In this blog and the corresponding videos, we will talk about the two most common type of arthritis (osteoarthritis and rheumatoid arthritis).
Osteoarthritis is by far the most common form of arthritis. When you think of OA think DEGENERATIVE PROCESS, involving wear and tear of the cartilage that caps and protects the bones in your joints. As the cartilage wears down over time, the bones lose their lining, the nerve endings become exposed causing pain and decreased joint mobility over time.
Rheumatoid arthritis, on the other hand, is an AUTOIMMUNE DISORDER.
What does this mean?
It means that the body attacks itself. The body recognizes the lining of the joints as foreign and the immune system begins to attack it. This causes fluid and inflammation of the joint, subsequently breaking down the cartilage which is the protective lining of the joints.
RA is systemic and does not discriminate. As a result, multiple joints and bilateral sides can be effected. OA usually affects a single side and single joint.
Here is a picture of an RA knee, it has an inflammatory component. Fluid builds up in the joint, and you get erosions of the surrounding bone and wearing away of the cartilage.
So in both cases get cartilage damage, but the process is different. One is wear and tear (Osteoarthritis), the other is inflammation (Rheumatoid Arthritis).
The best way to prevent osteoarthritis, or in better words, stop its progression, is to maintain a healthy weight by staying active and exercising on a regular basis. This includes strengthening your muscles with weight training to help lower the stress on your joints.
Next comes the treatment of the symptoms with medication (usually short term)
NSAIDS (ibuprofen) — although too much can have GI and cardiovascular side effects, I don’t advocate the use of opioids due to its side effects and risk for dependency. Based on my experience there are much better and more effective ways to manage your arthritis.
In our clinic, we use ultrasound for precision guided injections and have excellent lasting results for mild, moderate and even moderate to severe OA.
Joint injections due not usually yield good results in severe OA, such as “bone on bone” arthritis. The best option at this stage is usually joint replacement surgery.
The goal is to manage your osteoarthritis early, because early treatment can help slow progression and prevent surgery.
RHEUMATOID ARTHRITIS Treatment
As we mentioned, RA is autoimmune inflammatory process.
The primary goal is to reduce the degree of inflammation and prevent joint damage.
The primary treatment for rheumatoid arthritis is medication. There are really few categories of medication commonly used to treat rheumatoid arthritis, including:
NSAIDS: just like osteoarthritis (Ibuprofen)
CORTICOSTEROIDS: Oral Prednisone
These two meds are for the short-term pain relief and have many unwanted side effects in the long run.
The next category are the DMARDS (Disease modifying Anti-rheumatic drugs)
They fall in 2 subcategories: Non-biologics & Biologics
Non-biologics: These medications help stop the immune system from attacking healthy tissue. Methotrexate, cyclophosphamide are two well-known medications in this class. Usually this is the first line of treatment. If the response is not good or if the patient has side effects, then the biologics may be used.
Biologics: These are the newest drugs that target and help block immune cells that cause this inflammation. Enbrel, Humira are two well-known medications in this class. These agents usually have a quicker onset of action and can be a very good choice when other treatments have not helped.
Along with medications, local steroid joint injections help relieve pain for rheumatoid arthritis as they have a strong anti-inflammatory effect. We do not have much data on PRP. Also, PRP induces a healing inflammatory response, and this may actually add to the inflammatory component of RA and worsen the condition. Also, hyaluronic acid is also not used since it helps lubricate the joint and do not address the underlying inflammatory component associated with RA.
Like osteoarthritis, the last-resort treatment for rheumatoid arthritis is surgery. This includes arthrodesis (fusion of the joint), and arthroplasty (joint replacement).
Posted on behalf of Advanced Healing Institute
22972 El Toro Road
Lake Forest, CA, 92630
Phone: (949) 239-3206