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Medicines and Arthritis

This fact sheet provides general information about the main types of medicines used for arthritis. It also gives tips on the safe use of medicines and where to go for further information. This sheet does not cover the full range of possible side effects for each medicine and you should discuss this further with your doctor or pharmacist.

Analgesics (pain relievers)

Pain relievers are often the first medicine your doctor will recommend to help with pain. Some pain relievers are available without a prescription, while others must be prescribed by a doctor.

Types: Paracetamol is a simple pain reliever that can ease mild to moderate pain. There are also stronger pain relievers, such as a combination of paracetamol and codeine, tramadol and a range of morphine-like medicines (opiates).

Effects: Pain relievers act on the nervous system to reduce pain. They do not affect other symptoms such as joint swelling or stiffness.

How are they used: In some cases pain can be controlled by using an analgesic just when it is needed. Sometimes pain is better controlled by taking an analgesic regularly, for example four times a day. Ask your doctor or pharmacist for advice on the best way to take analgesics for your condition.

Risks: Paracetamol has very few side effects when taken at the recommended dose. However taking more than the recommended daily dose can potentially cause severe liver problems. Be careful when taking pain relievers with over the-counter medicines, such as ‘cold and flu’ medicines. These medicines may also contain paracetamol and you may accidentally take more than the recommended daily dose. Always ask your pharmacist for advice before taking any over-the-counter medicines. Stronger pain relievers may cause constipation, nausea, vomiting and drowsiness.

Non-steriodal anti-inflamatory drugs (NSAIDs)

NSAIDs reduce inflammation, joint swelling and stiffness. They are often used to treat inflammatory forms of arthritis, such as rheumatoid arthritis. They can also relieve pain that is not controlled by analgesics alone. Some NSAIDs are available without a prescription, while others must be prescribed by a doctor.

Types: There are many different types of NSAIDs available, such as naproxen and ibuprofen. There is a certain group of NSAIDs called COX-2 inhibitors that are slightly less likely to cause stomach problems.

Effects: NSAIDs stop the body producing substances (prostaglandins) that cause inflammation. This reduces symptoms such as pain and swelling. NSAIDs do not cure or have a long-term effect on your arthritis.

How are they used: Some conditions can be effectively controlled by using NSAIDs occasionally, i.e. as needed. Other conditions may require more regular use of NSAIDs. Ask your doctor or pharmacist for advice on the best way to take NSAIDs for your condition and how to reduce the dose of NSAIDs if your pain is less.

Risks: Always talk to your doctor or pharmacist before taking NSAIDs as they may cause serious side effects compared to paracetamol. If you have problems with your blood pressure, kidneys or heart then the risk of heart attack, stroke and kidney failure may be increased in a small number of people.

One of the most serious side effects of NSAIDs is bleeding of the stomach and upper intestine. Signs of bleeding include stomach pain, blood in your stools (or dark stools) and coffee-coloured vomit. You should see your doctor as soon as possible if you have any of these signs while taking NSAIDs. Even though some NSAIDs are available without prescription, your doctor can advise which of the NSAIDs and dosage are best for you.

Corticosteroids

Corticosteroids are used to treat inflammatory forms of arthritis, such as rheumatoid arthritis. They can also be used to treat a single inflamed joint.

Types: Corticosteroids can be taken by mouth as tablets or liquid. They can also be given by injection into a joint, muscle or soft tissue.

Effects: These medicines have a strong anti-inflammatory effect and reduce pain and swelling. However they do not cure the disease.

How are they used: Your doctor will prescribe the lowest possible dose for the shortest time, due to the risk of side effects. You may need to restart corticosteroids again during a ‘flare’ (when symptoms worsen for a period of time).

Risks: Corticosteroids can have serious side effects if taken in high doses or for a long time (more than a few weeks). Your doctor will monitor you for side effects while you are taking corticosteroids. Common side effects include weight gain, thinning of the bones (osteoporosis), high blood pressure and increased susceptibility to infection. Corticosteroid injections usually produce fewer side effects than tablets.

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs are used to treat inflammatory forms of arthritis, such as rheumatoid arthritis and ankylosing spondylitis. Many DMARDs act on the immune system to cause ‘immunosuppression’. This reduces the activity of the immune system which is attacking and damaging healthy joints. There is also a newer group of DMARDs available, known as ‘biological DMARDs’. These block certain substances in the blood and joints that cause inflammation. This reduces inflammation and halts joint damage. DMARDs and biological DMARDs are usually only prescribed by specialists.

Important medicine tips

Understand why you are taking the medicine and what the possible side effects are. Ask your pharmacist for the Consumer Medicines Information (CMI) leaflet for your medicine. See the Australian Rheumatology Association’s Patient Medicine Information or ask your rheumatologist for a copy.

Always read all medicine labels and take your medicines as directed. If you have any questions check with your doctor or pharmacist. Keep a personal record of all your medicines with you, including doses and allergies. This can be useful when you are talking to your doctor or pharmacist.

