Overview Of Medications Used To Treat Spinal Arthritis A Common Cause Of Back Pain Also Called Osteoarthritis Or Spondylosis
The type of arthritis that more commonly affects the spine is osteoarthritis, also called spondylosis. Other types of arthritis that are inflammatory in nature include rheumatoid arthritis and ankylosing spondylitis. Here, youll learn about medications for osteoarthritis that affects your neck , mid back , and/or low back .It is not uncommon for arthritic neck or back pain to be accompanied by other symptoms, such as tingling sensations, numbness, or muscle spasms. Photo Source: 123RF.com.
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Other Immunomodulatory And Cytotoxic Agents
Some additional immunomodulatory drugs are used in RA including azathioprine , and cyclosporin A . Rarely cyclophosphamide and d-Penicillamine are used. Because the potential of high toxicity, these agents are typically utilized for life-threatening extra-articular manifestations of RA such as systemic vasculitis or with severe articular disease that is refractory to other therapy.
Azathioprine has some activity in rheumatoid arthritis but may take 8-12 weeks to see an effect. It is a purine analog that can cause bone marrow suppression and lowering of blood cell counts particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors. Increased risk of secondary malignancy due to azathioprine is controversial. Screening for levels of the enzyme thiopurine methyltransferase is recommended before initiating therapy with azathioprine. Certain individuals have deficiencies in this enzyme that metabolizes azathioprine with a concomitantly increased risk of toxicitiy for the medication. Side effects include nausea, and alopecia. Blood tests to monitor blood counts and liver function tests are necessary for patients on azathioprine.
Prescription Medications For Spinal Osteoarthritis
- Prescription strength NSAIDs are stronger doses of a chosen non-steroidal anti-inflammatory drug that helps block certain pain-producing chemicals in your body.
- Muscle relaxants have a sedating effect and are prescribed to ease muscle tension.
- Opioids may be prescribed to manage severe pain.
- Lidocaine in an adhesive patch form may be prescribed for placement on the skin over the painful area.
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Can You Die From Arthritis
Arthritis isnt a fatal condition. However, some types of arthritis, like rheumatoid arthritis and lupus, can cause or contribute to other medical problems that are life-threatening. Examples of health complications that can be caused by arthritis include heart disease, lung disease, and kidney problems. Conditions like these are potentially fatal, not the arthritis itself.
The Role Physical Therapy Plays In The Process
Physical therapy is definitely beneficial. Improving range of motion and strength in the knee are helpful, but physical therapy for knee osteoarthritis has a large focus on strengthening the hips, explains Dr. Day.
Weak hips put more pressure on the knees. If your hips are strong, when you get up from a chair or go up and down stairs your knees have less work to do.
Everyone with knee osteoarthritis should consult a physical therapist, according to Dr. Day. Not only will you be taught the right kinds of exercises, a physical therapist also provides valuable instruction about using assistive devices and modifying activities to reduce pain.
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Talk To Your Doctor About A Knee Brace
Often a knee brace can help. Theres evidence to show that even a simple compression sleeve can decrease pain, says Dr. Day. These are a good way to start because you can get one at the drugstore.
You can also talk to your doctor about a more customized unloader brace. These take pressure off a portion of the joint. The brace thats right for you will depend on the severity and location of arthritis, whether primarily in the inner or outer side of the joint or in the kneecap.
Make Sure Your Doctor Knows About All Medications Vitamins And Supplements
Talk to your doctor about which pain medications are best for you. Be sure to let your doctor know what other medications you are taking, even for other health problems. Besides other drugs you take, tell your doctor about any vitamins, supplements or herbal products you use. This can help you to avoid drug interactions. Here are other .
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How Is Osteoarthritis Treated
Treatment for osteoarthritis includes lifestyle changes and medications.
All patients with osteoarthritis should be enrolled in an exercise program because physical activity increases blood flow, and joints and muscles are supplied with more oxygen. Swimming, Tai Chi and weight-based exercises are usually suitable for people with osteoarthritis, although a physician should be consulted before starting any exercise program.
Weight loss can lower the risk of pain in weight-bearing joints and orthotics, devices that help to align joints orthotic shoe inserts, splints, and braces can help with movement. Heat or cold therapy can also relieve joint swelling.
Medications for osteoarthritis may include:
- Acetaminophen
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Hot Shots: New Injectable Treatment Options For Arthritis Pain
Theres good news for the more than 54 million Americans who have been diagnosed with some form of arthritis: a new class of medications are providing quick, safe relief from pain and swelling.
