How Chondroitin works on Arthritis:

Chondroitin is another substance needed for the strength and resiliency of the cartilage.  Research show that Chondroitin blocks the enzyme which causes the degradation of cartilage . It also has the ability to fight inflammation and stimulates the production of cartilage tissues. Chondroitin and Glucosamine works synergistally and they should be taken together.

Side Effects and Precautions of Chondroitin:

The most common side effect is increased intestinal gas and soft stools. It may cause bleeding in people who have bledding disorder. Take extra caution if you have diabetes or if you are allergic to shellfish. Some cases of nausea and heartburn is reported. Chondroitin may also cause bleeding in persons with bleeding disorders.

Forms, Dosage and Brand Names of Chondroitin:

Adults: Chondroitin sulfate: 1200 mg daily taken as 400 mg capsules or tablets three times a day. Glucosamine HCl dosage: 1500 mg daily taken as 500 mg capsules or tablets three times a day.

Pregnant Women: Consult your doctor before taking this medication

Children: There is no proven effective dose in children.

References about Chondroitin and Arthritis:

Reginster JY, Gillot V, Bruyere O, Henrotin Y. Evidence of nutriceutical effectiveness in the treatment of osteoarthritis. Curr Rheumatol Rep 2000; 2: 472-77.

Constantz RB. Hyaluronan, glucosamine and chondroitin sulfate: roles for therapy in arthritis? In: Kelley WN, Harris ED, Ruddy S, Sledge CB, eds. Textbook of rheumatology. Philadelphia: WB Saunders, 1998.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis: the role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am 1999; 25: 379-95.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283: 1469-75.

Page last updated: May 02, 2009

How Glucosamine works on arthritis:

Glucosamine sulfate exists around the cartilage cels naturally. Chemically, glucosamine is an amino sugar which the body produces and then  carries it to connective tissues. The human body can produce the amount of glucosamine necessary for the maintennance of healthy joints. As the body ages,  it also  loses its ability to  generate enough glucosamine  to keep the joints in very good health. Research shows that supplementation of glucosamine may slow down the progression rate of arthritis by helping the joint cartilage healthy. Glucosamine also helps in easing the pain caused by osteoarthritis, rehabilitation of cartilage, joint repair, stimulation of proteoglycans and glycosaminoglycans, and renewal of synovial fluid.

Side Effects and Precautions of Glucosamine:

Glucosamine is fairly safe and does not carry the worrying side effects of NSAIDs. Some people may experience stomach cramps or loose stools.

Forms, Dosage and Brand Names of Glucosamine:

Adults: 1,500 mg a day given as 500 mg tablets or capsules three times a day.

Pregnant Women: It is best not to take glucosamine until more is known about the effects of this supplement.

Children: Not recommended

References about Glucosamine and Arthritis:

Reginster JY, Gillot V, Bruyere O, Henrotin Y. Evidence of nutriceutical effectiveness in the treatment of osteoarthritis. Curr Rheumatol Rep 2000; 2: 472-77.

Constantz RB. Hyaluronan, glucosamine and chondroitin sulfate: roles for therapy in arthritis? In: Kelley WN, Harris ED, Ruddy S, Sledge CB, eds. Textbook of rheumatology. Philadelphia: WB Saunders, 1998.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis: the role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am 1999; 25: 379-95.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283: 1469-75.

Page last updated: May 02, 2009

How Topical Lidocaine works on Arthritis:

Lidocaine is a very effective local anesthetic or numbing medication. This drug works by blocking the pain signals coming from  the nerve thus  preventing the body from feeling pain. Topical Lidocaine is  a version of Lidocaine which can be applied at the surface of the skin instead of injecting it .  The American Pain Society says that a skin patch containing Lidocaine (Lipoderm) results  in at leat 30%  improvement in knee pain  for those patients suffering from knee osteoarthritis. Lipoderm patch is recommended to be used once daily for at least 12 weeks.

Side Effects and Precautions of Topical Lidocaine:

Inform your doctor of any of these symptoms develop: stinging, burning, redness, tenderness, swelling, rash. Do not use this medication on areas with bacterial infection or on top of open wounds.

Forms, Dosage and Brand Names of Topical Lidocaine:

Lidoderm arthritis patch.

