Arthritis is inflammation of one or more joints that results in swelling, pain and decreased mobility of the joint over time. There are many different causes of arthritis but the two most common are osteoarthritis, resulting from prior injury or "wear and tear," and rheumatoid arthritis, resulting from a disorder of the immune system that allows the immune cells to attack joint tissue. The underlying cause is often incurable but treatments are available to reduce symptoms and sometimes modify the course of disease.
Analgesics
Analgesics only relieve pain. Analgesics such as acetaminophen are often recommended as the first line of treatment for the pain of osteoarthritis. Although it is over-the-counter, you should not exceed 4 grams per day. Prescription analgesics have stronger pain control through the use of an opioid either alone, or added to acetaminophen, such as in Percocet. Some prescription analgesics are longer-acting and do not need to be administered as frequently, while others are available in the form of a trans-dermal patch.
Nonsteroidal Anti-Inflammatories
NSAIDs provide pain relief and have the added benefit of reducing swelling, they all work by blocking the production of prostaglandins, which are substances made by the body to respond to irritants. There are three major categories of salicylates: aspirin, as in Ibuprofen and Naproxen; Cyclo-oxygenase-2, or COX-2, inhibitors, which are less likely to cause stomach ulcers; and traditional NSAIDs. Traditional NSAIDs include a large number of prescription drugs and carry the risk of stomach upset and gastrointestinal bleeding.
Disease-Modifying Antirheumatic drugs
Disease modifying antirheumatic drugs or DMARDs work by suppressing the immune system. People should be wary of any signs of infection while taking them, and report it to their doctors. When administered early in the course of the disease, DMARDs may potentially put arthritis into remission. A remission is defined as less than 15 minutes of morning stiffness and no painful or swollen joints for at least 3 months.
Biologic Response Modifiers
Biologics are the most recent class of drugs and tend to be quite expensive. They are made from living organisms such as a virus or protein and act by suppressing the immune response that normally initiates inflammation. They are often used in conjunction with DMARDs and you should not combine more than one biologic because of the risk of too much immune suppression.
Glucocorticoids
Glucocorticoids, a class of steroids, mimic the body's hormone cortisol and are very effective at reducing inflammation by modifying the immune response. In large doses they may be used for immediate relief of inflammation or, in lower doses, they can be used for a longer period of time to prevent flare-ups and often are used in conjunction with DMARDs. They are not good for long term use at high doses because of the immune suppression and other cortisol-instigated side effects. They can be used more safely directly at the point of inflammation in the form of a joint injection or topical cream.
