Oral “small molecule” treatments or biologic drugs given by intravenous infusion or injection are another possible option.

Non-Inflammatory Arthritis

Non-Inflammatory Arthritis is characterised by natural wear and tear of mostly the weight-bearing joints (back, hip, feet and knee). It can also affect both the smaller joints of the body, including the hands and wrists.

Unlike Rheumatoid Arthritis, this type of arthritis is very common in elderly people.

The most common type of Non-Inflammatory Arthritis is osteoarthritis. Other conditions within this category include scoliosis and torn ligaments.

Osteoarthritis Treatments

This is the most common type of non-inflammatory arthritis and is the most common form of arthritis in the UK7. Statistics from Arthritis Research reveal that 8.75 million people have sought treatment for osteoarthritis in the UK.

While this disease usually develops in people over the age of 50, it can develop at any age in response to anther joint-related problem or an injury. More than 30 percent of women have some degree of osteoarthritis by age 65.

Osteoarthritis make movement very difficult. In the early stages the disease affects the cartilage lining of the joints, leading to stiffness and pain. As the cartilage thins the joint bones start to rub together, increasing deformation and discomfort.

Initially, osteoarthritis starts with minor pain during activities, but soon the pain can become continuous and even occur while in a state of rest. The joints most commonly affected by osteoarthritis include the hips, knees, hands, and spine.

People with prior joint trauma, obesity, and a sedentary lifestyle are at the highest risk of developing osteoarthritis.

Treatment Strategies

The principal aims of treating osteoarthritis are to adequately control pain, enhance function, and minimise disability. All treatment plans should include a combination of therapies focusing on the best strategy for individual circumstances.

The primary treatment for osteoarthritis has been paracetamol for pain relief, although NSAIDs (nonsteroidal anti-inflammatory drugs) are also recommended in the case of moderate or severe pain8. The types of medications prescribed to help manage osteoarthritis will depend on other underlying health factors. For example, people suffering from osteoarthritis and hypertension should avoid NSAIDs and cyclooxygenase-2 (COX-2) inhibitors because they can increase blood pressure9. Corticosteroids and hyaluronic acid injections may also be a viable short-term treatment option for some patients.

Exercise, TENs and acupuncture10,11, heat or cold packs12, and healthy weight management13 are all important aspects of non-pharmaceutical osteoarthritis management strategies.

Occupational therapy combined with a healthy diet and nutritional supplements can help to lessen the burden on the joints and improve overall joint health.

Scoliosis and Torn Ligament Treatments

Scoliosis

Lateral curvature of the spine is termed scoliosis. It can be congenital, or develop as a result of abnormal muscles, a traumatic injury, or in some cases there is no known cause.

Braces or surgery may be recommended to correct the spine in children if the condition is severe. Adult scoliosis is rare, although it is sometime caused by a degenerative joint problem.

Torn Ligament

Torn ligaments can occur as a result of a sporting injury, accident, or repetitive strain. It can occur at any joint, although the knee and ankle are especially vulnerable when it comes to sports injuries.

Usually ligaments will naturally heal with careful management. In some severe cases surgery may be required. The affected joint may be more susceptible to arthritis later in life.

Connective Tissue Disease

This category includes Sjogren’s syndrome, lupus, and sclerosis.

Sjogren’s Syndrome, Lupus, and Sclerosis Treatments

Sjogren’s Syndrome

This auto-immune disease typically affects the salivary glands and eyes, although it can also affect other areas of the body. The severity of the disease can vary significantly, and the progression is unpredictable. One of the symptoms of Sjogren’s syndrome is joint swelling and associated pain.

There are a range of medications available that can be used in the treatment of Sjogren’s syndrome. These may include NSAIDs (nonsteroidal anti-inflammatory drugs) to minimise swelling and discomfort of the joints.

 Lupus

This auto-immune disease causes swelling of the tissues. The symptoms will vary depending on what part of the body is affected. There are four main types of lupus, with systemic lupus erythematosus being particularly detrimental to joint health.

Anti-inflammatories, corticosteroids, antimalarials, immuneosuppressives, and anticoagulants, may be among the recommended medications to help treat lupus. Treatment will be determined by the type of lupus and the severity of the condition.

Sclerosis Treatments

Abnormal hardening of the body tissue is called sclerosis. There are many different conditions associated with sclerosis; however one of the symptoms is swelling and inflammation which can affect the joints.

