Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
Still another way to manage serious inflammation is with steroids, either in pill form (prednisone) or as cortisone injections directly into the joint. RA patients are often put on prednisone, because it works throughout the body, but doctors don't like to use it for extended periods, because it has been linked to diabetes, high blood pressure, and osteoporosis. OA patients, who don't have a system-wide illness, can get the local injections. They relieve pain but don't stop the underlying cartilage degeneration; in fact, if repeated more than two or three times a year they can make it worse.
6. DISEASE-MODIFYING DRUGS
RA patients have other medication options, including newer drugs that block their immune systems from attacking their joints. Methotrexate, a mild immunosuppressant originally developed as a cancer drug, has become a valuable tool in the past decade. Now doctors have started combining this drug with others, like Enbrel or Remicade, which inhibit inflammatory immune system proteins. About 70 percent of patients given this combo soon after their diagnosis respond well, with big decreases in pain and big increases in their ability to function.
Methotrexate alone has made a huge difference for Cindy Morris, who was diagnosed with RA a year ago. The 37-year-old Peoria, Ill., woman had severe pain in her heels, ankles, and fingers. "But today it's unbelievable how good I feel. I forget I even have it," she says. "It's a lot different from what my mom has gone through." Morris's mother, Dorothy Maloney, 61, was diagnosed with RA a quarter century ago. "I started on coated aspirin, taking 10 pills a day, and it didn't help. Then ibuprofen, which was prescription back then." Today she has trouble walking because her toes have become all swollen and knobby--as have her fingers, making it difficult for her to hold a fork or zip up a dress. Maloney thinks her daughter will have a different future, and so do doctors.
7. OPIOID ANALGESICS
The demise of Vioxx has sent some patients, who have not gotten relief from NSAID s and who have intermittent, not constant, pain, to opioids like Darvocet and Ultram. For many, the pain is worse at night, and though drowsiness is an opioid side effect, that doesn't matter at bedtime. But doctors say patients are often scared to take these mild drugs, even though they've been in use for decades and have very good safety records. They are mostly afraid of addiction. Yet research has shown that addiction is more a function of personality than it is of the drugs, especially when they are used intermittently.
8. JOINT LUBRICATION
Because so many people now worry about taking oral medications, injections of substances called hyaluronans into the joint are growing in popularity. "It's like oil within your knee that lubricates it," says orthopedic surgeon Snibbe. It may also act as a chemical barrier, blocking cells involved in the inflammatory process. Injections are not for everyone, because not everyone gets relief. The best candidates have moderate, rather than severe, disease, with some cartilage damage but no bone-on-bone-crunching.
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