21 Arthritis Facts: It's A Game Changer

Do You Really Know What Arthritis Is?

Arthritis is so common almost everyone thinks they know what it is, but "arthritis" is really many different conditions.

The most common forms of arthritis are:

• Osteoarthritis: a breakdown of the cartilage in the joints due to wear-and-tear over time
• Rheumatoid arthritis: an autoimmune disease leading to inflammation of the tissue lining the joints, and inflammation of other body tissues in the most severe cases.

Rheumatoid arthritis and osteoarthritis may be confused because they are both often just referred to as "arthritis." But in fact, they are very different types of arthritis, with different causes, symptoms and treatments.

Arthritis Facts: It's A Game-Changer

Arthritis is common - in fact, as reported by the US Centers for Disease Control and Prevention an estimated 58.5 million US adults have arthritis: including osteoarthritis, rheumatoid arthritis, gout, lupus or fibromyalgia - all forms of arthritis.

• More than half of US adults (57.3%) with arthritis are of working age (18 to 64 years).
• Arthritis punches a hefty price tag, too: associated costs are at least $303.5 billion in direct medical expenditures and lost wages annually.
• Roughly 8 million working-age adults report that their ability to work is limited because of their arthritis.

And the number of people dealing with arthritis is growing - by 2040, an estimated 78 million (26%) of US adults are projected to have doctor-diagnosed arthritis, and the disability and costs that go along with it. Arthritis takes an enormous toll on the financial health and well-being of our society.

Arthritis Awareness: Get Up to Speed

National Arthritis Awareness Month is held each spring and encompasses a series of walks held throughout the country by the Arthritis Foundation to increase knowledge of the nation's leading cause of disability. The "Walk to Cure Arthritis" fundraiser is held each spring and summer and raises millions for arthritis research.

Warm weather is the best time to get outside and walk - because walking is one of the best exercises for people with arthritis.

Walk With Ease (WWE) is a six-week program developed by the Arthritis Foundation designed to help people manage their arthritis pain. Walk With Ease is convenient, too. It's an online tool that can safely help you make physical activity part of your everyday life. It includes a guidebook and a walking schedule to get you safely moving toward better health.

Rheumatoid Arthritis: Explained

Rheumatoid arthritis (RA) occurs when the body's immune system starts attacking itself in areas like the joints, bones, and internal organs.

RA leads to inflammation of the joints in areas like the hands, feet or wrist. The joints become painful, stiff, and tender and may feel warm or look red.

Normally, inflammation is a normal process used for repair of injury or illness. However, in an autoimmune disease like RA, healthy tissues are attacked. Maybe you've seen the way joints can become twisted and deformed in RA due to this destruction.

RA cannot be cured but there are treatments that help control the pain, inflammation and joint destruction. RA differs from osteoarthritis, which is due to the wear-and tear on the joints and cartilage over time.

Osteoarthritis: Explained

Osteoarthritis (OA) is what many people are thinking of when they talk about of arthritis. The aching pain in your knees, hips and back - often noticed with a change in weather - is usually due to osteoarthritis.

OA becomes more common with age and is due in part to the gradual wear and tear of cartilage (bone cushion) in the joints. Injuries, obesity, a family history and weak muscles can play a part in OA development, and symptoms can occur at a younger age, too.

OA most commonly occurs in the hands, knees, hips and spine with symptoms of pain, joint stiffness, and possibly swelling due to fluid accumulation.

Arthritis Symptoms

If you are suffering from arthritis you may have these common symptoms:

• Joint pain
• Swelling
• Early morning stiffness
• A warm, hot and/or red joint
• Reduced ability to move the joint
• Many joints affected
• Fatigue

For some forms of arthritis, like rheumatoid arthritis, early treatment is best to help prevent joint damage. See your doctor if any joint pain persists beyond 3 days, too.

How Is Arthritis Diagnosed?

A family history is important to know, so your doctor may ask about close relatives with arthritis.

Your doctor will also ask you about your symptoms.

• Do you have pain and swelling?
• How about morning stiffness?
• Do your joints feel hot to the touch?
• Are your joints red?

A physical exam will determine your range-of-motion - just how easily can you rotate your joints around? Blood tests and x-rays of your joints may be needed.

If you have fluid around your joints, your doctor may remove some with a needle to look for infection or other causes of arthritis, such as uric acid crystals, which cause gout.

Treatments for Arthritis: The Options

Ultimately, you and your doctor will select the most appropriate medication for your specific form of arthritis. Your treatment may be as simple as occasional use of:

• Over-the-counter (OTC) medicines like NSAIDs or acetaminophen (Tylenol).
• Prescription NSAIDs
• Anti-inflammatory corticosteroids
• Disease Modifying Anti-Rheumatic Drugs (DMARDs) for rheumatoid arthritis.
• Rarely, very short-term use of narcotic painkillers may be used to ease a flare-up; although most clinicians strongly discourage use of opioids due to side effects and concern for misuse.

