Arthritis Treatment Options
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 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).
Hyaluronic Acid Therapy (Viscosupplementation)
The joints contain a natural lubricant and shock absorber called hyaluronic acid that keeps them moving smoothly, but people with osteoarthritis have less of this substance than normal. Hyaluronic acid injections with products such as Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc-One can help relieve the pain of mild-to-moderate osteoarthritis of the knee and improve mobility. Side effects from viscosupplementation are usually mild and may include pain or swelling at the injection site.
Some doctors may recommend the use of an antidepressant drug for chronic pain whether you suffer from depression or not. In 2010, the FDA approved the antidepressant duloxetine (Cymbalta) for chronic musculoskeletal pain including the pain of osteoarthritis. Although not FDA-approved for this use, another class of antidepressants called tricyclics may also help manage chronic pain. These include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). Although it is unclear how they help with chronic pain, antidepressant effects on brain chemicals that cause you to feel pain is believed to play a role. Side effects can range from drowsiness to dry mouth and blurred vision. Rarely, these drugs can also lead to mood changes or suicidal thoughts.