Adults: Topical lidocaine is formulated in patches at 5% concentration. The patch sticks to the affected area and replaced after a few hours.

Pregnant Women: Generally safe

Children: There is no available information comparing the use of topical lidocaine in children with use in other age groups.

References about Topical Lidocaine and Arthritis:

Evaluation of eutectic lidocaine/prilocaine cream (EMLA) for steroid joint injection in children with juvenile rheumatoid arthritis: a double blind, randomized, placebo controlled trial. [2003.03]

Page last updated: May 02, 2009

How Acetaminophen works on Arthritis:

Acetaminophen a.k.a N-acetyl-p-aminophenol (APAP) belongs to a drug class known as analgesics (pain reliever) and antipyretics (fever reducer). It is important to note that acetaminophen does not in anyway reduce the inflammation due to arthritis, it only reduces the pain by its “numbing” effect. The exact mechanism or way of how this drug works is still uknown. Researchers suggests that Acetaminophen increases the person’s Threshold of Pain.

Side Effects and Precautions of Acetaminophen:

Hepatotoxicity is associated with acetaminophen overdose. Smoking may interfere with the effectiveness of this medication and smokers may need higher dose. Long term use of Acetaminophen may decrease the kidney function. The most common side effect with acetaminophen is lightheadedness. Acetaminophen is well tolerated and safer to use compared to traditional NSAIDs.

Forms, Dosage and Brand Names of Acetaminophen:

Sudafed®, Theraflu®, and Tylenol® Maximum dosage

Adults: 4,000 mg per day.

Pregnant women:- Acetaminophen has not been reported to cause birth defects or other complications. Consult your doctor for proper dosage.

Children: Dose must be determined by the doctor

References about Acetaminophen and Arthritis:

Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoarthritis. Part I. Osteoarthritis of the hip.American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1535–1540.

Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee.American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1541–1546.

Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000 Sep;43(9):1905–1915.

Page last updated: May 02, 2009

How traditional NSAIDs work on arthritis:

NSAIDS or Non Steroidal Anti Inflammatories work by blocking the production of prostaglandins. Prostaglandins are substances similar to hormones  but they are responsible for pain and inflammation. Prostaglandin has an  additional function of protecting the stomach lining and  it also maintains a normally  functioning kidney. When NSAIDs block prostaglandin, the person is relieved from pain and inflammation but he/she could suffer from upset stomach, ulcers and imroper kidney function. Additional research found out that NSAIDs also block an enzyme known as Cyclooxygenase or COX. Cyclooxygenase exists in two forms, COX-1 which also plays a role in the maintennance of healthy tissues and COX-2 which plays a major role in pain and inflammation. NSAIDs block both COX-1 and COX-2 which can lead to ulceration of the stomach.

Side Effects and Precautions of Traditional NSAIDs:

Take extra precaution of you are pregnant or if you have a history of kidney disease, liver disease or ulcers. It is best to take NSAIDs with food or with a glass of milk. Prolonged use of traditional NSAIDs can lead to ulcers and stomach bleeding.

Forms, Dosage and Brand Names of Tradional NSAIDs:

The following list are generic names and brand names of common traditional NSAIDs on the market.

Ansaid (Flurbiprofen), Arthrotec (Diclofenac/Misoprostol), Cataflam (Diclofenac Potassium), Clinoril (Sulindac)
Daypro (Oxaprozin), Dolobid (Diflunisal), Feldene (Piroxicam), Ibuprofen (Motrin, Advil),
Indocin (Indomethacin), Ketoprofen (Orudis), Lodine (Etodolac), Meclomen (Meclofenamate), Mobic (Meloxicam), Nalfon (Fenoprofen), Naproxen (Naprosyn, Aleve), Ponstel (Mefanamic Acid), Relafen (Nabumetone), Tolectin (Tolmetin), Voltaren (Dicolfenac Sodium).

Adults: Diclofenac - 75 mg to 100 mg per day. Naproxene - 275 or 550 mg two times a day.

Pregnant Women: It is not recommended to take NSAIDs when you are pregnant because of higher incidence of miscarriage.

Children: Consult your doctor for proper dosing.

