Knee Arthritis|Knock Knees|Virtual Knee Surgery

Drug treatment is usually the preferred "traditional" method of managing arthritis. Considerations need to be made regarding each person's individual reactions to side effects and contraindications of various arthritis drugs. With this in mind, acquiring knowledge of the many arthritis drugs available, and working with your doctor to find the most complimentary combination of medications possible can help you make an informed decision.

NSAIDs / COX-2 Inhibitors

Of all arthritis medications, NSAIDs (non-steriodal anti-inflammatory drugs) are one of the most popular and widely prescribed. Three types of NSAIDS include:

• salicylates - acetylated drugs (aspirin), non-acetylated ones like salsalate (Disalcid), choline magnesium trisalicylate (Trilisate), and magnesium salicylate (Doan's Pills, Novasal).


• traditional NSAIDs


• Cox-2 selective inhibitors

NSAIDs function by impeding cyclooxygenase (a COX enzyme) activity. COX enzymes like COX-1, which keep tissues healthy and COX-2, which have to do with inflammation pathways, are both affected by NSAIDs. Research undertaken in the development of NSAIDs has also led to the discovery of COX-2 selective inhibitors.

The Most Commonly Used NSAIDs Include:

• Ansaid (Flurbiprofen)


• Arthrotec (Diclofenac/Misoprostol)


• Cataflam (Diclofenac potassium)


• Clinoril (Sulindac)


• Daypro (Oxaprozin)


• Dolobid (Diflunisal)


• Feldene (Piroxicam)


• Ibuprofen (Motrin, Advil)


• Indocin (Indomethacin)


• Ketoprofen (Orudis, Oruvail)


• Lodine (Etodolac)


• Meclomen (Meclofenamate)


• Mobic (Meloxicam)


• Nalfon (Fenoprofen)


• Naproxen (Naprosyn, Aleve)


• Ponstel (Mefanamic Acid)


• Relafen (Nabumetone)


• Tolectin (Tolmetin)


• Voltaren (Dicolfenac Sodium)

COX-2 Selective Inhibitors include:

• Celebrex (Celecoxib)


• Vioxx (Rofecoxib) - pulled out of the market


• Bextra (Valdecoxib) - pulled out of the market

DMARDs

A class of "slow-acting anti-rheumatic drugs" are referred to as DMARDS (Disease-Modifying Anti-Rheumatic Drugs). These type of medications, also known as 'second-line agents", take several weeks and sometimes even months, for their healing effects to take hold. Despite the length of treatment, research has evidence that DMARDs are effective in treating rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, particularly when the diseases are diagnosed in its early stages. DMARDS has been known to halt the development of arthritis and arrest joint impairment.

There are several kinds of DMARDs:

• Arava (Leflunomide)


• Auranofin (Ridaura, Oral Gold)


• Azulfidine (Sulfasalazine)


• Mycophenolate (CellCept).0


• Myochrysine (Injectable Gold)


• Cyclosporine (Neoral,Sandimmune)


• Cytoxan (Cyclophosphamide)


• Imuran (Azathioprine)


• Leukeran (Chlorambucil)


• Methotrexate (Rheumatrex, Trexall)


• Minocin (Minocycline)


• Penicillamine (Cuprimine, Depen)


• Plaquenil (Hydroxychloroquine)

Corticosteroids (Steroids)

For fast acting swelling and inflammation relief, powerful steroids like corticosteroids or glucocorticoids are often used. Closely mimicking the behaviour of cortisol, a hormone secreted at the cortex of adrenal glands, steroid dosage is prescribed based on the type of rheumatoid condition and treatment objective.

Steroids keep joint and organ inflammation in check, particularly with rheumatoid arthritis, lupus, polymyalgia rheumatica and vasculitis. Unfortunately, because of its potency, long term steroid use can cause grave side effects, especially in high dosages. Administering corticosteroids like Triamcinolone (Kenalog) for a limited period of time, intravenously or via injections, can precipitate relief from chronic joint symptoms.

Some Corticosteroids Medications:

• Betamethasone (Celestone)


• Cortisone (Cortone)


• Dexamethasone (Decadron)


• Hydrocortisone (Cortef)


• Methylprednisolone (Medrol)


• Prednisolone (Prelone)


• Prednisone (Deltasone)

Analgesics - The Painkillers

Pain is a controlling factor in arthritis. Alleviating pain symptoms play a vital role in the management of the disease. To achieve this, analgesics like Acetaminophen (Tylenol) are prescribed as painkillers. For the relief of severe pain, doctors prescribe stronger narcotic analgesic drugs. Analgesics can help control pain, however they cannot rid joints of arthritic inflammation.

