Conditions & Treatments

Conditions:

• Arthritis: The word means, 'inflammation of the joints', but it is used as a general term which acknowledges that something is wrong with the body's musculoskeletal system. Diagnosis of the exact disease among the over 200 or so different types of arthritis is often difficult and may take some time.


• Rheumatoid Arthritis: A systemic form of inflammatory arthritis affecting one's general health as well as a variety of one's joints. There are very specific criteria for its diagnosis. Modifying treatment is becoming more and more effective. If left untreated the disease could affect any anatomical part of the body.


• Osteoarthritis: A degenerative form of arthritis found mainly in older patients and resulting either from overused or previously damaged joints or due to hereditary factors.


• Osteoporosis: Thinning of the bones seen mostly in postmenopausal women and older people, causing weak and easily broken bones, especially of the hip, spine and wrist.


• Gout: A very specific form of arthritis due to uric acid crystal deposits in joints and in soft tissues too. Is eminently treatable in this day and age.


• Systemic Lupus Erythematosis (SLE, or Lupus): an autoimmune disease primarily affecting the skin and vascular system. A disease of primarily young women aged between 15-40 with a strong familial tendency among first-degree relatives. In the US, black and Hispanic people are the main sufferers and in South Africa, people of mixed lineage are more affected than either blacks or whites. If left untreated the prognosis is not a happy one so seek the very best and latest treatment available.


• Fibromyalgia Syndrome: A chronic form of arthritis where the primary symptom is widespread aching in addition to pain on applying pressure to a range of identified tender points in the body. Its origin is unknown, although there are psychological factors involved.


• Polymyalgia Rheumatica: A specific condition seen mostly in patients of caucasian descent older than 50, causing severe pain and stiffness of the hip and/or shoulder girdle and characterized by high blood sedimention rates in samples. It responds dramatically to small doses of prednisone and leaves no damaged joints or tissue.


• Systemic Sclerosis (Scleroderma): A collagen-vascular disease causing tight skin as well as organ damage in some cases. It is vital to Seek advice early on. Soft Tissue Rheumatism: Inflammation in the muscles or adjoining tendons or bursas leading to pain and discomfort in the affected area.


• Rheumatism: One way of describing aches and pains in muscles and joints.


• Rheumatology: The medical discipline that specializes in all types of arthritis, rheumatism and associated disorders.

Treatments:

Drugs used to treat arthritis:

Some drugs control symptoms. For example, analgesics reduce pain and anti-inflammatory drugs reduce swelling and stiffness. Other drugs affect the disease itself. A combination of drugs may be used to treat arthritis.

Groups of drugs used to treat arthritis:

Drugs used to treat arthritis can be divided into four broad groups:

Painkillers (analgesics)

These relieve pain. They are used for many different types of arthritis and are often used together with other drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These reduce inflammation of the joint as well as pain. They are used for many different types of arthritis, often with other drugs. If one type does not work, your doctor may try another. They are usually given by mouth but may also be given by suppository or in slow-release preparation (also called ‘retard’). ‘Slow-release’ means that the drug is gradually absorbed by the body a little at a time, rather than all at once. NSAID creams or gels may also be used by rubbing onto the skin over a painful joint or muscle.

NSAIDs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period of time. They should therefore only be used with caution and only continue to be used if they are controlling your symptoms. You should not take them if you have a history of indigestion or stomach ulcers.

Some of the newer NSAIDs known as COX-2 inhibitors (or ‘coxibs’) are less likely to cause stomach problems. However, several have been linked with increased risks of heart attack and stroke, so they are not suitable for people who have had a heart attack or stroke in the past, or for people who have uncontrolled high blood pressure.

Disease-modifying anti-rheumatic drugs (DMARDs)

This group of drugs (sometimes called ‘second-line drugs) includes gold, chloroquine, lefluomide, penicillamine and sulfaslazine. They are used mainly in the treatment of rheumatoid arthritis but also in some other rheumatic diseases. They reduce pain, swelling and stiffness. They do not work at once but may take several weeks to work. If you do not do well on one of these drugs, or if you develop any side-effects, then your doctor may try on of the others.

Another group of disease-modifying drugs are immunosuppressant drugs. They are termed ‘immunosuppressant’ because they suppress the immune system (the body’s own defence system). They include azathioprine, ciclosporin, cyclophosphamide and methotrexate. Because they affect the immune system they may produce side-effects, and so need careful monitoring. Immunosuppressant drugs are often used to treat cancer but you can be reassured that your arthritis has nothing to do with this disease, and when used for arthritis lower doses of the drug are administered.

Biologics

A new group of drugs called biologics is the anti-TNF drugs – adalimumab, atanercept and infliximab. Anti-TNF drugs can reduce inflammation in people with rheumatoid arthritis. These drugs are currently only being used in people who have not responded to other disease modifying drugs. The B-cell drug rituximab is the newest drug in this group, which is known as biologics.

Corticosteroids (steroids)

Corticisteroids are very effective in controlling inflammation and may have some disease-modifying effects. However, if used for a long time (many months) or in high doses they produce side-effects. For this reason doctors try to avoid these drugs or use them in as low a dose as possible.

Osteoporosis (thinning of the bones) can be caused by steroids and for this reason your doctor may prescribe treatment to protect your bones while taking steroids. However, they do have an important role to play in many different rheumatic diseases. For example, if one particular joint is inflamed, your doctor may inject it with a steroid preparation. Steroids can also be injected into a vein or a muscle.

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