References about Tradional NSAIDs and Arthritis:

Nonsteroidal Antiinflammatory Drugs (NSAIDs), Omudhome Ogbru, Pharm.D., Jay W. Marks, M.D., MedicineNet, 9/18/2005;

Questions and Answers: FDA Regulatory Actions for the COX-2 Selective and Non-Selective Non-Steroidal Anti-inflammatory drugs (NSAIDs), FDA/Center for Drug Evaluation and Research, April 7, 2005

Page last updated: May 02, 2009

Ordinary or Conventional NSAIDs or Non Steroidal Anti-Inflammatories block both COX-1 and COX-2 enzyme. Cyclooxygenase-1 or COX-1 has a very important function in the body and this is the maintenance and protection of the stomach lining against acids. The inhibition of COX-1 enzyme due to the long term use of NSAIDs would often result into stomach irritation and in some cases it results into ulcers.  The newer COX-2 Inhibitors are more specific in inhibiting the COX-2 enzyme but not the COX-1 enzyme. COX-2 enyzme is the main cause of pain and inflammation. COX-2 inhibitors reduces the incidence of stomach ulcers and bleeding during arthritis treatment. The effectiveness of COX-2 Inhibitors in reducing pain and inflammation is the same or even more effective than traditional NSAIDs.

Side Effects and Precautions of COX-2 Inhibitors:

Since prostaglandins are involved in the regulation of blood pressure, there is an associated cardiovascular risk with COX-2 specific inhibitors. There is an increased risk of cardiovascular death, heart attack, stroke, or heart failure with the long term use of COX-2 inhibitors.

Forms, Dosage and Brandnames of COX-2 Inhibitors:

Adults: Celebrex (Celecoxib) 800 mg/day
Vioxx (Rofecoxib)
Bextra (Valdecoxib
Prexige (Lumiracoxib)
Arcoxia (Etoricoxib)

Pregnant Women: Pregnant women are encouraged to avoid COX–2 inhibitors during the third trimester. Consult your doctor if you want to take this medication.

Children: No research has been done about the effects of COX–2 inhibitors on children

References about COX-2 Inhibitors:

The cost-effectiveness of acetaminophen, NSAIDs, and selective COX-2 inhibitors in the treatment of symptomatic knee osteoarthritis”; C. C. Kamath, H. M. Kremers, D. J. Vanness, W. M. O’Fallon, R. L Cabanela, S. E. Gabriel; Value Health 2003, Mar-Apr;6 (2); 144-57.

“At what care level are cyclo-oxygenase-2 inhibitors prescribed?”; Montero, Fernandez MJ, Rodriguez, Alcala FJ, Valles Fernandez N, Lopez de Castro, F, Esteban, Tudela M, Cordero, Garcia B; Aten Primaria 2002 Oct 30:363-7.

“You and A: Arthritis drugs. Pain and confusion”; Francesca Lunzer Kritz; Washington Post; Sept. 4, 2001; HE01.

“Vioxx (rofecoxib) reduces night-time osteoarthritis pain better than celecoxib or acetaminophen”; European League Against Rheumatism (EULAR) conference proceedings.

Page last updated: May 02, 2009

How Salicylates work on Arthritis:

Salicylates are naturally occuring compounds that can be found on the bark and leaves of the Willow plant. It has a long history of medicinal usage dating back to the Roman times where it is used for easing the symptoms of fever and headache. Pharmaceautical companies have concentrated the salicylates from the willow bark and offers it in two forms. The first form is non-acetylated and the second one is acetylated or chemically combined with acetic acid. Aspirin is an example of the acetylated version of salicylic acid while Magnesium Salicylate and Choline Magnesium Trisalicylate are the non-acetylated versions. Salicylates work by reducing the production of prostaglandins inside your body.  Prostaglandins are substances inside the body which are responsible for pain and inflammation.

Forms, Dosage and Brandnames:

Salicylates occur in tablet or capsule form and should be taken with food to avoid stomach irritation. Drugs in this class include aspirin (Anacin, Ascriptin, Bayer Aspirin, Ecotrin) and salsalate (Mono-Gesic, Salgesic).

Adults: 350 to 500mg once a day.

Pregnant Women: Avoid salicylates if you are pregnant.

Children: Consult your doctor for proper dosing.

References about Salicylates and Arthritis:

Boardman PL, Hart FD. Clinical measurement of the anti-inflammatory effects of salicylates in rheumatoid arthritis. Br Med J. 1967 Nov 4;4(5574):264–268.