Types of Arthritis
There are more than 100 types of arthritic conditions. Symptoms include inflammation and swelling of the joints, which causes pain, discomfort, and movement issues. One of the biggest misconceptions about arthritis is that it only affects seniors, but two-thirds of arthritis patients are younger than 65 years of age. It can even affect children. As a rheumatologist, we are trained to diagnose and treat every type of arthritis in patients of all ages.
There are two types of arthritis:
Treating Inflammatory Arthritis
For inflammatory arthritis, treatment is focused on stopping the immune system from attacking the joints. Because each persons body responds to treatment differently, there are two classes of medications that we use: Disease Modifying Anti Rheumatic Drugs and biologic agents. An example of DMARD is methotrexate.
Treating Non-Inflammatory Arthritis
For patients with non-inflammatory arthritis like osteoarthritis, the prevailing treatment had been aspirin until non-steroidal anti-inflammatory drugs were developed 50 years ago. This class of medications include Motrin, Advil, naproxen, and ibuprofen.
Over-the-Counter Options
Some options include:
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Nsaids Vs Opioids: Was There A Clear Winner
A recent study compared oral NSAIDs and oral opioids for relief of osteoarthritis pain. Researchers at Harvard-affiliated Brigham and Womens Hospital performed a meta-analysis . They included clinical trials in which patients with knee osteoarthritis were chosen at random to receive treatment that lasted at least 2 months.
The researchers carefully chose which studies to include, and two members of the team independently reviewed each study and extracted the data. They selected studies that used a common, well-validated, and widely-accepted measure of pain . Data from over 5,500 patients were included, and the researchers found that, on average, oral NSAID treatment reduced pain by around 18 points on the WOMAC scale. Treatment with less potent oral opioids also reduced pain by around 18 points, and potent oral opioids reduced pain by around 19 points on the WOMAC scale. Since, on average, patients started out with pain ratings of around 50-60 out of 100, each of these medications achieved around a 30% reduction in patients pain.
What Foods Make Arthritis Worse
Inflammatory foods like refined sugar, alcohol, refined carbs, and fried foods tend to put stress on the body. When the body tries to process these foods, it becomes inflamed and makes arthritis worse. Several dietary items can cause or worsen gout arthritis in susceptible people. If you have gout or a strong family history of it, ask your doctor about this.
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Nutritional Supplements And Dietary Changes
There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it’s important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There’s also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
For example, calcium and vitamin D supplements may help prevent osteoporosis if you’re taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.
There’s some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Further information
- National Rheumatoid Arthritis Society : diet and rheumatoid arthritis
Page last reviewed: 28 August 2019 Next review due: 28 August 2022
What Does Arthritis Feel Like
On the other hand, rheumatoid arthritis is not directly linked to the ageing process. The latter type of arthritis causes the inflammation of the joints. It is not understood why the synovial membrane becomes inflamed. This inflammation is accompanied with swelling, heat, and reddening, yet the intensity of the symptoms also varies from person to person. Rheumatoid arthritis is known to cause a myriad of discomforts all over the body amongst victims. These discomforts include fatigue, fever and weight loss. It causes minor discomfort in its mild state. It gets complicated in its more serious state. You are likely to experience severe joint pains and consequent damage. Stiff and swollen joints are common among the victims of the condition.
In gout, there is usually a collection of needle shaped crystals which collect in the joints. These crystals are made of uric acid. They result from the bodys inability to metabolize purines. Purines are naturally occurring chemicals which are common in such foods as liver, kidney and anchovies. Gout arthritis is known to target overweight, inactive people, particularly men over the age of thirty-five.
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Prescription Medication For Arthritis
Arthritis is a chronic condition that affects millions of Americans. Characterized by inflammation of the joints and surrounding tissues, arthritis symptoms can range from uncomfortable to debilitating. There are several types of arthritis, the most common are osteoarthritis and rheumatoid arthritis. Osteoarthritis is caused by the break down of cartilage surrounding joints. Rheumatoid arthritis is an autoimmune disorder where the bodys immune system attacks the lining of the joints. Gout, infections, psoriasis, lupus, and other diseases can also lead to forms of arthritis. Arthritis symptoms include: swelling, pain, varying degrees of stiffness, limited range of motion, and skin redness. Treatment is available in the form of prescription medications to relieve symptoms and improve joint performance. Below are the major categories of prescription medications for arthritis:
Analgesics
Hyaluronic Acid Substitutes
Disease Modifying Anti-Rheumatic Drugs
Analgesics relieve pain, but do not treat inflammation. Acetaminophen is the most commonly used analgesic and can be purchased over-the-counter in the from of Tylenol and Excedrin. Higher dosage acetaminophen in combination with other other drugs such as Oxycodone or Tramadol require a prescription. Brands names for analgesics: Codeine, Ultram, etc.
