Ask An Expert: Arthritis Medications

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Ask An Expert: Arthritis Medications

Question:

Do pain medications prevent arthritis from worsening, directly or indirectly? If I choose not to take medications for chronic arthritis pain due to a concern about potential side effects, am I allowing the arthritis to worsen?

Answer:

Your question is a good one because arthritis medications are prescribed for a number of different reasons. The most common reason arthritis medications are prescribed is to relieve symptoms; in fact, reducing the pain and stiffness of arthritis can dramatically improve a person's quality of life. However, there are other good reasons to take medications for arthritis, including maintenance of joint function and avoiding joint damage.

Function is also a key part of quality of life, and certain medications or treatments can improve it; for example, people with osteoarthritis of the knee may gradually walk less and less, reducing their independence over time. Effective treatment can help to maintain function. For other types of arthritis, therapy can prevent joint damage; an example is methotrexate, which can slow the progression of rheumatoid arthritis and reduce the amount of joint damage over time.

In general, medications prescribed purely for pain do not prevent arthritis from worsening. However, some medications have multiple effects; they can reduce pain, improve function and protect the joints over time. To answer your question directly, I would need to know the type of arthritis you have — there are more than 100 types — and the specific treatment you are receiving (or considering).

Here are three of the most common types of arthritis, some commonly prescribed medications for them, and some of these medications' benefits:

• Osteoarthritis (also called degenerative joint disease) — This "wear and tear" joint disease is commonly treated with acetaminophen or a non-steroidal anti-inflammatory drug (NSAID, such as ibuprofen) for pain and stiffness, but these medicines do not prevent worsening of arthritis over time; in fact, there is no medication that is clearly effective at preventing osteoarthritis from worsening over time. (Although it remains controversial, some believe that glucosamine may provide some measure of joint protection.)

• Rheumatoid arthritis – While acetaminophen or NSAIDs can reduce symptoms, they do not protect the joints; "disease modifying agents," however, such as methotrexate, leflunomide, adalimumab, etanercept, or infliximab, may prevent joint damage as well as relieve pain and improve function over time.

• Gout – NSAIDs and corticosteroids are highly effective for reducing pain and inflammation related to attacks of gout, but allopurinol or probenecid (recommended for the more severe cases of gout) have the potential to protect the joints from damage in the future.

Talk to your doctor about the specifics of your situation — the type of arthritis you have, the medications you are considering, and the reasons each medication was prescribed. If you are trying to decide whether or not to take a recommended medication, you'll make a better decision if you understand why it was prescribed, the expected risks and benefits of taking it, and the risks and benefits of not taking it.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

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Last updated:	January 24, 2007