Bochner F, Graham GG, Cham BE, Imhoff DM, Haavisto TM. Salicylate metabolite kinetics after several salicylates. Clin Pharmacol Ther. 1981 Aug;30(2):266–275.

Borgå O, Cederlöf IO, Ringberger VA, Norlin A. Protein binding of salicylate in uremic and normal plasma. Clin Pharmacol Ther. 1976 Oct;20(4):464–475.

Cham BE, Ross-Lee L, Bochner F, Imhoff DM. Measurement and pharmacokinetics of acetylsalicylic acid by a novel high performance liquid chromatographic assay. Ther Drug Monit. 1980;2(4):365–372.

Day RO, Shen DD, Azarnoff DL. Induction of salicyluric acid formation in rheumatoid arthritis patients treated with salicylates. Clin Pharmacokinet. 1983 8(3):263–271.May–Jun;

Mason L, Moore RA, Edwards JE, et al. Systematic review of efficacy of topical rubefacients containing salicylates for the treatment of acute and chronic pain. BMJ 2004 Apr 24; 328(7446):995

Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004 Apr 24; 328(7446):991

Tramer MR. It’s not just about rubbing–topical capsaicin and topical salicylates may be useful as adjuvants to conventional pain treatment. BMJ 2004 Apr 24; 328(7446):998

Page last updated: May 02, 2009

The medicines used for the treatment of Gouty Arthritis are listed below. Persons suffering from gouty arthritis also needs to modify their diet to avoid an raising blood levels of Uric Acid. Elevated uric acid levels in the blood causes the formation of uric acid crystals which worsens Gouty Arthritis.

1. Acetaminophen ( Tylenol ) and other analgesics or painkillers.

2. NSAIDs ( nonsteroidal anti-inflammatory drugs ), indomethacin ( Indocin ) - To reduce inflammation.

3. Colchicine - For the prevention and relief of gout attacks.

4. Corticosteroids - Anti-inflammatory

5. Probenecid (Benemid, Probalan) - used to decrease the uric acid blood levels by increasing the rate of uric acid excretion.

6. ColBenemid (Col-Probenecid and Proben-C) - Contains Probenecid which is a uricosuric agent and Colchicine that has anti-gout properties.

7. Allopurinol (Zyloprim) - Prevents uric acid production. Allopurinol also blocks the conversion of purine which can be found in foods into uric acid.

8. Losartan (Cozaar and Hyzaar) - It is an angiotensin II receptor antagonist. It also functions as an antihypertensive drug which may help control the uric acid levels.

9. Fenofibrate (Tricor) - Is a lipid-lowering drug that can also help reduce uric acid levels.

Gout Diet: Foods that you should avoid:

1. Foods with very purines levels include:
hearts, herring, mussels, yeast, smelt, sardines, sweetbreads

2. Foods with moderately high purines levels include:
anchovies, grouse, mutton, veal, bacon, liver, salmon, turkey, kidneys, partridge, trout, goose, haddock, pheasant, scallops

3. Not all foods which are rich in purines were directly related with an increased risk of gout. There was no increased gout risk with the following foods:
peas, beans, mushrooms, cauliflower, spinach

4. Avoid alcohol because it is known to increase uric acid levels.

References:

Gout Diet: Foods To Avoid
What Should You Scratch From Your Grocery List?
By Carol & Richard Eustice, About.com Updated: June 3, 2006

Amazing Arthritis Relief
All Natural. Safe. No Side Effects. End Your Pain Now, Works Great!
www.AmazingArthritisPainRelief.com

Gout arthritis
Answers to your questions about arthritis, joint pain and more!
yourtotalhealth.ivillage.com

How I Lost My Belly Fat
I fought with excess belly fat for years until I found this 1 trick.
www.TruthAboutAbs.com

Dr. Hyon K. Choi, March 11, 2004 issue of The New England Journal of Medicine,

Page last updated: May 02, 2009

Psoriatic Arthritis treatment is suppressive rather than curative. In cases where psoriatic arthritis is very aggressive and potentially destructive, DMARDs (Disease Modifying Anti-Rheumatic Drugs) are prescribed early in the course of the disease. A list of DMARDs is presented below and should be considered. Weight loss program and exercise at home should be also done. A physical therapist should be consulted so that he/she can customize an exercise program that would suit the severeity of the disease and the physical abilities of the patient. Exercise strengthens, maintain and improves the range of motion of the joints. The use of hot compress helps well in relaxing the muscles before doing an exercise.

