Arthritis is defined as joint inflammation

Posted 6/28/22

Arthritis simply means “joint inflammation.”  There are many causes and some dangerous medications that can help.  The most common is degenerative arthritis (or osteoarthritis) …

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Arthritis is defined as joint inflammation

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Arthritis simply means “joint inflammation.”  There are many causes and some dangerous medications that can help.  The most common is degenerative arthritis (or osteoarthritis) where wear and tear of the cartilage is the culprit.  There are inflammatory arthritis conditions that cause joint pain and destruction such as rheumatoid arthritis, psoriatic arthritis and lupus.  There are chemically caused arthritis like gout and pseudogout.

In rheumatoid arthritis the body is tricked into believing that the joint lining (synovium)  is a dangerous germ.  This all out assault destroys the joint, causing significant deformities and pain. The treatment for rheumatoid arthritis consists of the medications methotrexate.  Plaquenil (hydroxychloroquine) is another option - it can cause blindness so regular eye exams are needed.  There are “biologicals” - which are very expensive and can cause death such as Humira. In general you need to fail methotrexate or Plaquenil (hydroxychloroquine) therapy before insurance will pay for biologicals.  A baseline TB blood test (quantiferon gold) and a blood test for hepatitis B need to be done prior to taking a biological.  Inflammatory arthritis can often be diagnosed with blood tests and x rays.  If taking methotrexate, folic acid should be taken the other 6 days of the week, not the day methotrexate is taken. 

Degenerative “osteoarthritis” can be caused by old injuries, infections, or wear and tear.  Sometimes its just genetic.  The cartilage gets damaged and causes pain - usually with movement. Joint replacement is an option for some, especially arthritis in knees and hips.  We have no medication to prevent joint worsening or improve the joints. If obese losing weight will help some. Approximately 30 years ago a study in Great Britain showed regrowth of knee cartilage by taking the supplement “glucosamine” 1500 mg daily.  This study has been replicated and half the studies showed it helped and half showed it didn’t help.  Glucosamine may be worth a trial. I take it.

Gout is when the blood chemical “uric acid” gets into high concentration in a joint and causes profoundly painful arthritis attacks.  The most common joint is the base of the big toe, but other joints can be affected.  During the attack the uric acid can be low, so a follow up blood test will be necessary.  Another joint disease is “pseudogout” - which can only be diagnosed by putting a needle into the joint and drawing off the material, which is then sent to the lab.  NSAIDS like Advil (ibuprofen) and Aleve (naproxen) are often effective.  A short course of steroids gives the most profound relief quickly.

Tylenol (acetaminophen) helps many, but overdoses can cause fatal liver disease.  The daily dose shouldn’t be more than 3000mg daily.  NSAIDS cause intestinal bleeding, heart attacks, kidney damage and liver damage - especially in overdose.  You may take an NSAID with Tylenol, but you can’t take 2 NSAIDS or an NSAID with aspirin.  Naproxen is safer than the others in the class regarding heart attacks.  If one has active coronary artery disease (blocked arteries) only Tylenol (acetaminophen) should be taken, not the NSAIDS. 

Family Medical Practice

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