Help Patients Manage Arthritis Pain

The term arthritis means the inflammation or swelling of one or more joints, and it encompasses more than 100 conditions that affect the joints, tissues around the joints, and other connective tissues.¹ Specific symptoms vary depending on the type of arthritis but usually include joint pain and stiffness. Osteoarthritis is the most common form of arthritis. Gout, fibromyalgia, lupus, and rheumatoid arthritis are other common rheumatic conditions.¹

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Prevalence

Based on data from the National Health Interview Survey, between 2016 and 2018 an estimated 58.5 million US adults were diagnosed with some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia.¹ By 2040, an estimated 78.4 million US adults aged 18 years or older are projected to have doctor-diagnosed arthritis.²

Arthritis and other rheumatic conditions are a leading cause of work disability among US adults. Among working-age US adults (aged 18 to 64 years) with arthritis, nearly 1 in 3 (30.2%) had work disability between 2011 and 2013.³

Medications

Medications can ease symptoms and slow disease progression, helping patients improve their quality of life. Options include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), targeted DMARDs, and biologics.

Analgesics

General pain relievers, such as acetaminophen, may ease mild to moderate pain but do not do anything for inflammation (hot, swollen joints). They are often used for arthritis pain because of their minimal adverse effects on the gastrointestinal system. Pharmacists should caution patients not to take too much, however, as it can damage the liver in high doses. Also exercise caution when choosing a product, as they come in combination with many other drugs.⁴

NSAIDs

NSAIDs, such as ibuprofen, naproxen, and aspirin, are available as OTC products and work to decrease pain and inflammation by blocking hormone-like substances call prostaglandins.⁴ Although they work in the same way, some NSAIDs require a prescription, such as indomethacin and celecoxib. All NSAIDs can increase the risk of heart attack, stroke, or gastrointestinal bleeding.⁴

Corticosteroids

Corticosteroids, also called steroids or glucocorticoids, reduce inflammation by mimicking the natural hormone cortisol. These work quickly and are therefore good for short-term relief. Unfortunately, the adverse effect profile is significant for weight gain, cataracts, and hypertension. If patients do take corticosteroids in the long term, the dose should be low.⁴

DMARDs

DMARDs are also known as immunosuppressants because of their actions on the immune system. They work in several ways to hold back the immune system in order to decrease pain and inflammation, reduce joint damage and bone erosion, slow disease progression, and preserve joint function.⁵

Traditional DMARDs include methotrexate, sulfasalazine, hydroxychloroquine, and azathioprine. DMARDs may take weeks to months to take effect and leave patients immunocompromised.⁴

Targeted DMARDs

Targeted synthetic DMARDs, also known as small molecule DMARDs, have specific targets in the immune system, decreasing immunocompromising properties common in other DMARDs. These drugs can be taken by mouth, which can greatly improve adherence to therapy.⁴

• Janus kinase (JAK) inhibitors: These medications interfere with phosphorylation of key proteins involved in the signal transduction that leads to immune activation and inflammation.⁴
• Phosphodiesterase-4 (PDE-4) inhibitors: These medications act at a cellular level to stop the degradation of cyclic adenosine monophosphate (cAMP), which increases the rate of cAMP. This higher rate of cAMP may decrease inflammation.⁴

Biologics

Biologics are special types of DMARDs. These are harder to make than traditional DMARDs and are priced accordingly. These are injected or infused medications that are powerful. Not all biologics work for all people, and if a patient fails to improve on one type, they can try others.⁴

Several biologics exist, each working in a different way⁴:

• Tumor necrosis factor inhibitors: These work by blocking tumor necrosis factor, a cytokine present in the inflammatory process.
• Interleukin inhibitors: Different biologics target different interleukins (IL-1, IL-6, IL-12, IL-17, and IL-23). Interleukin inhibitors disrupt communication between cells involved in the inflammatory process.
• B-cell inhibitors: These biologics rapidly deplete B-cells, a major contributor to the inflammatory response. These medications are typically reserved for patients for whom other biologics have not worked.
• Selective costimulation modulators: These bio logics specifically modulate T-cell function to reduce the inflammatory response. Like B-cell inhibitors, these are reserved for patients for whom other biologics have not worked.