Medications for Psoriatic Arthritis:

Methotrexate - It is effective on cutaneous and peripheral articular effects of psoriases. Methotrexate is the first choice of DMARD because of its efficacy and tolerance profile. Anti-malarial drugs, retinoic acid and its derivatives may also help in psoriatic arthritis treatment.

Sulfasalazine - it has great benefit on the peripheral joints but does not help very much on the activity of cutaneous diseases. Sulfasalazine blocks the inflammatory response and gives fewer side effects.

Cyclosporin A - it is effective for both cutaneouse and articular disease but care must be taken because as many as 21% of patients taking this medication may develop hypertension and 17% may have nephrotoxicity. Cyclosporin can be used to taper down severe inflammation quickly.

Etanercept®, Remicade®, and Humira®, Tumor necrosis factor (TNF) inhibitors - these drugs have been found to well tolerated and also effective in treating psoriasis and psoriatic arthritis. Etanercept (Enbrel) inhibitis TNF, the cytokine that contributes to inflammation.

Prednisolone ( Corticosteroid ) - corticosteroids can be injected into the joints fro treating severe cases of psoriatic arthritis.

Nonsteroidal anti-inflammatory drugs - Ibuprofen (Motrin, Ibuprin, Advil, Excedrin IB) - NSAIDs decrease inflammation and pain by reducing the synthesis of prostaglandins. It is best to take this with food because it reduces the chances of stomach irritation.

5-Aminosalicylic acid derivatives - Sulfasalazine (Azulfidine, EN-Tabs) - these medications also inhibit the synthesis of prostaglandin resulting into the reduction of inflammation and pain.

References:

Mease PJ: Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomized trial. Lancet 356:385, 2000.

Mease PJ: Cytokine blockers in psoriatic arthritis. Ann Rheum Dis 60:iii37, 2001.

Willkens RF, Williams HJ, Ward JR, et al: Randomized, double blind, placebo-controlled trial of low dose pulse methotrexate in psoriatic arthritis. Arthritis Rheum 27:376, 1984.
Iyer S, Yamauchi P, Lowe NJ: Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy. Br J Dermatol 146:118, 2002.

Cauza R, Spak M, Cauza K, Hanusch-Enserer U, Dunky A, Wagner E. Treatment of psoriatic arthritis and psoriasis vulgaris with the tumor necrosis factor inhibitor infliximab. Rheumatol Int 22(6):227, 2002.

Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, Sharp JT, Ory PA, Perdok RJ, Weinberg MA; Adalimumab Effectiveness in Psoriatic Arthritis Trial Study Group.Arthritis Rheum. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 52(10):3279-89, 2005.
Espinoza LR, Zakraoni L, Espinoza CG, et al: Psoriatic arthritis: Clinical response and side effects of methotrexate therapy. J Rheumatol 19:872, 1992.

Gupta AK, Matteson EI, Ellis CN, et al: Cyclosporin in the treatment of psoriatic arthritis. Arch Dematol 125:507, 1989.

Salvarani C, Macchioni P, Olivieri I, et al: A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J Rheumatol 28:2274, 2001.

Sarzi-Puttini P, Cazzola M, Panni B, et al: Long-term safety and efficacy of low-dose cyclosporin A in severe psoriatic arthritis. Rheumatol Int 21:234, 2002.

Page last updated: May 02, 2009

Nondrug Treatments:

The range of motion of the joints can be improved by physical therapy. Physical therapy also increases the strength of the muscle and at the same time reduces pain. Exercise in warm water can make  your muscles relax and ease joint pain. Hot or cold compress treatments also works in relieving pain and inflammation. You can use ice packs or moistened towel to serve as compress.

Medications:

Treatment of rheumatoid arthritis include 2 components. First, reduction of inflammation and the prevention of joint damage and disability. Second, relief of symptoms such as pain. Treatment options for rheumatoid arthritis would include reduction of the stress on the joints, physical therapy, medications and in severe cases, surgical procedures.

