There are many things that help reduce pain, relieve stiffness, and keep you moving. Your care may involve more than one kind of treatment. Your doctor may recommend medications, but there are many things you can do on your own to help manage pain and fatigue and move easier.
Finding the right treatment takes time. It can involve trial and error until you find what works best. Be sure to let your doctor know if a treatment is not working. Your treatment may also change as your arthritis changes.
Treatments for arthritis can be divided into several categories: medication, exercise, heat/cold, pacing, joint protection, surgery and self-help skills. You can do things in each of these areas to help yourself feel better and move easier.
Many different drugs are used to treat arthritis.
Analgesics are pain killers which have no effect on the inflammation in the joints. Paracetamol and tramadol are the two most commonly used drugs.
Anti-inflammatory medicines reduce both pain and swelling. These are called nonsteroidal anti-inflammatory drugs (NSAIDs). The most common side effect of these medications is stomach upset. Call your doctor if stomach pain is more than mild and lasts. Over a dozen different NSAIDs are available and commonly used ones are naproxen, indomethacin, ibuprofen, diclofenac and others. Cox-2 inhibitors are a new type of NSAID. They tackle inflammation in a similar way, but have been developed to be safer for the stomach, but are costly. Cox-2s include celecoxib (Celebrex), meloxicam (Mobic), and etoricoxib (Arcoxia).
Corticosteroids (steroids, cortisone, prednisolone) are prescribed to reduce severe pain and swelling. They are given by injection or in pill form. Injections can bring quick relief, but can only be used several times in one year because they weaken bone and cartilage. Because of potentially serious side effects, corticosteroids must be prescribed and monitored by a doctor. You must never suddenly stop taking them.
Disease modifying antirheumatic drugs (DMARDs) are used in diseases like rheumatoid arthritis and lupus in the hope of inducing a disease remission and preventing further damage to joints. They are fairly safe in expert hands and if they are monitored for side effects by appropriate blood and urine tests. Drugs used to treat rheumatoid arthritis include sulphasalazine, methotrexate, hydroxychloroquine, and leflunomide.
Biologics include a group of drugs known as anti-TNF drugs such as infliximab (Remicade), etanercept (Enbrel), certolizumab pegol (Cimzia), golimumab (Simponi) and adalimumab (Humira) that block the action of a chemical called tumour necrosis factor (TNF), and are very effective for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and some other conditions. However, they are quite costly.In india several cheaper alternatives called “biosimilars” are now available. These are said to be effective and as safe as the parent drug, but are much cheaper. Other injectable biologics now available include rituximab (MabThera), abatacept (Orencia), ustekinumab (Stelara), secukinumab (Cosentyx), and tocilizumab (Actemra). Among biologics, etanercept (Enbrel) can be self-administered by the patient under the skin every week, and the same is true of adalimumab (Humira), which is taken once in 2 weeks. Rituximab is given into a vein as an infusion, two doses being generally administered 14 days apart, every six months. Certolizumab (Cimzia) is given under the skin as two injections at separate sites on Day 1, then one injection at Weeks 2 and 4, followed by 200mg every other week. Maintenance may be done with one injection every month. Golimumab (Simponi) can be given as one injection under the skin every month. Ustekinumab (Stelara)is just one injection under the skin every 3 months. Secukinumab (Cosentyx)is a monthly injection under the skin. Tocilizumab (Actemra)is given once weekly under the skin. New oral drugs are tofacitinib (Xeljanz) and baricitanib (Olumiant), given once or twice a day as tablets. In lupus, azathioprine, cyclophosphamide, mycophenolate, and other similar drugs have proved helpful. These drugs may take several weeks or months to work.
If you are thinking of having a baby, it is very important you discuss this with your doctor. Your doctor may recommend that you cease taking some of your drugs several months before conception. Other drugs may need to be stopped as pregnancy progresses, and some will be safe to take throughout pregnancy. Some adjustments in your medication may also need to be made if you decide to breast feed. If the husband is the patient, he may also need to stop some drugs before the couple try for conception.
Sleep medications may promote deeper sleep and help relax muscles. These drugs may help people with fibromyalgia sleep better. They are used in very low doses at bedtime.