The right treatment can get you back to your old self again. Here are the most common treatments
So, you’ve got a diagnosis of arthritis. What you probably want to ask now is can it be treated, and how? Well, the good news is it can be treated.
There are a range of levels of treatment, from simple painkillers like paracetamol to specific arthritis medication prescribed by a rheumatology doctor. These are explained below.
In some cases, surgery might be recommended, though this happens far less often now. Ongoing research has given doctors a greater understanding of how to control the different types of arthritis, and new medicines have increased the treatment options available. Both have helped to reduce the number of people at a late stage requiring surgery. It is now only in a minority of cases that surgery may be recommended as a way to improve your ability to function and get on with life independently, with less discomfort or restriction.
You may be prescribed painkillers such as paracetamol, codeine or co-codamol. They’ll help control the pain you’re in, but have to be taken regularly to maintain this effect.
Your GP can advise and prescribe them for you, so you will know how to take them safely to get the best effect. A pharmacist at your local chemist may also be a helpful person to talk to about your medicines.
Some painkillers may make you feel drowsy or a bit “spaced out”. You may find that once another drug treatment takes effect, you don’t need painkillers as much.
Medicines in this group help to reduce pain, stiffness and swelling. There are loads of different NSAIDs but common ones include ibuprofen, naproxen and diclofenac. They have to be taken regularly to get the full effect.
Some people may benefit from taking a PPI (proton pump inhibitor) when taking NSAIDs. PPIs protect the stomach from possible side-effects. Ask your GP or consultant if this could apply to you.
The most common of these is methotrexate. You have to take this for a while before it takes effect – but it has been proven to reduce inflammation, which in turn reduces joint damage, and can slow down the progression of arthritis.
Research has shown it to be very effective, although it needs to be carefully and regularly monitored for the length of time it is prescribed.
Patients commonly take methotrexate for several years. It can be taken as a child or an adult, in tablet or injection form.
It’s not just methotrexate, of course. There are many different DMARDs that can work very effectively, for a length of time, to gain good control of your condition and protect your joints for the long term. In fact, it may take a little time for your medical team to find exactly the right DMARD, or combination of DMARDs, for you. It’s best to stay as positive and patient as possible during this time.
Arthur’s Place founder, Advanced Rheumatology Nurse Practitioner Andrea McBride advises that you also give your medicine time to work properly: “Try not to expect too much, too soon, from these medicines. They take a little while to kick in, so don’t judge them too quickly. Let your rheumatology team know how you are getting on, because they can advise about pain relief to keep you comfortable in the interim.”
For some a medicine may cause side-effects. There may be ways to alleviate this, to allow your body time to get used to the treatment that may be working the best for you. According to Nurse McBride: “With a little patience, the right support and a positive outlook, the right medicine can make all the difference.”
Finally, remember that while it is often tempting to compare your medicine plan to others, either someone in your family with a similar condition or other people with arthritis that you meet along the way, it can be unhelpful too. One size doesn’t fit all; what works for you may not be what works for someone else. Plus, the progression of the condition for one person is never identical for the next person. It may seem that you are taking the same path but it doesn’t mean your treatment should be the same. Every case is individual.
These are newer medicines which have been around for the last decade or so. They’re commonly used in patients who have a limited response, no response, or are unable to tolerate methotrexate or similar medicines.
Biological therapies can slow down the progression of arthritis and in turn reduce pain, swelling and stiffness. Biological therapies are more commonly given as an injection, though some may be given in hospital via a drip (infusion).
These are drugs that help to block certain key points of the inflammatory pathway. They can be very effective, but they need careful supervision and they do have potential side-effects. Common biologics can be found in our A-Z of arthritis medicines.
Some people are reluctant to take various medicines for a number of different reasons but it’s important to understand why you’re taking this medication and what they can do for you. At the end of the day it’s your body – so make sure you have all the facts. If you have any problems with your drug treatment, talk to your rheumatology team – that’s what they’re there for.
Young people with arthritis may be given steroids. This can be in the form of tablets, through a drip, or in two different forms of injection: either into a muscle to get generalised relief, or into the affected joint, for targeted relief. Like other drug therapies, this reduces inflammation, pain and stiffness.
An injection into a joint can be done under general anaesthetic for young children, but as you get older you can have the injection with a local anaesthetic. Resting the affected joint after the procedure, for between 24-48 hours, can make all the difference to how long it will last. The injections can be effective for several months and have few side-effects. Your rheumatology nurse can advise you further.
If you are prescribed steroid tablets it may be necessary to carry a Steroid Card, to inform others in an emergency that you are taking steroids. Your pharmacist will provide you with one of these, if appropriate for you, when you collect your prescription.
Steroid tablets may be prescribed as a short course to help quickly gain control if you are in a flare. For some they may be prescribed for a longer period of time depending on your circumstances and how you have responded to your other medication – either way it is very important that you always seek medical advice about how and when to stop taking them. The majority of people will be recommended a gradually reducing dose to allow your body to readjust. Never dabble and always get advice from your doctor before doing anything.
The need for surgery for arthritis is quite unlikely these days, particularly if you have been treated quickly.
Dr Moorthy Arumugam, consultant rheumatologist at the University Hospitals of Leicester NHS Trust, says: “Nowadays with modern targeted treatment, surgery is less often required.”
However, some people with arthritis may benefit from surgery. It is important to note that surgery is never rushed into, and is often only necessary as an absolute last resort for the few patients who don’t respond to other treatments, or experience complications.
Types of surgery that may be recommended are:
- Synovectomy – This is done to remove inflamed joint tissue (synovium) that is causing unacceptable pain or is limiting your ability to function. The procedure may be done using arthroscopy (keyhole surgery).
- Hip, knee, shoulder or elbow joint replacement – Damaged joint surfaces are replaced with artificial parts. For some this type of surgery may significantly relieve pain, increase mobility and improve function.
- Foot, ankle, hand or wrist surgery – Occasionally patients may need this type of surgery, although it is possibly less common than surgery to the bigger joints.
Your Rheumatologist or GP can refer you to an Orthopaedic Consultant for opinion and advice.