by Doug Legge, Community Pharmacist

Arthritis is one of Canada’s most common chronic conditions, affecting 4 million Canadian residents. It is a leading cause of pain and physical disability. Arthritis means “joint inflammation.” This inflammation causes pain, stiffness, and sometimes swelling around the joints, which can make even the simplest everyday tasks difficult. Most people believe that arthritis is a disease of the late middle age and elderly populations. In fact, this disease has more than 100 variations and affects the very young to the elderly. The two most common and most recognized forms are osteoarthritis and rheumatoid arthritis.

Osteoarthritis (OA) is the most common form of arthritis in Canada. It begins with the breakdown of the cartilage (cushion between the joints) causing joint pain and stiffness. This breakdown results in bones rubbing against each other, which is painful and limits movement. It mostly affects middle-aged and elderly people, with pain ranging from very mild to very severe.

Rheumatoid arthritis (RA) is the second most common form of arthritis, and like OA it affects the joints and causes pain and stiffness. RA causes inflammation of the lining of the joints (called synovium) and results in swelling, warmth, and redness in addition to pain and stiffness. RA generally occurs in a symmetrical pattern, if one hand is affected the other most likely will be as well. Other symptoms of RA are loss of appetite, fever, loss of energy, anemia, and a general not feeling well. People with RA may experience periods of worsening symptoms (flares) or periods of feeling better (remission); however, RA can last for many years and lead to serious joint damage and disability.

The following questions will help determine if you have the symptoms of arthritis:

· Do you feel stiff when you get up in the morning or after sitting still for a long time?

· Does your knee, shoulder, elbow, hip and/or other joints hurt or ache without having been injured directly?

· Do you have trouble sleeping due to pain in your joints?

· Are you limited in which exercises you can participate due to joint pain or stiffness?

· Do you have difficulty with self-care activities (dressing, eating, bathing, or grooming)?

· Do you have a family history of arthritis?

If you answered yes to any of these questions, you may want to speak to your physician or pharmacist for advice on how to manage your symptoms.

Treatments

There are numerous treatments, both drug and non-drug, available to help you manage arthritis. Regular exercise offers many benefits to people with arthritis because it helps reduce joint pain and stiffness, helps build muscle around joints, and increases flexibility. Low impact activities, such as swimming and walking, are useful as is stretching to help keep muscles and tendons flexible. Maintaining a recommended weight reduces stress on joints, thus lessening pain.

Physical therapists can assist in restoring joint motion and muscle strength. Occupational therapists can provide advice on the use of aids to daily living such as reaching aids, canes, and walkers. The use of heat or cold therapies may help in reducing arthritis pain. Your therapists or pharmacist can offer advice on which one may be most beneficial to you.

There are many medications available to help reduce the pain and inflammation associated with arthritis. Some medications are available over-the-counter at your community pharmacy, while others require a prescription from you doctor.

Acetaminophen (Tylenol) should be the first choice in treating the symptoms of mild to moderate osteoarthritis. It reduces pain but does not reduce inflammation. It can be safely taken with most other medications, but there are maximum daily limits, which should be considered. Too much acetaminophen, taken over a period of time, can cause liver damage. Consult your pharmacist for advice before staring on a regular course of treatment.

Non-steroidal anti-inflammatory drugs (NSAIDS), such as ASA (Aspirin), ibuprofen (Motrin IB, Advil), are medications that help reduce pain and inflammation, and may be purchased without a prescription. Some other NSAIDS that require a prescription are naproxen, indomethacin, and diclofenac. Many NSAIDS have undesirable side effects, such as heartburn and indigestion and may increase the possibility of a gastric bleed. Again, you should consult your physician or pharmacist before embarking on a regimen of use.

COX-2 inhibitors (Celebrex, Bextra, Mobicox) are the latest development in the treatment of arthritis pain and inflammation. These medications work as well as NSAIDS but are less likely to cause gastric upset. In recent months, there has been some controversy surrounding the use of COX-2 inhibitors with the withdrawal of Vioxx due to cardiovascular events associated with some patients who were taking the drug over an 18-month period. At the time of preparing this article, the other COX-2 inhibitors have not been implicated with these findings and are being used safely as an alternative.

The use of corticosteroids (cortisone) is given by injection directly into the affected joint to reduce severe arthritic pain. This usually provides almost immediate relief; however, it should only be used a few times a year as it has its own set of side effects.

Rheumatoid arthritis sufferers may benefit from the use of disease-modifying anti-rheumatic drugs, which target cells in the immune system. These may be used in conjunction with an NSAID or prednisone to prevent inflammation. Biologic response modifiers are medications given by injection that target specific components of the immune system to reduce the symptoms and inflammation associated with RA.

The use of natural medicines has increased in recent years to ease arthritis discomfort. Glucosamine occurs naturally in the body and is believed to help with cartilage formation and repair. Chondroitin, similar to glucosamine, aids with cartilage elasticity. MSM, found in green plants, is said alleviate arthritis symptoms, but its effectiveness and safety have not been proven. Also, Devil’s Claw, which has been used for a variety of conditions, may have some anti-inflammatory properties but may have side effects and potential drug interactions. Before combining a prescription medication with a natural medicine, you should consult your pharmacist.

Arthritis is a disease that can only be diagnosed by your doctor and early diagnosis will mean getting a jump-start on treatment before the condition progresses. While arthritis can be a debilitating condition and can impose barriers to quality daily living, implementing an effective treatment plan can limit joint pain and discomfort and allow you to enjoy everyday activities. Ask your pharmacist about a management plan or consult the Arthritis Society (www.arthritis.ca) or the Arthritis Foundation (www.arthritis.org) for more information.

[1]. Excerpts from Shoppers Drug Mart Healthwatch: Living with Arthritis

-30-