Treatment for Arthritis

This is a chronic inflammatory disease characterized by the inflammation of bone and joint leads to swelling and pain on the joint. There is no known cure for arthritis, now the treatment aims toward achieving the lowest possible level of arthritis disease and remission if possible, the minimization of joint damage and enhances the physical function and quality of life.

Treatments include arthritis are

1. Corticosteroids
2. Non steroidal anti inflammatory agent.
3. Disease modifying anti rheumatic drug.

CORTICOSTEROIDS:

The chronic inflammatory diseases such as asthma, rheumatoid arthritis, inflammatory bowel disease and autoimmune diseases are characterized by the increased expression of inflammatory genes. Glucocorticoid increases the transmission of anti-inflammatory genes and decreases the transmission of inflammatory genes. A variety of synthetic glucocorticoids are using for the treatment of arthritis such as deflazacort, prednisolone, dexamethasone.

MECHANISM OF ACTION:  Corticosteroids having wide range of biological activities including anti inflammatory activities and immune suppression effect on leukocyte movement, in a lesser extent in leukocyte function. This will inhibits the production of prostaglandins and leukotrines, as well as certain types of cytokines.

CONTRAINDICATION: Systemic infection, patients receiving live virus immunization and hypersensitivity to deflazacort or any of the ingredients of the formulation

ADVERSE EFFECT: Increased susceptibility to opportunistic infections with suppression of clinical symptoms and sign, gastro intestinal disturbances, osteoporosis, neuropsychiatric events such as headache, vertigo, psychological dependence, hypomania or depression, skin atrophy, fluid and electrolyte disturbances, glaucoma.

NON STEROIDAL ANTI-INFLAMMATORY AGENT:

The major effect of NSAID is to reduce the inflammation, thereby decreasing the pain and improving the function. All of these drugs also have mild to moderate analgesic properties independent of their anti-inflammatory effect. It is important to note that these drugs cannot cure the rheumatoid arthritis or prevent joint destruction. The major NSAIDs used for the treatment of arthritis are , aspirin, paracetamol, mefenemic acid etc.

MECHANISM OF ACTION:  The NSAID s inhibits the generation of prostaglandin by blocking cycloxygenase enzyme, COX-1 and COX -2. Prostaglandins are mediators of pain and inflammation. In addition to this prostaglandin play an important role in normal body functions include protection from the stomach acids, maintains the kidney blood flow and contributing to platelet stickiness and vascular function.

SIDE EFFECTS: Gastro intestinal disturbances such as burning, belching or irritation. NSAIDs also will cause to salt retention, edema and also increase in blood pressure.

DISEASE MODIFYING ANTI RHEUMATIC DRUGS:

Studies shows that the rheumatic arthritis is an immunological disease that causes significant systemic effects which shortens life. The NSAID s has a limit on its action on the bone and joint destruction. So interest is turned to disease modifying ant rheumatic drugs because it has better efficacy than NSAIDs.

DMARDs suppress the over active immune or inflammatory system. The choice of DMARDs depends on the number of factors including the severity of joint destruction, balance between the side effects and expected benefits, patient’s preference. These drugs are not designed to get fast relief from the symptom. The most commonly used DMARDs are sulfasalazine, methotrexate, hydroxychloroquine and leflunomide.

SIDE EFFECTS: Stomach upset, temporary hair loss, liver damage, nausea, weight loss, abdominal pain, decreased appetite, blood or protein in the urine, skin rash etc.