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Arthritis Treatment Options

(continued)

Medications continued...

Acetaminophen (Tylenol) is another option for easing arthritis pain. In the past, doctors thought acetaminophen was only good for pain relief and that it did little, if anything, to reduce inflammation. Now some research suggests that acetaminophen may have some anti-inflammatory properties.

For some people, acetaminophen can relieve pain as well as NSAIDs, and it doesn't come with the gastrointestinal and heart risks. Acetaminophen isn't entirely free from side effects, though. Because it can harm the liver and kidneys, make sure to stick with the recommended dosage and talk to your doctor if you need longer-term pain relief.

An alternative or addition to pain relievers you take by mouth, are creams or gels that you rub on your affected joints. These topical pain relief options include:  

  • Capsaicin, the ingredient that gives cayenne peppers their kick, may help curb arthritis pain.
  • Counterirritants distract your brain away from the pain in your joints by irritating nerve endings and contain ingredients like menthol, camphor, and eucalyptus oil. NSAIDs also come in topical formulations, some of which are only available by prescription. Recently, the FDA issued a warning that the topical form of the NSAID diclofenac can be harmful to the liver. If you're using this drug, your doctor will need to check your liver function four to eight weeks after you start treatment.  

If you've already tried a variety of pain relievers and your joints are still throbbing, or you just can't tolerate NSAIDs or acetaminophen, your doctor may recommend stronger opioid or narcotic pain relievers. These drugs can become habit-forming, so it's important that you keep in close touch with your doctor while taking them.

Disease-Modifying Drugs

Pain relievers can make you feel better, but they're not going to change the course of your arthritis. Disease-modifying anti-rheumatic drugs (DMARDs) can actually slow joint damage in people with arthritis from an overactive immune system such as rheumatoid arthritis and psoriatic arthritis. These drugs can't reverse damage that's already been done to your joints, however, and they can cause side effects such as in increased risk of serious infection.

The DMARD that's often tried first is methotrexate (Rheumatrex, Trexall). Other DMARDs include:

  • Hydroxychloroquine (Plaquenil)
  • Sulfasalazine (Azulfidine)
  • Leflunomide (Arava)

Newer disease-modifying drugs called biologics include etanercept (Enbrel), certolizumab pegol (Cimzia), adalimumab (Humira), infliximab (Remicade), abatacept (Orencia), rituximab (Rituxan), and anakinra (Kineret). Downsides to biologic drugs include their high price tag, which can reach $20,000 a year, and an increased risk of infection as well as other side effects.  

Corticosteroids

Corticosteroids also dampen the immune response and help reduce inflammation. Some might take a steroid drug if NSAIDs aren't budging your arthritis symptoms, or when you've just started treatment and you're waiting for your DMARD to take effect. Corticosteroids for arthritis are most often taken by mouth or via an injection directly into the joint. Injections offer speedy pain and inflammation relief, and their effects can last for a few weeks or months. The side effect many people complain about with oral corticosteroids is weight gain, but these drugs can also increase your risk for infection, cataracts, and weak bones (osteoporosis).

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