The three general classes of drugs used in the treatment of rheumatoid arthritis:

Non-Steroidal Anti-inflammatory Agents (NSAIDs) - The main effect of this drug class is the reduction of inflammation which in turn decreases pain and improves the overall physical function of the joints. These drugs does not alter the course of the disease and does not even prevent joint destruction.

Over the counter NSAIDS are Ibuprofen, (Advil ®, Motrin®, Nuprin ®) and naproxen (Alleve®). Prescription only NSAIDs are Meloxicam (Mobic®), etodolac (Lodine®), nabumetone (Relafen®), sulindac (Clinoril®), tolementin (Tolectin®), choline magnesium salicylate (Trilasate®), diclofenac (Cataflam®, Voltaren®, Arthrotec®), Diflusinal (Dolobid®), indomethicin (Indocin®), Ketoprofen (Orudis®, Oruvail®), Oxaprozin (Daypro®), and piroxicam (Feldene®). COX II inhibitors like (celecoxib, Celebrex®, etoricoxib, Arcoxia®; lumiracoxib, Prexige®). COX II inhibitors are designed to minimize the risk of gastrointestinal irritation but it may also increase the risk of cardiovascular diseases. Some COX II inihibitors (rofecoxib, Vioxx®; valdecoxib, Bextra®) are already pulled out from the market because of this side effect.

Corticosteroids - they posses both anti-inflammatory and immune regulatory properties. Corticosteroids can be given orally, intramuscularly or intravenously. It is only given to patients with severe arthritis that is not controlled by NSAIDs and DMARDs.

(Prednisone; methylprenisolone, Medrol®)

Disease Modifying Anti-rheumatic Drugs (DMARDs) - DMARD agents are reported to stop or slow the course of rheumatoid arthritis, what they do is interfere in the immune processes which promote inflammation in arthritis. DMARDs can also suppress the infection fighting capability of the immune system. It would be advisable to watch out for signs of infection like fever, cough or sore throat.

Example of DMARDs are antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran). leflunomide (Arava®), etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), abatacept (Orencia®), rituximab (Rituxan®), anakinra (Kineret®), methotrexate, sulfasalazine. DMARDs can take several weeks or months before its full clinical effect can be demonstrated.
Methotrexate (Rheumatrex®, Trexall®) - It is very effective in reducing the symptoms and signs of rheumatoid arthritis as well as psoriatic arthritis.

Hydroxychloroquine (Plaquenil ®) - This is actually an antimalarial drug which is safe and well tolerated by most patients suffering from rheumatoid arthritis but this drug has limited ability in the prevention of joint damage when used alone. It is usually combined with methotrexate and sulfasalazine for a synergistic effect.

Sulfasalazine (Azulfidine®) - the effectiveness of this drug is less than that of methotrexate but it is also reported to reduce the signs and symptoms of rheumatoid arthritis and slows down joint damage.

Leflunomide (Arava®) - it has similar efficacy to methotrexate and is a good alternative for patients who cannot tolerate methotrexate.

Tumor necrosis factor (TNF) inhibitors - TNF or tumor necrosis factor alpha promotes inflammation and is found in the rheumatoid joint.

Surgical Approaches:

Synovectomy - this procedure is usually not recommended for people with rheumatoid arthritis because the relief is transient. However, synovectomy of the wrist is recommended specially if synovitis persists even if medical treatment is applied for over 6 to 12 months.

Arthroplasty - arthroplasty of the knee, wrist, hip and elbow have high success rates. Arthroplasty of the joints of the knuckle can also reduce pain and improve its physical functions.

References:

Rheumatoid Arthritis Treatment
by Alan K. Matsumoto, M.D. , Joan Bathon, M.D. and Clifton O. Bingham III, M.D.

Harris ED Jr (2005). Clinical features of rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley’s Textbook of Rheumatology, 7th ed., vol. 2, pp. 1043–1078. Philadelphia: Elsevier Saunders.

O’Dell JR (2005). Rheumatoid arthritis: The clinical picture. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1165-1194. Philadelphia: Lippincott Williams and Wilkins.

Kremer JM (2001). Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Annals of Internal Medicine, 134(8): 695–706.

Firestein GS (2005). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.

Page last updated: May 02, 2009