Medications to relieve symptoms or pain

• Each of the conditions described in "Our Patients" offers a variety of effective medications.  Some medications are effective in relieving symptoms.  Others have the potential to modify the disease process. Dr. Nelson may recommend using more than one medication at a time, with each having a distinctly different purpose.

• Careful monitoring is required with the use of prescription as well as over-the-counter medications. Dr. Nelson will weigh the potential benefits against known risks of various medications.  He will also recommend a program of periodic monitoring to make sure that long-term side effects are avoided.

• NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin, ibuprofen, naproxen sodium and others, are commonly used to help treat pain and inflammation.  They are also often used in conjunction with other medications.

• Analgesics such as acetaminophen (Tylenol), acetaminophen with codeine, propoxyphene (Darvon), tramadol (Ultram) and others are often used for pain relief, but are not as effective for inflammation or swelling.  Some have the potential for drug dependence if used over a long period of time.

• Glucocorticoids such as cortisone and prednisone, whether injected or taken orally, can be effective in reducing inflammation and soothe joints that are constantly swollen or painful.  Injections offer quick, temporary relief, but require regular monitoring because of the range of potential side effects.

Medications designed to modify the disease process - DMARDS

• Methotrexate (Rheumatrex) has become a common treatment for rheumatoid arthritis. It works more quickly than gold and maintains control of the disease for more people. Frequent monitoring is required to check for liver function and other possible serious side effects.      

• Arava (Leflunomide) is a new antimetabolite which is somewhat similar to methotrexate, but blocks different pathways.     

• Sulfasalazine (Azulfidine) was initially developed in the 1940's to treat rheumatoid arthritis.  It has been used primarily to treat inflammatory bowel disease until the last 20 years when it was rediscovered as a very effective and safe treatment for rheumatoid arthritis.

• Gold Therapy has been used for more than 70 years in the treatment of rheumatoid arthritis.  Gold Therapy is usually administered as an injection or pill form. Gold salt injections have been shown to relieve joint pain and stiffness and to reduce swelling and bone damage.     

• Hydroxychloroquine (Plaquenil) is another  example of medications which have been used for many years. It is usually used in combination with other DMARDS.

• There are many other medications in this class of drugs which Dr. Nelson will consider and discuss with you.

Biologic Response Modifiers

• This new class of drugs was first introduced in the late 1990's.  They work by blocking the action of tumor necrosis factor (TNF), a chemical that plays an important role in tissue damage and inflammation. They have the ability to target this specific chemical without affecting the entire immune system, as most traditional medications do.  Popular medications are etanercept (Enbrel) and infliximab (Remicade) and Humira.  There are also other immune target medications such as IL-1 (Kineret) and a new drug which will be released soon (Abatacept) which blocks the co-stimulatory pathway and prevents lyphocyte activation..

Exercise & Diet

• Most people with arthritis can benefit greatly from regular exercise. The type and amount of exercise will vary greatly from person to person.  The type of disease, your general health, medications you take, and the course of your condition will help Dr. Nelson make appropriate recommendations of exercise, activity and rest.  A good program can help decrease fatigue, strengthen muscles and bones, increase flexibility and stamina, and improve your general sense of well-being.

• Therapeutic exercise, which is usually tailored to your needs by a physical or occupational therapist, is sometimes recommended for those who have joint damage. Special equipment and aids are often provided to reduce stress to your joints and assist with daily tasks.

• Diet has been shown to help some people with arthritis.  It is important to maintain a healthy diet that includes adequate protein and calcium and avoid excessive weight gain.  Reducing or eliminating alcohol may be necessary with certain medications. Many physicians will recommend vitamins and/or other supplements.

Joint Surgery

• Total joint replacement (arthroplasty) may be recommended when severe joint damage exists.  Joint replacement surgery can often help in keeping you mobile and independent.  A specialist will replace damaged parts of the joints with metal and plastic components.  Total hip and total knee replacements are the most common, followed by hand surgeries.  Doctors will typically prescribe a program of medications and other therapies before considering joint replacement surgery.

• It is our goal to find appropriate medications and treatments to help preserve your joints so that joint surgery is not needed.