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Arthritis Treatment and Research

Although there is no cure for most forms of arthritis, various therapies can help patients manage symptoms and improve their overall quality of life. The choice of treatment depends on the type of arthritis, the severity of symptoms, the patient's general health, and other factors.

Treatment and Research - Osteoarthritis

Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can include exercise, rest and joint care, pain relief, weight control, medicines, surgery, and non-traditional treatment approaches.

Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but right now there are no treatments that can cure osteoarthritis.

Exercise is one of the best treatments for osteoarthritis. It can improve mood and outlook, decrease pain, increase flexibility, and help you maintain a healthy weight.

The amount and form of exercise will depend on which joints are involved, how stable the joints are, whether or not the joint is swollen, and whether a joint replacement has already been done. Ask your doctor or physical therapist what exercises are best for you.

For temporary relief of pain from osteoarthritis, you can use warm towels, hot packs, or a warm bath or shower. In some cases, cold packs such as a bag of ice or frozen vegetables wrapped in a towel can relieve pain or numb the sore area.

A doctor or physical therapist can recommend if heat or cold is the best treatment. For osteoarthritis in the knee, wearing insoles or cushioned shoes may reduce joint stress.

Doctors consider a number of factors when choosing medicines for their patients. In particular, they look at the type of pain the patient may be having and any possible side effects from the drugs.

For pain relief, doctors usually start with acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used.

In addition, COX-2 inhibitors such as celecoxib and valdecoxib may be used. These medicines reduce inflammation similarly to traditional NSAIDs, but they cause fewer gastrointestinal side effects. However, these medications occasionally are associated with harmful reactions ranging from mild to severe.

Corticosteroids, hyaluronic acid, and topical creams are also used. Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over age 65 and those with any history of ulcers or stomach bleeding should use non-steroidal anti-inflammatory drugs, or NSAIDs, with caution.

Protecting and supporting the affected joint or joints is important. Some people use canes and splints to protect and to take pressure off the joints. Splints or braces are used to provide extra support for weakened joints.

For some people, surgery helps relieve the pain and disability of osteoarthritis. A doctor may perform surgery to smooth out, fuse, or reposition bones, or to replace joints.

The decision to have an operation depends on several factors. Both surgeon and patient should consider the patient's level of disability, intensity of pain, lifestyle, age, and occupation. Today, more than 80 percent of surgeries for osteoarthritis involve replacing the hip or knee joint.

Researchers suspect that heredity plays a role in 25 to 30 percent of osteoarthritis cases. Scientists have identified a mutation, or gene defect, affecting collagen -- an important part of cartilage -- in patients with an inherited kind of osteoarthritis that starts at an early age.

In the future, a test to determine who carries a genetic defect or defects could help people reduce their risk for osteoarthritis with lifestyle adjustments.

Tissue engineering is an exciting area of research in osteoarthritis. This approach involves removing cells from a healthy part of the body and placing them in an area of diseased or damaged tissue. In some cases, this improves joint movement.

Researchers also are studying whether exercise can treat or prevent osteoarthritis. Studies on knee osteoarthritis and exercise found that strengthening the thigh muscle, also known as the quadriceps, can relieve symptoms of knee osteoarthritis and prevent more damage.

Studies also show that people with knee osteoarthritis who exercise feel less pain and function better. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials, including those funded by the NIH, at ClinicalTrials.gov.

Early research suggests that acupuncture, which is the use of fine needles inserted at specific points in the skin, may provide pain relief for some patients. Some people claim that the dietary supplements glucosamine and chondroitin sulfate can relieve the symptoms of osteoarthritis.

The NIH is currently funding the Glucosamine and Chondroitin Arthritis Intervention Trial, or GAIT, to test whether or not glucosamine and/or chondroitin have a beneficial effect for people with knee osteoarthritis. The results of the recently completed first phase of the study indicate that these supplements have a limited effectiveness for most patients with osteoarthritis.

Treatment and Research - Rheumatoid Arthritis

Treatments for rheumatoid arthritis can help relieve your pain, reduce swelling, slow down or help prevent joint damage, increase your ability to function, and improve your sense of well-being.

Exercise, medication, and, in some cases, surgery are common treatments for rheumatoid arthritis.

People with rheumatoid arthritis need a good balance between rest and exercise; they should rest more when the disease is active and exercise more when it is not.

Reducing stress also is important. Doing relaxation exercises and taking part in support groups are two ways to help reduce stress. For more information on exercise classes, you may want to contact the Arthritis Foundation at 1-800-283-7800.

Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. Still others, called disease-modifying anti-rheumatic drugs or DMARDs, can often slow the course of the disease.

DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine. Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids.

New types of drugs called biological response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, and anakinra.

Early treatment with powerful drugs and drug combinations -- including biological response modifiers and DMARDs -- instead of single drugs may help prevent the disease from progressing and greatly reduce joint damage.

In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Surgery may also improve a person's ability to perform daily activities. Joint replacement and tendon reconstruction are two types of surgery available to patients with severe joint damage.

Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although such approaches may not be harmful, scientific studies have not yet shown any benefits.

An overall nutritious diet with the right amount of calories, protein, and calcium is important. Some people need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis.

Scientists are making rapid progress in understanding the complexities of rheumatoid arthritis. They are learning more about how and why it develops and why some people have more severe symptoms than others.

New drugs called biologic response modifiers and combinations of drugs are under study. Research efforts are focused on developing drugs that can reduce inflammation and slow or stop the disease with few side effects.

Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. Investigators are trying to identify the infectious agents and understand how they work. This knowledge could lead to new therapies.

Researchers are also exploring why so many more women than men develop rheumatoid arthritis. In the hope of finding clues, they are studying complex relationships between the hormonal, nervous, and immune systems in rheumatoid arthritis.

For example, they are exploring whether and how the normal changes in the levels of steroid hormones such as estrogen and testosterone during a person's lifetime may be related to the development, improvement, or flares of the disease. Scientists are also examining why rheumatoid arthritis often improves during pregnancy.

The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov.

Treatment and Research - Gout

With proper treatment, most people with gout are able to control their symptoms and live productive lives.

The goals for treatment are to ease the pain that comes from sudden attacks, prevent future attacks, stop uric acid buildup in the tissues and joint space between two bones, and prevent kidney stones from forming.

The most common treatments for an attack of gout are high doses of non-steroidal anti-inflammatory drugs, or NSAIDs, which are taken by mouth, or corticosteroids, which are taken by mouth or injected into the affected joint. Patients often begin to improve within a few hours of treatment. The attack usually goes away completely within a week or so.

Since NSAIDs are now available over the counter, it is important to check with your doctor concerning the safety of using these drugs and to verify the proper dosage.

When NSAIDs or corticosteroids fail to control pain and swelling, the doctor may use another drug, colchicine. This drug is most effective when taken within the first 12 hours of an acute attack.

Scientists are studying which NSAIDs are the best ones to treat gout. They are analyzing new compounds to develop safe, effective medicines. Current research is also focusing on the structure of certain enzymes to gain a better understanding of defects that can cause gout.

Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They are also looking at the role of calcium deposits and how they contribute to the development of gout in the hope of finding new treatments.

In addition, researchers are investigating how genetics and the environment may influence the level of uric acid in the blood.