Different Narcotic Drugs For Severe Pain:

• Codeine (Tylenol#3)


• Darvocet (Propoxyphene/Acetaminophen)


• Darvon (Propoxyphene)


• Duragesic (Fentanyl Skin Patch)


• Hydromorphone (Palladone)(no longer on market)


• Morphine Sulphate (MS Contin)


• Oxycodone (OxyContin)


• Percocet (Oxycodone/Acetaminophen)


• Percodan ( Oxycodone/ Aspirin)


• Talwin NX (Pentazocine/Naloxone)


• Ultracet (Tramadol/Acetaminophen)


• Ultram (Tramadol)


• Vicodin (Hydrocodone/Acetaminophen)

Biologics: Biologic Response Modifiers (BRMs)

When the body's immune system is impaired in some way, the ability to combat disease or infection is aversely affected. Biologic Response Modifiers, or BRMs can invigorate and re-establish the body's immunity response. BMRs are naturally derived from living organisms, not manufactured in laboratories. Some of the most common and widely used BMR drugs and their functions include:

• Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab) - intercept TNF-alpha, one of the most prevalent cytokines in rheumatoid arthritis. These BMRs act to constrain TNF-alpa, reduce inflammation and minimize joint impairment.


• Kineret (anakinra) - an IL-1 antagonist and selective blocker, which can be used singly or combined with other DMARDs. This BMR works against an excess of interleukin-1 (IL-1), a protein prevalent in rheumatoid arthritis. This action slows inflammation and pain symptoms.


• Orencia (abatacept) - the first T-cell co-stimulation modulator recommended for the management of rheumatoid arthritis symptoms.


• Rituxan - considered the world's most popular drug in the treatment of cancer, Rituxan selectively works against CD20-positive B-cells. This medication was approved by the FDA in early 2006, and administered with methotrexate to inhibit symptoms of moderate-to-severe rheumatoid arthritis in adults. Rituxan is normally prescribed for arthritis sufferers exhibiting negative symptom response from anti-TNF drug treatments.

Fibromyalgia Solutions

There are many medications used for the management of Fibromyalgia, although no drug specific to the condition has been approved by the FDA. At present, doctors prescribe related drug treatments to treat symptoms of the disease. It may be heartening to note, however, that drugs are currently being developed for the exclusive treatment of Fibromyalgia.

Gout Treatment

Considered to be among the most severely painful forms of arthritis, Gout treatment involves proper medication and a regulated diet. People suffering from this disease require pain killers, anti-inflammatory agents,and drugs to correct the accompanying metabolic dysfunction that results in serious attacks of Gout due to excessive amounts of uric acid in the blood.

Drugs used for Gout:

• Analgesics or painkillers - like Acetaminophen (Tylenol).


• NSAIDs (nonsteroidal anti-inflammatory drugs) like indomethacin (Indocin) - reduces inflammation.


• Colchicine - averts and lessens incidences of Gout attacks.


• Corticosteroids - fights against inflammation.


• Probenecid (Benemid, Probalan) - lowers uric acid levels in the blood.


• ColBenemid (Col-Probenecid and Proben-C) - relieves gout symptoms.


• Allopurinol (Zyloprim) - reduces uric acid levels and inhibits its production.


• Losartan (Cozaar, Hyzaar) - although not a gout drug, it is antihypertensive in nature and works to contain uric acid levels


• Fenofibrate (Tricor) - also not a gout drug but acts to reduce lipids to aid in lowering uric acid levels.

Osteoporosis Medication

Osteroporosis is characterized by frail and brittle bones, especially in older people. However, it may also strike long-term users of corticosteroids. To treat this disease, various drug regimens may be prescribed, including estrogens, parathyroid hormones, bone formation agents, bisphosphonates, and selective receptor molecules. These medications can allay bone degeneration, assist in bone growth, and lower the risks of fractures.

Osteoporosis drugs include:

• Actonel (Risedronate)


• Boniva (Ibandronate)


• Didronel (Etidronate)


• Estrogens (Hormone Therapy)


• Evista (Raloxifene)


• Forteo (Teriparatide)


• Fosamax (Alendronate)


• Miacalcin (Calcitonin)