Disease-Modifying Antirheumatic Drugs Effectively Treat Arthritis

Arthritis

The CDC defines arthritis as inflammation or swelling of the joints. It is a nonspecific term to describe many diseases, including osteoarthritis, rheumatoid arthritis, childhood arthritis, fibromyalgia, gout, and lupus.

Approximately one-quarter of adults in the US suffer from arthritis, amounting to nearly 58.5 million people. This disease is more common in women, affecting 23.5% of women in the US. A significantly lower percentage of men deal with arthritis, at 18.1%. The CDC notes that having poor health is more likely to be associated with higher rates of arthritis, with 40.5% of adults with fair or poor health having arthritis. Comparatively, those in excellent or perfect health have a lower rate of arthritis at 15.3%. The CDC also notes that arthritis is “less common among adults who meet physical activity recommendations (18.1%) compared with adults who are insufficiently active or inactive (23.1% and 23.6%, respectively).”

Common Types of Arthritis

Osteoarthritis — a breakdown of the cartilage — and rheumatoid arthritis are the most common types. In healthy patients, cartilage is thick enough to prevent bones from rubbing against each other at the joint, allowing for frictionless and painless movement. However, osteoarthritis can lead to damaged connective tissues, inflammation, and swelling.

Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the joints. According to the Mayo Clinic, “in rheumatoid arthritis, the body's immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining (synovial membrane) becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.”

Risk Factors and Symptoms

Arthritis risk factors include family or genetic history, age, sex, previous joint injury, and obesity. Arthritis symptoms include pain, stiffness, swelling, redness, and decreased range of motion.

Managing Arthritis

Managing arthritis can be done through various methods, and the CDC suggests five different steps to managing this condition. The first of these steps is to learn self-management skills, including learning strategies to reduce stress, improve mood, manage pain, and communicate with healthcare providers. Another management strategy can incorporate physical activity into a patient’s routine. According to the CDC, physical activity can be a natural pain reliever and improve sleeping habits. Among the other steps, the CDC also recommends communicating with a healthcare professional, managing weight, and protecting joints.

Medications for Arthritis

Medications are also used to manage this disease because, in many cases, lifestyle changes are not adequate for symptom relief and for preventing disease progression. The type of medications used to treat arthritis varies based on the kind of arthritis and its cause. According to the Johns Hopkins Arthritis Center, rheumatoid arthritis treatments attempt to minimize arthritic disease activity and joint damage, enhance physical function, and improve quality of life.

Counterirritants

For aching joints, doctors may offer counterirritants such as menthol or capsaicin creams to alleviate pain. The Mayo Clinic notes that these chemicals “may interfere with the transmission of pain signals from the joint itself.”

NSAIDs

The Mayo Clinic states that nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to manage pain and minimize inflammation.

Unlike other available medications, NSAIDs do not treat or cure the disease. Instead, these types of medication help manage the symptoms. The most historic NSAID is aspirin. However, aspirin also has several concerning side effects that cause providers to opt for different NSAIDs.

NSAIDs block certain enzymes, COX-1 and COX-2, to prevent the generation of prostaglandins. Avoiding the generation of prostaglandins means that they can no longer mediate inflammation or pain. However, blocking prostaglandins also interferes with bodily functions such as kidney blood flow.

“While in some cases lower doses of NSAIDs are effective, in rheumatoid arthritis and other forms of inflammatory arthritis, a higher dose is often required to decrease inflammation. A lower dosage can initially be used if inflammation is mild, if mechanical pain is the major problem, if the patient is elderly, or if the patient suffers from conditions that increase the risk for toxicity,” stated the Johns Hopkins Arthritis Center.

NSAIDs typically begin working within hours. There are multiple side effects associated with continued NSAID use, including the following:

• GI disturbances
• impaired renal function
• cardiovascular issues

Corticosteroids

Another option may be corticosteroids, such as prednisone, given as a pill or injection. These can minimize inflammation, pain, and joint damage. Although corticosteroids can be a good option for some patients, they are accompanied by side effects such as thinning bones, weight gain, and diabetes.

Corticosteroids may include prednisone, methylprednisolone, and Medrol. In addition to the anti-inflammatory effects of NSAIDs, corticosteroids also have immunoregulatory effects. Common side effects of corticosteroids include weight gain, cushingoid appearance, high blood pressure, high blood sugar, cataracts, and avascular bone necrosis.

DMARDs

Finally, disease-modifying antirheumatic drugs (DMARDs) can slow disease progression and prevent permanent damage. As a subset of DMARDs, biologic and synthetic DMARDs are available to treat arthritis. The Johns Hopkins Arthritis Center notes that many rheumatologists advocate for the early use of DMARDs as cartilage damage and bone erosions are typical within two years of disease onset.

Unlike NSAIDs, DMARDs can alter disease progression and improve radiographic outcomes. Despite their ability to change the disease course, they work slightly slower than other medications, such as corticosteroids and NSAIDs.

Compared to NSAIDs, DMARDs have a much longer length of action. NSAIDs and corticosteroids typically treat patients and alleviate symptoms for a short time. Conversely, DMARDs, including methotrexate, sulfasalazine, leflunomide (Arava), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), and several others, can yield positive outcomes for weeks or months.

With many tools — pharmacological and otherwise — available to treat and manage the symptoms of arthritis, patients and providers must assess the appropriate treatment route on a case-by-case basis.