Are the side effects of arthritis medication worth it?

Arthritis is a chronic inflammatory autoimmune disease that recruits immune cytokines causing degradation to joints.  There are multiple types of arthritis that affect different areas of the body and stimulate different cytokines.  In this blog, the focus is on the major types of arthritis, osteoarthritis, rheumatoid arthritis, and infectious arthritis.  The symptoms associated for each are as follows:

           

Osteoarthritis: stiffness, swelling, chills and fever during normal activity. Medications usually target similar to rheumatoid targets but may also target osteoclast formation.

           

Rheumatoid Arthritis: Painful swelling, inflammation, stiffness in the fingers, arms, legs, and wrists.  These symptoms can occur in bilateral joints and seen most upon awakening. This in turn, targets inflammatory cytokines of the immune system.

Infectious Arthritis: Fever, joint inflammation, tenderness in joints, and piercing pain. Symptoms can be associated with a pervious injury or disease. 

Each type of arthritis has similar and different symptoms and treatments due to different areas of infection.  Furthermore, the drugs and treatment methods are different for every type of arthritis.  Table 1 shows the type of treatments for arthritis. (The drug name changes with different type of arthritis due to the different cytokine being blocked)

Table 1. Medications used to treat rheumatoid arthritis

	Generic Name	Brand Names
Analgesics*	acetaminophen	Tylenol®, various†
	tramadol	Ultram®
Narcotics*	propoxyphene propoxyphene/acetaminophen	Darvon® Darvocet®‡
	oxycodone hydrocodone/acetaminophen	OxyContin®‡ Roxicodone®‡ Vicodin®‡
NSAIDs*	celecoxib	Celebrex®
	diclofenac sodium	Voltaren®
	ibuprofen	Motrin®, various‡
	naproxen	Aleve®, various‡
	ketorolac	Toradol®
Corticosteroids*	prednisone	various
Nonbiologic DMARDs*	auranofin (oral gold)	Ridaura®
	azathioprine	Imuran®
	cyclosporine	Sandimmune®, Neoral®
	gold sodium thiomalate (injectable gold)	Myochrysine®
	hydroxychloroquine sulfate	Plaquenil®
	leflunomide	Arava®
	methotrexate	Rheumatrex®, Trexall™
	minocycline	Minocin®
	sulfasalazine	Azulfidine®
Biologic DMARDs§	abatacept	Orencia®
	adalimumab	Humira®
	anakinra	Kineret®
	certolizumab pegol	Cimzia®
	etanercept	Enbrel®
	golimumab	Simponi®
	infliximab	Remicade®
	rituximab	Rituxan®
	tocilizumab	Actemra

Medications for arthritis:

1. Tylenol. (Analgesics) Is used to prevent acute pain, headaches, and is a mild anti-inflammatory.  Used for acute arthritis.                                                                                                              Side effects: If overdosed leads to liver damage and ulcers.
2. Vicodon. (Narcotic) Is used to alleviate chronic pain in arthritis users.                      Side effects: Liver damage, death, dependence, anaphylaxis, respiratory depression, and increased intracranial pressure.
3. Vimovo/Celebrex. (NSAIDs)  Is approved to decrease the symptoms of osteoarthritis and rheumatoid arthritis by decreasing the gastric ulcers and stress on joints. This is not an adequate medication for acute pain. Vimovo is a COX-2 inhibitor that prevents inflammation and pain.                                                                                                                Side effects: Cardiovascular thrombotic events, hypertension, edema, congestive heart failure (fluid retention), Gastrointestinal events (ulcers), active bleeding, renal problems (diaharria)   
4. Cortisone. (Corticosteroids) Is a short term anti-inflammatory injection that relieves inflammation in joints?                                                                                   Side effects: cortisone flare (crystallization at injection site causes pain), whitening of skin, and infection.
5. Ridaura. (Non-biologics) this decreases pain, inflammation, and swollen joints by blocking the immune system.                                                                                     Side effects: metallic taste, loose stool, vomiting, stomach pain, hair loss, and rash.
6. Orencia. (Biologics) is a biologics that work early in the inflammation process to decrease T cell activity and decrease the inflammatory process.                                                                  Side effects: Allergic reactions to treatment (get an immune response to medication); serious infections (due to decreased immune system), Hepatitis B (decreased immune response), Respiratory problems (COPD), cancers, and patient can’t receive any vaccines (cause a counter reaction to Orencia).
7. Embrel. (Biologics) is a TNF inhibitor seen mainly in rheumatoid arthritis            Side effects: serious infections, death, TB, lymphoma, exhaustion of central nervous system, Guillian Bare, heart failure, anemia, hepatitis B, autoimmunity, Wegner’s granulomatosis.
8. Actemra (Biologics) is a TNF antagonist that blocks IL-6 cytokine through an IV injection.                                                                                                              Side effects: increases risk of cancers, upper respiratory infections, death, tears in stomach, hepatitis B, low platelet numbers, and suppressed immune system.
9. Acupuncture: eases the pain associated with arthritis.                                               Side effects: insomnia, stress, and infection.
10. Physical therapy: can be applied to increase bone production through hypertrophy and increase the mobility while decreasing stiffness in joints.                                    Side effects: can injure one’s joints more, cardiac arrest, and breaking bones ( by falling)

Arthritis is a pain and debilitating autoimmune disease that has plenty of medications but still no real cure.  All these medications decrease the risk but don’t completely eliminate the problem.  The medications have such severe side effects because they are suppressing some part of the immune system.  Inflammation is good, in moderation.  To answer the question of meds or no meds depends on how serious the progression of the arthritis is.  Each individual must weigh the side effects of each medication to the pain and/or lack of ability to do things.  Every person has a different pain tolerance as well as quality of life. Every person needs to make an educated decision that fits the outline of your life.

References

http://www.webmd.com/osteoarthritis/guide/understanding-arthritis-symptoms

http://www.enbrel.com/RheumPro/dosing-administration.jspx?WT.z_co=P&WT.z_in=RA&WT.z_ch=PDS&WT.z_se=G&WT.srch=1&WT.z_ag=+enbrel_dosing&WT.mc_id=P_RA_PDS_G_+enbrel_dosing

http://www1.astrazeneca-us.com/pi/vimovo.pdf

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000851/

http://www.medicinenet.com/cortisone_injection/article.htm

http://orthopedics.about.com/cs/paindrugs/a/cortisone.htm

http://www.medicinenet.com/acetaminophen/article.htm

http://www.vicodin.com/hcp/?cid=ppc_ppd_vcdn_ggl_ppc_0616

http://www.orencia.com/about/how-it-works.aspx