– [Voiceover] The basic treatments for rheumatoid arthritis and osteoarthritis come at it from very different angles. I think the key phrase for rheumatoid arthritis would be to control. Shorthand here. Control it and reduce inflammation. Remember, this is an autoimmune disease, so the inflammation comes from our own immune system attacking the body. So if we can temper down this, oops, that’s not a parentheses, if we can temper down this inflammation, then we’ll really get to the source of the problem. But of course we treat the symptoms of pain as well. And then on this side for osteoarthritis, which is the wear-and-tear degeneration of the cartilage, our dogma here is gonna be pain control. Pain control. And as a bonus, we wanna work on health in general, the general state of health, and increasing the function and decreasing the symptoms. Okay, under these very different umbrellas, we can only look at one at a time, on the rheumatoid arthritis side, we have a class of drugs called, it’s conveniently named, “Disease-Modifying Antirheumatic drugs.” So, disease, this is gonna be a long name.
Disease-modifying. So this tells you that it not only treats the symptoms, but it also modifies the process, the progression, of the disease on the joint. So modifying antirheumatic, because when these were first produced, they were used to treat rheumatoid arthritis. But today, they’re actually used to treat all kinds of autoimmune diseases as well. So I wanna point out that there are many different kinds of drugs that fall under this category. I’m just gonna put different X’s instead of the names. And the fact that they all have different mechanisms. So they don’t actually attack, or try to temper down, the inflammation at the same place. And what puts them together is the fact that they not only treat the immune system, or decrease the inflammation, but this disease-modifying part tells us that this group of drugs decreases joint damage.
As you can see, a lot of the therapies surrounding arthritis goes to the symptoms of pain and function, but this one actually decreases and slows down the distortion of the joint. So there’s disease-modifying, decrease of inflammation, but then there’s also just good, old, anti-inflammatory drugs that decreases the inflammation in the body as a whole. So it might not target the specific ways that the joint is damaged, therefore it’s not disease-modifying, but it also works in terms of getting the inflammation markers down. So we have our good, old steroids. They can be taken by mouth. What steroids do is that in the inflammation pathway, where A leads to B leads to C, all the way to different inflammation markers, steroids comes in in the middle of this pathway, and just stops it. So this is effective, but it’s not specific, and it does not decrease joint damage, like the D.M.A.R.D.’s do. And of course, there are N.S.A.I.D.’s. This is your ibuprofen, your over-the-counter pain control. So they’re effective in controlling the pain, but they also do decrease the inflammation as well.
So these are the first-line soldiers fighting the war, the steroids and N.S.A.I.D.’s, might be on a case-to-case backup basis. And then there’s just pain control. All the different, traditional ways of controlling pain can be applied here as well. But hopefully with these two drugs, we don’t need too many additional pain killers. So just a side note, really quick here, about side effects. If you look at these drugs, they’re anti-inflammatory, as in they decrease the immune system. So decreasing the immune system is great for autoimmune symptoms, but it also just decreases our body’s defense as well. So sometimes these drugs, like steroids of some of the disease-modifying drugs, can make a person more susceptible to common things like a cold.
And they might have to be stopped temporarily when they have some sort of other illness that we have to treat first, and activate the immune system for. So, it can be a tug-of-war. Just keep in mind these side effects, in the back of your mind. So we come here on the O.A. side, pain control, health. Remember the demographics here are people that tend to be elderly, overuse joints, or they’re carrying extra weight. So lifestyle here is gonna be number one.
Number one as in the first thing to try and the last thing to stop trying. So we have diet, exercise, whatever it takes for weight loss. Being at a healthy weight really decreases the strain on our joints. Weight loss. And of course, if you’re not overweight to begin with, then a lot of the O.A. probably couldn’t be attributed to that. So weight loss in the case of extra weight exacerbating the arthritis. There’s physical therapy, people to teach you how to use your joints correctly, so as to not damage them more. But also building up muscles, because a lot of times when your joints hurt, people stop using that joint or that limb, and their muscle can go into what we call atrophy, or they shrink, and they become not as effective. So P.T., physical therapy, and getting muscle training, using the joint correctly, could actually decrease a strain on that joint when the muscle is strong. So physical therapy can stop people from spiraling into this bad cycle of my joints hurt, so I don’t use my muscles, so my joints hurt more, because my muscles are not working.
Now on this side, we also have the N.S.A.I.D.’s. And actually because this is people who might need to take it for a long time, acetaminophen, what we think of as Tylenol, is also used, and can be used, first-line for less of your symptoms. Because this is bad for, for example, G.I. side effects. Side effects. The acetaminophen does not hurt the gut in the same way. So these are both over-the-counter and they treat pain. But since we know over here that they’re also anti-inflammatory, there’s gonna be local inflammation in the joint from the osteoarthritis, so this is also a good way of just keeping the area under control. Since the pain is so localized here, usually to the specific joint, and it’s not global, like in rheumatoid arthritis, we can do injections into the joint. It can be a very good release of pain, and these can be steroid injections.
So if your shoulder hurts, they can inject the steroid right into the shoulder. And steroids, we know from here, also decrease inflammation in the area. They can also inject analgesics. Analgesics. So deliver the pain control right to the area. I just realized my color coding is off here. I should have used white for these, so let me put some white dashes, but you get the idea here. And then, of course, at the end, we can also think about surgery. I’m gonna put it kinda in the middle, because technically you can do surgery for both sides. We don’t want to get to this point. But sometimes when the damage is too great, we may need to replace the joint.
It involves some risk and a lot of recovery, so we don’t wanna do this for first-line. In fact, they don’t wanna do this in young people, because the joint they put in will fail, too, after a while. So if you put it in someone who is 30, they’re gonna have to keep getting joint replacements. So try to prolong their function and decrease their symptoms, so that they don’t get to surgery. Or if they do, it will be later on..
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