Physical Therapy

Physical therapy for arthritis improves symptoms and enhances movement quality. Physical therapy is typically part of an arthritis treatment plan that also includes medication, supplements, and/or topical treatments. A physical therapist will evaluate posture, muscle imbalances, and body mechanics and create exercises to improve movement in such a way that helps prevent injury, reduces pain, and aligns the body.⁶

Although exercising has many benefits for patients with arthritis, patients should check with their physicians before starting an exercise program. When starting an exercise routine, patients should make sure to stretch before and after exercise, start slowly, and always do low-impact exercises.⁶

Complementary Therapies

Some other therapies can complement medications and physical therapy. Although some findings have been mixed, most of the literature has shown that acupuncture can help improve chronic pain.⁷ Massages can also be helpful, and in addition to stress reduction and relaxation, massages can relieve tension around connective tissue.⁷

Finally, thoughts and actions can affect the autonomic nervous system. A biofeedback machine will help patients learn how to control their breathing and heart rate as well as other physical reactions, such as pain.⁷

Surgery

As a last resort, surgery may be necessary. There are several types of surgery that can be performed. Arthroscopy can be performed to repair damaged cartilage and ligaments, and remove broken, free-floating cartilage pieces.⁸ Joint resurfacing is a more invasive procedure to replace a portion of a joint, and osteotomy involves cutting and removing bone or adding a wedge of bone near the damaged joint.⁸

Synovectomy involves removing all or most of the synovium, which is the connective tissue lining the inside of the joint capsule.⁸ Arthrodesis or fusion utilizes pins, plates, rods, or other hardware to join 2 or more bones.⁸ Finally, total joint replacement is performed to replace a damaged joint with an implant that mimics the motion of a natural joint. Implants are made from metal, plastic, and/or ceramic components.

About The Author

Kathleen Kenny, PharmD, RPh, earned her doctorate from the University of Colorado Health Sciences Center. She has more than 25 years of experience as a community pharmacist and works as a clinical medical writer based in Homosassa, Florida.

References

1. Theis KA, Murphy LB, Guglielmo D, et al. Prevalence of arthritis and arthritis-attributable activity limitation – United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2021;70(40):1401-1407. doi:10.15585/mmwr.mm7040a2
2. Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol. 2016;68(7):1582-1587. doi:10.1002/art.39692
3. Barbour KE, Boring M, Helmick CG, Murphy LB, Qin J. Prevalence of severe joint pain among adults with doctor-diagnosed arthritis – United States, 2002-2014. MMWR Morb Mortal Wkly Rep. 2016;65(39):1052-1056. doi:10.15585/mmwr.mm6539a2
4. Medications for arthritis. Arthritis Foundation. Reviewed April 21, 2021. Accessed August 30, 2023. https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/medications-for-arthritis
5. Disease-modifying anti-rheumatic drugs (DMARDs). Arthritis Society Canada. Accessed August 30, 2023. https://arthritis.ca/treatment/medication/disease-modifying-anti-rheumatic-drugs-(dmards)
6. Cronkleton E. Treating arthritis with physical therapy. Healthline. Reviewed March 23, 2022. Accessed August 30, 2023. https://www.healthline.com/health/arthritis/does-physical-therapy-help-arthritis
7. Natural relief for arthritis pain. Arthritis Foundation. Updated July 7, 2023. Accessed August 30, 2023. https://www.arthritis.org/health-wellness/ healthy-living/managing-pain/pain-relief-solutions/natural-relief-for-arthritis-pain
8. Understanding the most common kinds of arthritis surgery. Arthritis Society Canada. Accessed August 30, 2023. https://arthritis.ca/living-well/2019/understanding-the-most-common-kinds-of-arthritis-surgery