medications may be prescribed to control the pain and stiffness of
arthritis. Nonsteroidal anti-inflammatory medications (NSAIDs) are
the most commonly prescribed arthritis medications. NSAIDs work by
reducing pain and inflammation, but do not repair the damage of arthritis.
However, for some preparations, greater pain relief can be obtained
when the drugs are taken on a consistent basis for 10-14 days.
are more than 30 different preparations, including aspirin. Ibuprofen
(Advil) and Naproxen (Aleve) are NSAIDS are available by prescription,
and in a lower dose that can be purchased over the counter. All
NSAIDs may cause bleeding ulcers, damage the kidneys, and decrease
the effectiveness of certain blood pressure medications. Therefore,
safe use of these medications, including non-prescription preparations,
requires medical supervision. If you take NSAIDs for more than 3
months, blood tests for kidney and liver function should be obtained.
Vioxx, Bextra and Celebrex are arthritis medications that have
similar action to NSAIDs, but are less likely to cause ulcers. Vioxx
and Bextra have been removed from the market due to increased risk
of stroke or cardiac problems in certain individuals taking the
medications for long periods of time. Celebrex remains on the market,
and should be considered for patients on blood thinners or at higher
risk for bleeding problems. The pain relieving potency of Celebrex
is comparable to other NSAID drugs.
Tylenol: Tylenol can be used to control arthritis
pain. Studies suggest that Tylenol provides pain relief comparable
to NSAIDs, but does not provide anti-inflammatory activity. How
Tylenol works is not known. Tylenol has relatively few side effects.
Doses exceeding the label recommendations may be harmful to the
Steroids: Corticosteroid preparations, like prednisone,
are powerful anti-inflammatory medications, having significant systemic
side effects. Steroids are usually reserved for severe arthritic
conditions. Side effects include severe osteoporosis, fluid retention,
susceptibility to infection and increased blood sugar. Steroids
injected into joints have far fewer systemic side effects, in that
the medication is made to stay in the joint. Therefore, the dose
is smaller, and systemic absorption is less.
Steroids used to treat arthritis are not the same as the anabolic
steroids abused by athletes to enhance performance. Steroids used
to treat arthritis are corticosteroids. In contrast, steroids used
by athletes are anabolic steroids, chemically similar to naturally
occurring male sex hormone, testosterone.
Narcotics: Narcotic containing pain relievers
have no role in the long term treatment of arthritis pain. In our
practice, narcotics are dispensed only for treatment of acute painful
conditions, and only on a short term basis.
Chondroitin / Glucosamine: Chondroitin and glucosamine
are compounds normally found in articular cartilage. The effectiveness
and dosing of these compounds is still being studied. In our clinical
experience, a small percentage of patients experience some improvement
in arthritis symptoms on a temporary basis.
Topical Rubs: Topical treatments work by causing
some irritation to the skin, resulting in the “freezing” or “heating”
feeling. Our clinical experience is that a small percentage of patients
get temporary, partial pain relief from these preparations. The
only medical caution for most preparations is to avoid contact with
the eyes or broken / sensitive skin. The exception to the rule is
DMSO which can be toxic, and should not be used.