There are a range of medications used to treat sclerosis. Physical therapy is also important, along with a healthy diet and stress relief.

Arthritis Treatment Types

The treatment of arthritis aims to minimise symptoms so that joint health is improved. Using a range of therapies, patients can reduce inflammation, pain, and swelling to improve mobility and slow the progression of joint degradation.

The best arthritis treatments will include a combination of approaches, varying depending on individual conditions. For example, a psoriatic arthritis treatment plan may differ from an osteoarthritis treatment plan due to differences in the underlying cause of the joint degradation.

Painkillers and Anti-Inflammatories

Painkillers (analgesics) such as paracetamol are often recommended to be taken regularly during a pain flare-up. Many doctors recommend taking analgesics prior to any activity that may aggravate pain to lessen the severity of the discomfort.

NSAIDs (Non Steroidal Anti-Inflammatory Drugs) can be useful in short bursts to reduce inflammation during a flare-up in combination with analgesics if necessary. These anti-inflammatories are available in oral or topical treatments. NSAIDs are not suitable for long-term use due to their strong side effects on the digestive system.

In the case of inflammatory arthritis or connective tissues diseases, steroid tablets or localised injections of steroids may be used to stop inflammation. In the treatment of osteoarthritis some doctors may recommend steroid injections for the infected joint.

Suitable treatment timeframe: SHORT-TERM

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Inflammatory Disease Suppressants

Slow acting Disease-Modifying Anti-Rheumatic Drugs (DMARDs) can be used to suppress inflammation.

Usually these medications are taken together with NSAIDs until they start to take effect.

If DMARDs are unsuccessful, biological therapies may be recommended. These are a relatively new class of drugs made to block the messages between inflammation-causing white blood cells and other proteins.

Suitable treatment timeframe: MEDIUM-TERM

Physical Therapy

As part of an arthritis treatment plan doctors may recommend physical therapy.

Hydrotherapy in a warm water pool is useful for reducing pressure on the joint and muscles while facilitating important exercise.

Physiotherapy exercises especially tailored to individual conditions can help to reduce inflammation and increase mobility, together with other pain relieving treatments such as massage, or heat and ice packs.

Occupational therapies to help manage everyday tasks are also an important part of arthritis treatment. This helps to educated people to better manage fatigue and protect their joint from further degradation.

Suitable treatment timeframe: LONG-TERM

Surgery

In some extreme cases, hip, shoulder, elbow, and knee arthritis treatments may include surgery.

This may be recommended if the damage to the joint is so advanced that it makes day-to-day life difficult or other treatments are unsuccessful.

There are three main forms of joint surgery:

  • Arthroplasty – A joint replacement procedure
  • Arthodesis – A joint fusion procedure
  • Osteotomy – A procedure where the bone is cut and then realigned

Modern surgical methods make joint replacements or pain-relieving reconstructions highly successful. However, surgery is usually the last resort and the procedures are not without risks.

Suitable treatment timeframe: SHORT-TERM

Diet

Attempts to reduce arthritis symptoms treatments must also include dietary changes.

While there isn’t any scientific proof that dietary changes can cure arthritis, certain foods can aggravate or reduce symptoms.

A healthy diet rich in foods that reduce inflammation and limit weight gain is important. This helps to take the pressure off the joints and minimizes discomfort, ultimately improving mobility.

Antioxidant rich fruit and vegetables, whole grains, low fat dairy and meats are recommended. Foods containing saturated and trans fats, sodium/salt, and sugar should be avoided.

Suitable treatment timeframe: LONG-TERM

Food Supplements

There are many different supplements that can be used in the treatment for arthritis. Omega 3 fatty acids, pine bark extract, chondroitin, glucosamine, and MSM (methyl sulfonylmethane), are some of the natural compounds commonly used in supplements as part of arthritis treatment.

These are often formulated with other key vitamins and minerals to help protect joint health.

There is strong scientific evidence that these compounds can help to reduce inflammation, decrease pain, and defend the joints from damaging enzymes. Clinical studies have shown that these common arthritis nutraceutical ingredients can minimise the reliance on painkillers and NAIDs, which is important for long-term health14, 15, 16,17

Suitable treatment timeframe: LONG-TERM

The high-street and online market is awash with so-called “joint food” supplements. But be careful, the products differ significantly in quality and value for money.