Topical capsaicin or topical diclofenac (Voltaren Gel 1%) may help relieve the symptoms of OA, and injectable joint lubricators such as hyaluronan (Orthovisc, Synvisc) may relieve OA pain for up to six months.

In Feb. 2020, the FDA approved an over-the-counter version of Voltaren Gel known as Voltaren Arthritis Pain (diclofenac sodium topical gel, 1%) for the temporary relief of arthritis pain.

Oral OTC Arthritis Pain Options

Mild pain relievers you can take in a pill, such as over-the-counter acetaminophen (Tylenol) or NSAIDs (like Advil or Motrin) are effective for mild or intermittent forms of arthritis and may be most affordable.

Acetaminophen reduces mild pain but does not help with inflammation or swelling like Advil or Motrin. However, acetaminophen may show success in patients with milder forms of osteoarthritis. These agents may also be used with other medications for more severe forms of arthritis, like rheumatoid arthritis.

An excessive dose of acetaminophen, and mixing with alcohol, can lead to liver toxicity. High doses and long-term use of NSAIDs can cause side effects like stomach ulcers and bleeding, or kidney problems, so be sure to check with your doctor for the right dose for you.

Prescription NSAIDs

There are many NSAIDs on the market that require a prescription if OTC products don't do the trick, but they can be associated with serious bleeding side effects, too.

For example, these older NSAIDs may be options:

• piroxicam (Feldene)
• fenoprofen (Nalfon), or
• indomethacin (Indocin)

Celebrex, somewhat safer for the stomach, is now available in a generic form known as celecoxib.

However, just like the non-prescription NSAIDs, these agents can still be linked with stomach ulceration and bleeding. Also, the FDA asked manufacturers of all NSAIDs to include a warning label on their products that alerts users to an increased risk of cardiovascular events (like heart attacks and strokes) and stomach bleeding.

In May 2018, the FDA approved Consensi (amlodipine and celecoxib), from Kitov Pharma, a combined calcium channel blocker and NSAID for the treatment of both hypertension and pain associated with osteoarthritis. It is thought that combining the two agents for osteoarthritis and hypertension might enhance adherence, but this combo may also boost your cost compared to taking the medicines separately. Important NSAID warnings such as cardiovascular and gastrointestinal risk remain on the Consensi label.

Are Glucosamine and Chondroitin Useful?

The use of glucosamine and chondroitin for the treatment of osteoarthritis (OA) is controversial even though they are widely marketed and used in the U.S.

Research has yielded conflicting results on the benefits of glucosamine and chondroitin.

• In general, the research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis. How well glucosamine helps osteoarthritis knee pain in unclear. The effect of either supplement for pain in other joints is not known.
• In an NIH study, patients with mild knee osteoarthritis were given either glucosamine hydrochloride, chondroitin, both supplements together, celecoxib, or a placebo (an inactive substance).
• Those who received celecoxib (Celebrex) had better short-term pain relief (at 6 months) than those who received a placebo. But those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate-to-severe pain who took glucosamine and chondroitin together.

Glucosamine and chondroitin have few toxic side effects so your doctor may agree to a trial of use. However, there may be a risk of an interaction with the anticoagulant drug warfarin (Coumadin). Patients who are allergic to shellfish should not use glucosamine. Treatment should be stopped after 6 months if there is no positive effect on OA symptoms.

DMARDs: The Backbone of RA Therapy

Non-biologic disease-modifying anti-rheumatic drugs (DMARDs) are the anchor drugs used for treatment of rheumatoid arthritis (RA), but their full effect may take one to three months. DMARDs decrease inflammation, lessen joint damage, and help to maintain joint function.

Methotrexate (MTX) is a first-line DMARD that is often used in conjunction with an NSAID or glucocorticoid anti-inflammatory while MTX takes affect. MTX is usually taken once per week as a pill or injection.

Common oral non-biologic DMARDs include:

• methotrexate
• hydroxychloroquine
• leflunomide
• sulfasalazine

Biologic DMARDs: An Advance in Treatment

What if your rheumatoid arthritis (RA) does not respond to the nonbiologic DMARDs? Another nonbiologic DMARD might be added, or a biologic can be tried alone or added to the nonbiologic DMARD.

The biologics are additional treatments for patients with a low initial response or who have severe RA disease. Most biologics are given by injection and can be added to non-biologic DMARDs, NSAIDs or corticosteriods.

Biologic DMARD examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), abatacept (Orencia), certolizumab (Cimzia), golimumab (Simponi), rituximab (Rituxan), and tocilizumab (Actemra).

