Arthritis natural remedies and arthritis medications a hard nut to crack
When we are talking about arthritis natural remedies and arthritis medications we must know what is arthritis. Arthritis means inflammation of one or more joints. Diseases those fall in this group are rheumatoid arthritis , seronegative arthritis ( Reactive arthritis , psoriatic arthritis , ankylosing spondylitis ), crystal arthopathy like gout, vasculitis , traumatic arthritis, collagen diseases like SLE, DLE , arthritis with systemic diseases like haemolytic diseases etc.
Arthritis remedies fall in three categories
- Natural remedies for arthritis
- Arthritis medications
The general aims of management are to:
- educate the patient
- control pain
- optimise function
- modify the disease process where this is possible
- identify and treat related comorbidity.
Simple and safe interventions should be tried first. Symptoms and signs will change with time, so the plan requires regular review and readjustment. Effective management may require the expertise of a variety of health professionals, with a coordinated multidisciplinary team approach.
Natural remedies of arthritis
Remedies that need no drug ingestion are considered as natural remedies . Wide range of natural remedies are available .
Education of patient about the nature of disease ,investigation, treatment , possible outcome can be useful to improve patients compliance to therapy thereby improve outcome. A physical therapist can help a patient to be educated and have an appropriate designed therapy.
Aerobic fitness training can reduce pain and long term disabilities. This exercise includes walking , swimming etc. This is beneficial for sleep and reduction of co morbidities like obesity .
Local strengthening exercise of muscles can improve muscle strength ,improve proprioception , reduce pain, disabilities for over compromised joints .
We should not let our compromised joint to do a lot of works. Or after initial impact we should be careful not to get same impact again. We should perform our works using other joints or at least work of the joint should be divided to other joints or appliances. Use of shock absorbing footwear with thick soft soles , walking stick etc can be
Obesity aggravates pain at most sites of the body through increased mechanical strain and is a risk factor for more rapid progression of joint damage in patients with arthritis. This should be explained to obese patients. And appropriate measure to reduce weight should be taken.
Personal life changing
The person is asked to reduce excessive alcohol intake, especially beer. In case gout Thiazide diuretics should be stopped if possible and substituted with angiotensin converting enzyme (ACE) inhibitors, as these have a uricosuric effect.
Right food choice can aid reduction of pain. In case of osteoporosis patient should be asked to take foods containing calcium like milk , phytoestrogen containing soya protein , flurides. In gout patients should be advised to avoid large amounts of seafood and offal, which have a high purine content, but a highly restrictive diet is not necessary.
Hot and cold therapies
Hot water bag can be used for application of heat therapy. It can reduce pain and inflammetory edema. You can also use cold bath , ice compression to apply cold therapy . This also serves same purpose.
Acupuncture is an oldest way to get relief from arthritis pain.
Infrared therapy and short wave ultrasonography
This two also can reduce arthritis pain.
Hydrotherapy induces muscle relaxation and facilitates enhanced movement in a warm, pain relieving environment without the restraints of gravity and normal loadbearing.
Relaxation therapies are also proved to reduce arthritis pain.
Then provide rest of joint by cast , back slab, slings etc. Elevation of limbs can be helpful to reduce the inflammetory edema , reduce hematoma. Wrist splints, knee orthoses, and iron and T straps etc can help rest affected joint.
Self-help and coping strategies
The aim is to increase selfmanagement through self assessment and problem solving, so that patients can recognize negative but potentially remediable aspects of their mood (stress, frustration, anger or low self esteem) and their situation (physical, social, financial). These may then be addressed by changes in attitude and behavior.
It may be hard to believe but it is true that those can’t relieve patients arthritis pain.
A raised toilet seat, raised chair height, extended handles on taps, a shower instead of a bath, thick handled cutlery, and extended ‘hands’ to pull on tights and socks. Full assessment and advice from an occupational therapist maximize the benefits of these.
Know more about natural remedies of arthritis.
Paracetamol (1 g up to 4 times daily) is the oral analgesic of first choice . If it is successful, it is the preferred long term oral analgesic. If paracetamol fails to achieve an adequate response, it can be used in combination with opioids such as codeine and dihydrocodeine in compound analgesic preparations like cocodamol (codeine and paracetamol) or codydramol (dihydrocodeine and paracetamol). The nonopioid analgesic nefopam (30–90 mg 3 times daily) can help moderate pain. Patients with severe or intractable pain may require stronger opioid analgesics such as oxy-codon and morphine.
Non-steroidal anti-inflammatory drugs
These are among the most widely used drugs. Oral NSAIDs are particularly useful in the management of pain that has an inflammatory component, and a long acting NSAID taken in the evening may help reduce early morning stiffness. There is marked variability in individual tolerance and response; patients who do not respond to one NSAID may still gain relief from another. Traditional NSAIDs, such as ibuprofen, diclofenac and naproxen and newer NSAIDs, such as celecoxib and etoricoxib are mostly used.
Commonly used NSAIDs and their relative risk of gastrointestinal bleeding and perforation:
- Very low risk(Selective COX-2 inhibitor):Celecoxib Etoricoxib
- Low risk(Weak anti inflammatory effect ):Ibuprofen, Etodolac, Meloxicam, Nabumetone
- Medium risk: Ibuprofen, Naproxen, Diclofenac
- High risk: Indometacin, Ketoprofen
- Highest risk(Restricted use in those >60 yrs):Piroxicam, Azapropazone
Topical NSAID creams and gels and capsaicin (chilli extract; 0.025%) cream can help in the relieve of arthritis pain affecting hands, elbows and knees.
Disease-modifying anti-rheumatic drugs (DMARDs)
When all measure fails to control pain these agents are used. These also prevent the complications and deformities. Here are some commonly used DMARDs : Hydroxychloroquine,Cyclophosphamide ,Ciclosporin ,mycophenolate mofetil, Methotrexate, Sulfasalazine, Hydroxychloroquine , Leflunomide, D-Penicillamine ,Gold, Ciclosporin
Systemic corticosteroids have disease modifying activity. But their primary role is in the induction of remission in many diseases particularly in collagen diseases, rheumatoid arthritis, vasculitis and seronegative arthritis . They act by inhibiting prostaglandin synthesis. Prednisolone and triamcinolone are used as intra muscular or intra articular injections or orally. Side effects are GIT ulcers , cushing syndrome, glaucoma , weight gain, osteoporosis, high blood pressure , cataract etc
The use of biological agents (often abbreviated to ‘biologics’) is reserved for the treatment of patients who have high disease activity despite having had an adequate trial of traditional DMARDs. These agents are targeted towards specific cytokines and other cell surface molecules regulating the immune response. Although generally well tolerated, biological therapies increase the risk of serious infections due to suppression of the immune response.
Some biological agents are : Rituximab, Abatacept, Anakinra, Tocilizumab, Infliximab, Etanercept, Adalimumab.
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A variety of surgical interventions can relieve pain and conserve or restore function arthritis . Soft tissue release and tenosynovectomy may reduce inflammatory symptoms, improve function and prevent or retard tendon damage for variable periods, sometimes indefinitely. Synovectomy of joints does not prevent disease progression but may be indicated for pain relief when drugs, physical therapy and intraarticular injections have provided insufficient relief. For damaged joints following procedures done:
osteotomy (cutting bone to alter joint mechanics and load transmission),
excision arthroplasty (removing part or all of the joint),
joint replacement (insertion of prosthesis in place of the excised joint)
arthrodesis (joint fusion).
If surgery is successful, the operation should be integrated with rehabilitation, by multidisciplinary teams of surgeons, allied health professionals and physicians.