Biologic Therapy For Arthritis
Approved to treat certain forms of inflammatory arthritis such as psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis, biologic response modifiers work by altering the function of the immune system that attacks the joints.
These drugs must be administered by intravenous infusion or by an injection, and they are more expensive than other arthritis drugs.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and keep it from freezing or excess heat.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
How To Use Pain Medications Properly
There are two types of over-the-counter pain medications that can be used for osteoarthritis. Acetaminophen is a pain reliever but not an anti-inflammatory. It may help with mild knee pain.
NSAIDs can be more effective because they both relieve pain and reduce inflammation. However, they come with potential side effects and risks. NSAIDs can irritate the lining of the stomach, which may lead to an ulcer or other stomach problems. They also can impair kidney function. Some NSAIDs can increase blood pressure. And theyve been linked to an increased risk for heart disease.
Because of the risks, Dr. Day cautions against using NSAIDs regularly over long periods of time. Instead, she uses NSAIDs for her patients in two ways. First, people who have a flare-up of pain can take them regularly for three to five days and then stop. Second, they can be used over the long term, but only occasionally, maybe a couple of times a week as needed.
If youre taking NSAIDs several times a day for long periods of time, Dr. Day advises reducing their use by maximizing the other treatment strategies. She also suggests trying a topical NSAID, such as diclofenac , which has fewer potential side effects.
Opioid pain relievers are discouraged for long-term treatment of chronic knee pain. The milder narcotic tramadol might be appropriate for occasional use in some people, says Dr. Day.
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Supplements For Those With Mild Pain
For people with milder pain, Dr. Day suggests trying supplements, such as the combination of glucosamine and chondroitin or the spice turmeric.
The evidence for glucosamine and chondroitin is mixed, but they are safe. So it might be worth trying. However, people with a shellfish allergy may not be able to tolerate them. Any effect wont kick in right away. Dr. Day recommends trying it for six to eight weeks. If you notice improvement, great if not, then stop it, she says.
Turmeric has anti-inflammatory properties, and there is some evidence for its usefulness for painful knee arthritis. You can add turmeric to your food or take it as a supplement. It can thin blood, so people who take a blood thinning medication should not use turmeric.
What Are The Precautions Of Arthritis Medicine
Even the best medicines for arthritis pain can have side effects. As such, it is important to exercise precaution.
Some of the side effects you need to watch out for are as follows:
For acetaminophens dizziness, nausea, constipation, vomiting, and lightheadedness for prescription-strength acetaminophens. Non-prescription acetaminophens have no side effects when taken as directed. Taking in more than the prescribed dosage, however, can lead to liver damage. It will also help if you consult with your doctor before taking acetaminophen to make sure that it will not react with whatever other medication you are seeking.
For corticosteroids bone loss, cataracts, increase blood sugar levels and elevated levels of blood fats.
For NSAIDS edema, stomach upset, possible increased blood clots risk, stomach ulcers, increased risk of stroke and heart attack, heartburn.
For DMARDS increased susceptibility to infections, and stomach upset. Some brands have certain side effects, too.
For biologics when biologics are injected, one can develop an adverse or adverse reaction to the injection such as swelling and redness nausea, rapid/weak pulse, vomiting, and difficulty in breathing.
All these side effects can be prevented and managed if you consult with your doctor first before choosing any product.
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Topical Diclofenac May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- dryness, redness, itching, swelling, pain, hardness, irritation, swelling, scaling, or numbness at application site
- acne
- fast heartbeat
- excessive tiredness
Topical diclofenac may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Injections Are Another Low
If other strategies dont provide enough relief, injection therapy is an option with low risk.
A corticosteroid injection involves delivering this anti-inflammatory drug directly to the knee. The benefits are typically short lived. But it varies from person to person. I tell my patients the pain relief can last anywhere from a week to a year, says Dr. Day. One cautionary note with corticosteroids is the potential to increase blood sugar, which is a concern for people with uncontrolled diabetes.
For a possibly longer lasting effect, an injection of hyaluronic acid can be tried. Hyaluronic acid is a substance that healthy joints have a lot of and arthritic knees dont, says Dr. Day. It takes longer to start working than a corticosteroid injection, but the effect often lasts six months to a year.
Currently, research is being done on the effectiveness of platelet-rich plasma , which is not yet covered by insurance. PRP involves drawing some blood, spinning it in a centrifuge, and injecting part of it into the knee.
If youre not able to get your symptoms under control with a combination of these measures, she says, it could be time to talk to your doctor about surgery.
This article originally appeared in Cleveland Clinic Arthritis Advisor.
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