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For many patients with arthritis, mild pain relievers such as aspirin and acetaminophen (Tylenol) may be sufficient treatment. Studies have shown that acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis. Since acetaminophen has fewer gastrointestinal side effects than NSAIDS, especially among elderly patients, acetaminophen is often the preferred initial drug given to patients with osteoarthritis. Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Examples include capsaicin, salycin, methyl salicylate, and menthol.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain as well as inflammation in the joints. Examples of NSAIDs include aspirin (Ecotrin), ibuprofen (Motrin), nabumetone (Relafen), and naproxen (Naprosyn). It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects. This is more often possible with osteoarthritis because the symptoms vary in intensity and can be intermittent. The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Newer NSAIDs called cox-2 inhibitors have been designed that have less toxicity to the stomach and bowels.
Some studies, but not all, have suggested that the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA. The U.S. National Institutes of Health (NIH) is studying glucosamine and chondroitin in the treatment of osteoarthritis. Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of these products for osteoarthritis. Patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning effect and cause excessive bleeding. Fish oil supplements have been shown to have some anti-inflammation properties, and increasing the dietary fish intake and/or taking fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
Cortisone is used in many forms to treat arthritis. It can be taken by mouth, given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.
For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan, and others) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.
Arthritis that is characterized by a misdirected, overactive immune system (such as rheumatoid arthritis or ankylosing spondylitis) frequently requires medications that suppress the immune system. Medications such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) are examples. Newer medications that target specific areas of immune activation are referred to as biologics (or biological response modifiers). Sometimes combinations of medications are used. All of these medications require diligent, regular dosing and monitoring.
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