Necessary Lifestyle Adjustments

If left untreated conditions such as rheumatoid arthritis and osteoarthritis will significantly worsen as the joint degradation accelerates. In order to preserve quality of life it’s essential to make positive lifestyle adjustments.

This includes maintaining an arthritis-friendly diet, rich in anti-inflammatory foods and antioxidants.

The Importance of Diet and Nutrients

Making smart food choices can significantly improve joint health, reducing inflammation and associated pain to make movement easier. This will lessen joint swelling and stiffness, providing better joint mobility.

Routinely taking appropriate effective joint food supplements can also significantly reduce arthritis symptoms. The high-street and online market is awash with so-called “joint food” supplements.

But be careful, the products differ significantly in quality and value for money. We have taken the guesswork out for you and compared over 20 joint food supplements.

 

Regular participation in low impact sports is also an important aspect of an arthritis treatment plan. Low-impact exercise such as swimming, rowing, cycling, yoga, bowling and golfing will help to maintain joint movement, reduce joint instability and help to minimise pain.

Of course, regular (ideally outdoor) exercise also increases your endorphine levels and helps to keep your body weight in check. This reduces general pressure on your joints keeping you happy and healthy.

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Bibliography

  1. “Crowson, C. et.al. (2011). The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis and Rheumatology, Volume 63, Issue 3, (pp. 633-9).”
  2. “Schipper, L. et.al. (2012). A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry. Annuals of Rheumatic Diseases, Volume 71, Issue 6, (pp. 845-50).”
  3. “Demoruelle, M. and Deane, K. (2012). Treatment strategies in early rheumatoid arthritis and prevention of rheumatoid arthritis. Current Rheumatology Reports, Volume 14, Issue 5, (pp. 472–480).”
  4. “Allaart, C. and Huizinga, T. (2011). Treatment strategies in recent onset rheumatoid arthritis. Current Opinions in Rheumatology, Volume 23, Issue 3, (pp. 241-4).”
  5. Schipper, L. and van Riel, P. (2011). Ups and downs in the treatment strategies of rheumatoid arthritis. Rheumatology, Volume 50, Issue 5, (pp. 818-20).”
  6. “Breedveld F. and Combe, C. (2011). Understanding emerging treatment paradigms in rheumatoid arthritis. Arthritis Research & Therapy, Volume 13, Issue 1.”
  7. “VanItallie TB (October 2010). “Gout: epitome of painful arthritis”. Metab. Clin. Exp. 59(Suppl 1): S32–6. doi:10.1016/j.metabol.2010.07.009. PMID 20837191″
  8. “Puttini, P. et.al. (2005). Osteoarthritis: an overview of the disease and its treatment strategies. Seminars in Arthritis and Rheumatiodism, Volume 35, Issue 1, (pp. 1-10).”
  9. “Verdecchia, P. et.al. (2010). Treatment strategies for osteoarthritis patients with pain and hypertension.” Therapeutic Advances in Musculoskeletal Disease, Volume 2, Issue 4, (pp. 229-40).”
  10. “Itoh, K. et.al. (2008). A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA). Chinese Medicine, Volume 3, Issue 2.”
  11. “Zhang, W. et.al. (2010). OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and Cartilage, Volume 18, Issue 4, (pp. 476-99).”
  12. “Denegar, C. et.al. (2010). Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clinical Interventions in Aging, Volume 5, (pp.199-206).”
  13. “Turley, M. et.al. (2006) Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Australian and New Zealand Journal of Public Health, Volume 30, Issue 3, (pp. 231-237).”
  14. “Gruenwald et al. (2009). Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in Therapy, Volume 26, Issue 9, (pp.858-71).”
  15. “Henrotin et al. (2010). Chondroitin Sulfate in the Treatment of Osteoarthritis: From in Vitro Studies to Clinical Recommendations. Therapeutic Advances in Musculoskeletal Diseases, Volume 2, Issue 6, (pp. 335-48).
  16. “Beer, A. & Wegener, T. (2011). Vitamin E for gonarthrosis and coxarthrosis – results of a postmarketing surveillance study. MMW Fortschritte der Medizen, Volume 153, Supplement 1, (pp. 14-20).”
  17. “Belcaro, G. et al (2008). Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects. Phytotherapy Research, Volume 22, Issue 4, (pp. 518-23).”

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