Treatment Differences Between Osteoarthritis and Rheumatoid Arthritis
By: B. R. Kaye,
MD, F.A.C.P.
Osteoarthritis and
rheumatoid arthritis are the two most common types of arthritis. Osteoarthritis
is primarily a degenerative or “wear and tear” process on the cartilage,
whereas rheumatoid arthritis is an inflammatory arthritis due to the body
attacking the joint lining with its own immune system (called an auto-immune
disease). These two different mechanisms for the cause of the arthritis have a
strong bearing on the types of treatment.
In treating osteoarthritis, the
major goal is to diminish symptoms. As of 2003, we do not have a way to
regenerate cartilage in people. The single most helpful way to avoid further
deterioration of osteoarthritis of the hip or knee is for an individual who is
overweight to lose weight. Losing weight lowers the stress on the joint and
slows down the amount of “wear and tear.”
There are several ways that one can
lessen the pain of osteoarthritis. The most commonly used medications are
acetaminophen (the ingredient in Tylenol) and the non-steroidal
anti-inflammatory drugs such as ibuprofen, naproxen, Celebrex, and Vioxx. These
drugs can lessen the pain and help with stiffness, but do not alter the course
of the disease. The nutritional supplement glucosamine sulfate may also lessen
the pain of osteoarthritis.
When oral medications do not help
the symptoms of osteoarthritis, injections of cortisone in the affected joint
may provide symptomatic relief for two to three months and usually work in two
to three days. Another injectable preparation, hyaluronic acid (brand names
Synvisc, Hyalgan, and Supartz), is approved for treating osteoarthritis of the
knee. These compounds are given as a series of three to five weekly injections
and can take a month or more to work, but may provide symptomatic relief for
over six months in about two-thirds of patients given these injections.
In patients with severe
osteoarthritis of the knee or hip where oral medications and injections do not
help the pain and function enough, joint replacement surgery is often an
excellent treatment and effectively “cures” the arthritis in the joint that is
replaced.
In contrast to osteoarthritis, the
major goal in treating rheumatoid arthritis is to prevent damage to the joint,
as well as to reduce the pain, swelling, and stiffness. Therefore, in addition
to using non-steroidal anti-inflammatory drugs for symptoms, the disease
modifying anti-rheumatic drugs (DMARDs) are used to prevent further joint
damage. Examples of DMARDs include hydroxycholoroquine (Plaquenil),
sulfasalazine (Azulfidine), methotrexate, and leflunomide (Arava). Most of
these drugs take two to six months to reach their maximum effectiveness.
Recently, a new very powerful and expensive group of drugs for the treatment of
rheumatoid arthritis have come on the market — the biologic drugs. These drugs
include Enbrel, Humira, Kineret, and Remicade and are given either as a
self-injection or an intravenous (IV) infusion. These drugs can start working
as soon as a few days after a patient starts taking them! The biologic drugs
also seen to do an excellent job of reducing further joint damage in many
patients.
Often, low doses of prednisone (a
kind of cortisone) are used to help reduce symptoms when the slow-acting DMARDs
are first used to help serve as a “bridge” while waiting for the DMARD to start
working. Prednisone can quickly and effectively reduce symptoms, but must be
used cautiously because of side effects such as osteoporosis, weight-gain, and
elevated blood sugar and blood pressure. Cortisone injections into a joint may
relieve local joint pain. Reconstructive surgery for the hands, and joint
replacement surgery for the hips, knees, and shoulders are also used in severe,
advanced cases of rheumatoid arthritis.