As yet, there's no single cure for most rheumatic diseases, though many conditions can be effectively controlled. Research has led to great improvements in this area.
Treatments must be tailored to the needs of each individual, because the type, severity and impact of arthritis varies from person to person. You and your healthcare professionals will need to balance the risks and benefits of each treatment, based on your personal needs and circumstances.
Drugs for arthritis
In the case of inflammatory arthritis, the sooner drug therapies are begun the more effective they're likely to be. This can reduce the risk of long-term damage to joints and bones.
Drug therapy can be divided into two main groups:
- drugs that treat the symptoms of arthritis (for example pain and stiffness)
- treatments that suppress inflammatory disease and may improve the outcome.
Drugs may be available under different names. Each drug will have an approved (scientific) name – these are the names we use in these pages. But different manufacturers may give their own brand or trade name to a drug – for example, Voltarol is a brand name for diclofenac.
Unfortunately there's no effective treatment that doesn't occasionally cause side-effects. Minor side-effects aren't uncommon but serious side-effects are rare. For more information on the possible side effects follow the links below for the different types of drugs.
If you have any concerns about your treatment or its side-effects you should discuss these with your GP, rheumatology consultant, a rheumatology nurse or a pharmacist.
Drug therapy can be divided into two main groups:
1. Drugs that treat the symptoms of arthritis (for example pain and stiffness):
- Painkillers (analgesics) such as paracetamol reduce pain. These can be used for all types of arthritis. It’s best to take them before an activity that's likely to aggravate the pain rather than wait until your pain is very bad. They're also more effective if you take them regularly during a flare-up of pain. While some painkillers are available over the counter, if you're using these frequently or they aren't working, your doctor will be able to advise you about alternatives.
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce stiffness and swelling, as well as relieving pain. They reduce inflammation, but can also be helpful in types of arthritis where inflammation isn't the main problem (for example osteoarthritis). They can be used for short spells when your symptoms flare up, and in combination with analgesics if you need extra pain relief. You should take the lowest dose of anti-inflammatory drugs that controls your symptoms, and for the shortest time possible. NSAIDs can cause digestive problems (stomach upsets, indigestion or damage to the lining of the stomach) so in most cases NSAIDs will be prescribed along with a drug called a proton pump inhibitor (PPI), which will help to protect the stomach. NSAIDs also carry an increased risk of heart attack or stroke. Different forms of NSAIDs carry a varying degree of risk. Although the increased risk is small, your doctor will be cautious about prescribing NSAIDs if there are other factors that may increase your overall risk - for example, smoking, circulation problems, high blood pressure, high cholesterol or diabetes. Some NSAIDs are available as creams or gels that you can rub on the affected joint.
- Steroids are powerful, natural anti-inflammatory agents. They can be injected into painful joints or into the muscles, and can also be used in tablet form. They may also have some effect on the way the disease progresses. Steroids are most commonly used to treat inflammatory arthritis and connective tissue disease, but they're occasionally used for the short-term treatment of osteoarthritis. This is usually done as a joint injection to ease a flare-up in a single joint, or in inflammatory arthritis you may be given a steroid injection into the muscle which works throughout your body. Steroids can have side-effects - especially if used for a long time - as well as great benefits. One of the possible side-effects of steroid treatment is osteoporosis. Because of this, steroids are commonly used only for short periods. If you do need steroid treatment on a long-term basis you may be given other tablets with them to protect against osteoporosis. If you wish to stop using steroids you should discuss this with your doctor as you will need to reduce the dose gradually.
2. Treatments that suppress inflammatory disease and may improve the outcome:
- Disease-modifying anti-rheumatic drugs (DMARDs) suppress inflammation and treat the underlying disease. They are used to treat inflammatory types of arthritis and occasionally types of connective tissue disease. It may be several weeks before they have any effect so anti-inflammatory drugs are often used alongside them. It's usual to have regular blood tests while you’re on DMARDs, and your blood pressure, urine and eyes should also be checked regularly. These drugs can be stopped for short periods without harm, for example, if you’re on a course of antibiotics for an infection.
- Biological therapies are a newer class of drug. They’re used in the treatment of inflammatory arthritis when other types of disease-modifying drugs haven't been effective. They’re unique in the way they work, as they were made specifically to block messages between the white blood cells that cause inflammation.
Drugs are often beneficial, but they need to be used carefully, according to your doctor's instructions. If you're worried, or think that they may be causing side-effects, consult your doctor.
Physical therapies for arthritis
Often your doctor will recommend a course of physical therapies to help you overcome some of the symptoms of your arthritis. These may include any or all of the following:
- hydrotherapy – exercises in a warm-water pool. The water supports your weight and therefore puts less pressure on your muscles and joints.
- physiotherapy – helps to improve your general fitness and muscle strength, through specific exercises tailored to your condition and individual needs. It can be combined with pain-relieving treatments such as ice or heat packs and massage.
- occupational therapy – practical advice on managing everyday tasks, choosing specialised aids and equipment, protecting your joints from further damage and managing fatigue.
Surgery for arthritis
Surgery may be necessary and advisable if the damage to your joint is severe enough to cause difficulties in your everyday life, and when other treatment isn’t reducing the pain. Joint replacements are now very sophisticated and successful. Many different joints, including hip, knee, shoulder and elbow, are routinely replaced in people with advanced arthritis. There are also a number of other pain-relieving or reconstructive operations which can be helpful.
Some surgery can be performed with needles and implements without fully opening the joint up. This is called arthroscopy or is sometimes referred to as keyhole surgery. The surgeon will make small (less than 1 cm) incisions to allow a special light and camera to look at the inside of a joint. This can be seen by the surgeon on a television screen. Arthroscopy can be used to help with diagnosis or can form part of treatment.