Always talk to your doctor or pharmacist before taking any over-the-counter medicines, including natural medicines, as some medicines cause problems if taken together. Do not share your medicines with friends or relatives – the medicines you are taking may be harmful to them. Your healthcare team can give you more advice and information about whether any of these or other treatments might be useful for you.

Hyaluronic acid

(also known as hyaluronan, sodium hyaluronate, hylan GF20)

This information sheet has been produced by the Australian Rheumatology Association and Arthritis Australia to help you understand the medicine that has been prescribed for you. It includes important information about:

how you should take your medicine
what are the possible side effects
what tests you should have to monitor your condition and to detect unwanted effects
other precautions you should take.
Please read it carefully and discuss with doctor.

Important things to remember:

You should tell your doctor if pain and swelling in the joint increases following the injection.

You should tell your doctor if your joint becomes red and hot following the injection.

What is hyaluronic acid?

Hyaluronic acid (brand names Synvisc, Orthoartz) is used to treat osteoarthritis, a condition that affects the joints. It is most commonly used to treat osteoarthritis of the knee.

In a normal joint, a layer of cartilage or gristle covers the ends of the bones. Cartilage helps the joint move smoothly and cushions the ends of the bones. In osteoarthritis, cartilage breaks down and becomes thin. This leaves the ends of the bones unprotected and the joint loses its ability to move smoothly.

Hyaluronic acid is found naturally in joints and other parts of the body. In the joint, it is found in the cartilage and the synovial fluid that lubricate the joints to keep them working smoothly.

In people with osteoarthritis, the hyaluronic acid gets thinner and it is no longer able to protect the joint. Injections of artificial hyaluronic acid into affected joints can improve the protection.

Hyaluronic acid injections are usually offered to people with osteoarthritis of the knee if other treatments have not worked.

What benefit can you expect from your treatment?

Hyaluronic acid injections help reduce the pain caused by osteoarthritis. Some patients find relief from symptoms within a few days. Full benefits usually are reached 3-5 weeks after the treatment.

The treatment may provide pain relief for up to 6 months. Response varies and the injections do not help everyone. If successful, the injections can be repeated after 6 months.

How is hyaluronic acid given?

Your doctor will inject the hyaluronic acid directly into the knee joint. Local anaesthetic is sometimes used before the injection. Injections may be given once a week for three weeks or a single injection, depending on the particular product your doctor recommends.

Can other medicines be taken with hyaluronic acid?

Hyaluronic acid may be used with other arthritis medicines including:

1. Steroid medicines such as cortisone injections into the joint

2. Anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen, Nurofen) simple pain medicines such as paracetamol.

Are there any side effects?

Side effects from hyaluronic acid injections are not common. Most are limited to the site of injection and do not last long. Tell your doctor if you are concerned about possible side effects.

Most common possible side effectsLocal side affects may include:

1. Redness and tenderness at the site of the injection

2. Increased stiffness, swelling or warmth inflammation (flare) lasting 24 to 48 hours following the injection.

3. These local reactions may be treated by resting and applying ice to the injected area, or by simple pain relievers.

Less common or rare possible side effects:

These include:

Allergy including rashes, hives, itching, flushing and swelling of the face, tongue or throat, chest tightness and shortness of breath. If you experience any of these symptoms contact your doctor straight away.

Less commonly, a joint may become severely inflamed after injection. This may be due to acute pseudogout arthritis from crystals in the joint. Very rarely, an infection in the joint may develop after the injection. If the pain and swelling in the joint that was injected increases a great deal or the joint becomes red and hot contact your doctor quickly.

Other side effects that have been observed include: headache, muscle pain, nausea, sore throat and flu-like symptoms.

After the injection

It is recommended that strenuous activity (e.g. high impact sport such as jogging or tennis) or prolonged weight-bearing activities are avoided for about 48 hours after the injection.

Infection
Hyaluronic acid injections will not be given if you have an infection in your joint or a skin disease or infection around the area where the injection will be given.

Circulation
Hyaluronic acid injections will not be given if you have circulatory problems in your legs.

Tell your doctor if you have significant swelling or blood clots in your legs.

Allergy
Hyaluronic acid injections will not be given if you have had a prior allergic reaction to hyaluronan-based products.

Tell your doctor if you are allergic to products from birds such as feathers, eggs and poultry.

Use with other medicines

You should tell your doctor (including your general practitioner, rheumatologist and others) about all medicines you are taking or plan to take. This includes over the counter or herbal/naturopathic medicines.

You should also mention your treatment when you see other health professionals.

Use in pregnancy and breastfeeding

Hyaluronic acid has not been tested in pregnant women or women who are breastfeeding. It is important to tell your doctor if you are, or intend to become pregnant or if you are breastfeeding.

The information in this sheet has been obtained from various sources and has been reviewed by the Australian Rheumatology Association. It is intended as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information is not intended as medical advice for individual problems nor for making an individual assessment of the risks and benefits of taking a particular medicine. It can be reproduced in its entirety but cannot be altered without permission from the ARA. The NHMRC publication: How to present the evidence for consumers: preparation of consumer publications (2000) was used as a guide in developing this publication.

References

Australian Rheumatology Association

http://www.rheumatology.org.au

Revised 23 August 2011– next review July 2012

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