Several biologics are now approved as biosimilars, too:

• Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hyrimoz (adalimumab-adaz), Hadlima (adalimumab-bwwd), Abrilada (adalimumab-afzb), Hulio (adalimumab-fkjp), and Yusimry (adalimumab-aqvh) - all biosimilars to Humira
• Renflexis (infliximab-abda), Inflectra (infliximab-dyyb), Ixifi (infliximab-qbtx), and Avsola (infliximab-axxq), all biosimilars to Remicade
• Erelzi (etanercept-szzs), and Eticovo (etanercept-ykro), all biosimilars to Enbrel
• Riabni (rituximab-arrx), Ruxience (rituximab-pvvr), Truxima (rituximab-abbs), all biosimilars to Rituxan

What Should I Know Before Starting a TNF Blocker?

TNF blockers can lower the infection-fighting ability of your immune system. It is important you report any signs of infection, such as a fever, to your healthcare provider. Also report any night sweats or weight loss that occurs during treatment.

Review your vaccination history with your doctor as you may need to update your vaccinations before biologic treatment begins.

Tell your doctor if you have a history of congestive heart failure (CHF), cancer or hepatitis. You will also be tested for tuberculosis (TB) before starting a biologic agent.

JAK Inhibitors: Olumiant and Rinvoq

Roughly 60% of rheumatoid arthritis (RA) patients will not reach remission with their first tumor necrosis factor (TNF) inhibitor therapy, so other options may be needed.

In May 2018, Olumiant (baricitinib) was FDA-approved as a once-daily oral medicine for adults with moderate-to-severe RA and an inadequate response to TNF inhibitors. Olumiant is from Eli Lilly & Co.

• Like Xeljanz (tofacitinib), Olumiant is a Janus kinase (JAK) inhibitor.
• Olumiant may be used alone or in combination with methotrexate or other non-biologic DMARDs.
• However, Olumiant should not be used with other JAK inhibitors, biologic DMARDs, or potent immunosuppressants like azathioprine or cyclosporine.

In clinical studies, Olumiant had a significant response rate when compared to placebo at Week 12 (49% versus 27%, respectively). A Boxed Warning exists on the labeling for the risk of serious infections, malignancies and thrombosis.

In August 2019, the FDA cleared the way for AbbVie's oral JAK inhibitor known as Rinvoq (upadacitinib). Rinvoq is approved for adults with moderate-to-severe rheumatoid arthritis (RA) who have had an inadequate response or intolerance to methotrexate (MTX-IR). It's also now approved to treat psoriatic arthritis, moderate-to-severe atopic dermatitis, moderate-to-severe ulcerative colitis and ankylosing spondylitis.

Non-Drug Therapies for Arthritis

Medication is only one component for the treatment of arthritis. The phrase "use it or lose it" really applies here.

• Joint pain, inflammation, and stiffness often keep patients from using their affected joints.
• However, a regular pattern of exercise or physical therapy, range of motion exercises, and resting of inflamed joints are important added components to drug therapy.
• Non-weight bearing exercises like cycling or swimming can be helpful for those who experience pain while walking.

Occupational therapy, general education programs, and strategies for preserving joint function can be helpful to control pain, improve mood, and help patients maintain their activities of daily living.

Can Your Arthritis Symptoms Predict the Weather?

Fact or myth? People with arthritis may be able to tell you when the weather will turn cold or rainy better than your local meteorologist.

Patients with arthritis will swear by this statement, although it is frequently challenged by scientists. However, some studies show that weather changes, like a falling barometric pressure and temperature drops can increase pain. Tufts New England Medical Center conducted research and found that for every 10 degree drop in temperature an incremental increase in arthritis pain occurred.

Researchers suspect the reason these changes may happen is because atmospheric changes like a falling barometric pressure can increase swelling in the joint capsule. It simply could be chance too.

Is There Any Way to Prevent Arthritis?

Older age, family history, and being female are all unchangeable risk factors for arthritis. However, there are a few things you can do to help keep arthritis at bay.

1. Know that excess weight may increase the risk for osteoarthritis in the knees, hips and hands.
2. Also, osteoarthritis may be more likely to develop if you overwork a damaged or sore joint and engage in excessive, repetitive motions.
3. Be sure to get a correct diagnosis. Early treatment for rheumatoid arthritis (RA) can help to prevent disabling joint damage. Regular exercise, controlling your weight, and healthy food choices can also help keep your joints strong, even after you are diagnosed with arthritis.
4. Finally, consider joining the Drugs.com Support Group for either Osteoarthritis or Rheumatoid Arthritis to ask questions and educate yourself on the latest research, news, and treatment recommendations.