The treatment of arthritis depends on the cause, severity of symptoms and general health of the patient. Although physicians generally propose different combination therapies, pharmacology plays the leading role – rehabilitation is not able to inhibit the development of inflammation, while surgical procedures are applicable to extensive joint injuries. In the case of arthritis (regardless of the type of disease), several drugs from different groups are generally used. The idea is to treat the patient comprehensively – another drug will silence the symptoms of inflammation, another will stop or delay further damage to the joint, another will address the causes of the disease. The type of medication depends to a large extent on the general health of a patient with arthritis – drugs not only help, but also cause more or less severe side effects. Let’s check what pharmacotherapy of the affected joints looks like.
In the treatment of infectious arthritis, the cause of inflammation is strived to be eliminated – usually it involves bacteria and viruses, less often fungi and parasites. The choice of drugs depends on the source of infection. If the bacteria are responsible for the infection, the doctor chooses the optimal antibiotic based on the blood culture. With viral arthritis, non-steroidal anti-inflammatory drugs or glucocorticoids are usually administered. In other cases, antifungal and antiparasitic drugs are used accordingly. In addition, the patient can take painkillers that will relieve the symptoms associated with the infection.
After elimination of the cause of arthritis, drugs are usually not needed anymore, although the treatment may last for a long time – for example in the case of fungal infection, taking drugs may last six months, and infection with tuberculosis may require up to 9 months of treatment. In addition, it should be taken into account that reactive arthritis can lead to permanent damage to joint structures that require further treatment.
Arthritis in the course of rheumatic disease (RA, JIA, ASH, osteoarthritis) requires two-way treatment: symptomatic and inhibiting the progression of the disease. The first group includes glucocorticoids (abbreviated as GKS) and non-steroidal anti-inflammatory drugs (NSAIDs).
Although some NSAIDs are also available without a prescription, they should be taken under medical supervision due to a long list of complications and contraindications. Drugs for arthritis in this group contain various active substances, including: acetylsalicylic acid (popular aspirin), naproxen, ibuprofen, diclofenac, ketoprofen, celecoxib, nabumetone. These drugs used in too high doses and for a long time can seriously harm the body – a number of side effects include gastric ulcer and perforation, anemia, kidney failure, bleeding, headaches, depression. However, one can not forget about their beneficial effects on arthritis. NSAIDs inhibit inflammatory processes, relieve pain, reduce swelling. In addition, taken in small doses, reduce the risk of heart attack and stroke.
Symptomatic treatment of rheumatism may require the administration of glucocorticoids – these are very strong drugs, which is why they are recommended only when the disease is exacerbated and when there is no response to NSAID treatment. Preparations from this group work quickly, effectively relieving pain and other symptoms of inflammation. They can be administered orally or in intraarticular injections when the severity of inflammation involves single joints. However, due to the numerous side effects, GSK is administered for a short period, with at least three months between treatments. Long-term steroids increase the risk of many diseases (including osteoporosis, hypertension, diabetes, obesity, vision disorders, and even mental illness), therefore the treatment of arthritis should focus on safer drugs modifying the course of the disease.
In the case of rheumatic diseases, symptomatic treatment is not enough. NSAIDs and GKS drugs silence the symptoms and reduce inflammation, but they do not stop the progression of changes in the joints. In patients with arthritis, drugs should primarily counteract further damage and thus disability. Such action is taken by means of the group of classic disease-modifying drugs (LMPCh), hence, among others: gold salts (formerly used), antimalarial drugs, immunosuppressive drugs (cyclosporin, methotrexate, sulfasalazine, leflunomide). In order to obtain the best results of the therapy, the drugs in this group should be introduced immediately after confirming the diagnosis (preferably up to 3 months). Unlike steroids and NSAIDs, these drugs are safer for the body and can be used chronically. Unfortunately, they do not provide full cure, because after they are discontinued, the disease is still progressing and they are not able to completely prevent the disability. Because they start to work only after 1-2 months, patients often have to take them together with NSAIDs or steroids.
In some patients with chronic arthritis, traditional medications do not trigger the expected response – pain is still perceptible and the disease continues to progress. In this situation, the physician can decide on the implementation of biological drugs, most often used together with synthetic drugs (usually methotrexate). Biological therapy is also introduced in patients with numerous symptoms that indicate high activity of the inflammatory process and in poor prognosis. These drugs not only relieve pain but, above all, inhibit joint damage and contribute to the remission of the disease. They operate slightly faster than classical LMPCh, but due to the high costs of therapy they are used only in special cases. Although drugs from this group are less invasive than NSAIDs and GCs, they can also cause unwanted side effects – above all, they increase the susceptibility of the body to infections (they have a strong immunosuppressive effect) that may pose a threat to the patient’s health and life.