Arthritis

The term arthritis refers to inflammation in joints leading to increased pain. There are multiple types of arthritis with the most common being Osteoarthritis and Rheumatoid arthritis. While some symptoms such as joint pain and stiffness are present in both diseases, their cause, progression and treatment differ.

Osteoarthritis (OA) is commonly referred to a degenerative arthritis.

The cause is usually secondary to wear and tear of the protective cartilage over the joint. Diagnosis can be made after review of x-rays, but is largely based on physical exam. There is currently not a cure. However, treatment is aimed at decreasing inflammation through anti-inflammatories and procedure-based interventions to improve function and decrease pain. OA may affect any joint in the body, but the most common joints include: Knees, Hips, Shoulders, and Lumbar spine. Patients may also experience osteoarthritis in cervical facet joints (neck), atlanto-axial joint or atlanto-occipital joints in the cervical spine, thoracic facet joints, costochondral joints in the chest wall, sacroiliac joints where the low back meets the pelvis, ankle joints (including talocrural joint, with tibiotalar and fibulotalar portions, subtalar or talocalcaneal joint, tibiofibular joint), wrist arthritis, elbow arthritis, and hand and foot arthritis including metacarpophalangeal (MCP), Proximal interphalangeal joints (PIP), and Distal interphalangeal joints (DIP).

Rheumatoid Arthritis (RA) is an autoimmune disorder.

This means the body’s own immune system attacks the joints. Diagnosis is commonly made after review of blood work that tests for a specific antibody. Multiple joints can be affected and may have associated systemic symptoms such as a muscle aches and fatigue. In addition, some patients experience signs and symptoms outside of their joints (skin, heart lungs, etc.) Treatment is similar to OA. However, other medications termed Biologics, may be used to suppress the immune response and alleviate pain. Just as with OA, there is no current cure for RA. There are groups of physicians called Rheumatologists that specialize in auto-immune disorders such as Rheumatoid Arthritis and typically manage treatment.

New Treatment Options for Arthritis Mean You Don’t Have to Suffer Anymore

Thankfully there are many available treatments for arthritis, including topical and oral anti-inflammatories (NSAID’s), topical analgesics (lidocaine ointment and transdermal patches), physical therapy, home exercise programs, stretching, yoga and pilates. Many times, arthritis becomes severe enough to require a procedure to improve pain and function. Those procedures may include injections into the joint itself (synovial cavity) or capsule/ covering (bursa or peri-articular) including: steroid injections such as methylprednisolone, betamethasone, dexamethasone, triamcinolone or other steroids; a gel-like substance which mimics cartilage called Hyaluronic Acid / Viscosupplementation injection (sodium Hyaluronate), or Platelet-Rich Plasma injections (PRP). Other procedures may target the nerve to the joint/ innervation of the joint to denervate the joint, so it won’t hurt any more. Each of the joints in your body has a sensory nerve to it, and this sensory nerve carries pain signals from the inflamed joint. If a nerve block to the joint is performed, and it is successful, a radiofrequency ablation or other denervation procedure such as alcohol or phenol neurolysis may be performed to give you prolonged benefit. Radiofrequency ablation for joint pain denervates the joint permanently, and typically gives 12 months of pain relief or more. Some examples of nerve blocks to the joint include: extraarticular / genicular nerve blocks for knee arthritis followed by genicular radiofrequency ablation (using cooled RF technology or traditional thermal radiofrequency ablation), suprascapular nerve block and ablation for shoulder arthritis, cervical medial branch block followed by cervical medial branch radiofrequency ablation for neck spondylosis / arthritis, and lumbar medial branch block and a lumbar medial branch radiofrequency ablation for lumbar degenerative joint disease, facet syndrome / spondylosis. However, any joint in the body which is affected by arthritis may benefit from ablation. Radiofrequency ablation of the hip joint, sacroiliac joint (lateral branch blocks, nerve blocks to the sacrum, cluneal blocks), and coccyx / tailbone are performed regularly. Another nondestructive minimally invasive option for long-term control of joint pain includes pulsed radiofrequency, where a joint is denervated without thermal or alcohol neurolysis. Results are promising.

Talk with your provider today about management of your arthritis and treatment options.

Older Medications with continued use: NSAID’s in Arthritis Management

Non-steroidal anti-inflammatory drugs (NSAIDS) are a common class of medications used to treat pain and fever. The most widely prescribed and over the counter formulations are Ibuprofen, Naproxen, Meloxicam, Diclofenac and Celecoxib. These have been utilized for arthritis pain control for many years. Their role in decreasing inflammation has been proven to be beneficial in the management of acute pain, but also intermittently with chronic pain.

Risks of taking NSAIDs

Although these medications serve as good alternative to opioid medications, they do pose a risk to your overall health. In 2005, the Food and Drug Administration released a black box warning on the risk of experiencing a stroke or heart attack with NSAID use. In 2015, they strengthened their stance on this risk due to evidence revealing a stronger correlation between the two. In addition, NSAIDs have also been known to increase an individual’s risk of bleeding.

Talk with your provider before starting a new medication

Before starting you on an NSAID your provider will likely inquire about your previous medical history. Any individual with a history of a bleeding disorder, GI ulcer, previous heart attack/heart problems, or previous stroke will likely need to refrain from using these medications. If you are currently taking an NSAID and you answered yes to any of the above medications, it is important you discuss this with your provider.

Are NSAIDS the appropriate medication to help treat your pain?

In summary, while NSAIDS are very useful for pain control they are not always appropriate for every patient. They are preferably utilized short term for acute pain flares and discontinued after this time. However, they are always outlier situations in which they may be used for a longer periods of time. If you are concerned about your current NSAID use and how you can decrease your risk of side effects talk with your provider today.