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 The leading web portal for pharmacy resources, news, education and careers October 22, 2017
Pharmacy Choice - Arthritis Disease State Management - October 22, 2017

Arthritis Disease State Management

Oh My Aching Joints . . .
by Alan P. Agins, PhD
President - PRN Associates, Ltd. - Continuing Medical Education

Did you know that arthritis is the most common cause of disability in the United States with close to 30 million individuals suffering from one form or another of this disease. It is estimated that the total cost of arthritis cases is close to $100 billion annually and each year, arthritis results in nearly one million hospitalizations and close to 45 million outpatient visits to health care centers.

The term Arthritis derives from the Greek arthro ( joint) and itis ( inflammation). But it is not a solitary disease. In fact, there are actually many different forms of arthritis. Most people are familiar with the two most common forms, osteoarthritis and rheumatoid arthritis, but there are also septic arthritis, juvenile (idiopathic) arthritis, Still's disease, ankylosing spondylitis and others that occur secondary to certain diseases like psoriasis. Even gout and pseudo-gout are considered arthritis.

While both osteo and rheumatoid arthritis are associated with joint destruction, inflammation and pain, there are substantial differences between these two forms of the disease. Osteoarthritis (OA) is far more common, affecting nearly 27 million Americans while Rheumatoid Arthritis (RA) affects between 1- 2 million.

OA is considered a degenerative joint disease, primarily resulting from trauma to the joint or just plain aging. In fact, in demographic studies, "age" is the most consistently identified risk factor for OA. While it can begin to affect some people in their 40's and 50's, it is still predominantly a disease of the elderly and tends to affects the bigger, weight bearing joints like the back, upper and lower spine, knees, feet and pelvis. It can affect a single joint or multiple joints, is often asymmetrical in location and affects both genders equally.

On the other hand, RA is an autoimmune disease where joint destruction is due to the immune system attacking the joint. Furthermore, RA is really a systemic disease and can often affect other organs in the body. Although rheumatoid arthritis may present at any age, patients most commonly are first affected in their 20's and 30's. Interestingly, the incidence of rheumatoid arthritis is two to three times greater in women than in men. In contrast to the common sites for OA, Rheumatoid arthritis more commonly affects joints in the fingers, wrists, knees and elbows, is symmetrical in nature and more frequently leads to severe deformity in a few years.

For the pain and inflammation associated with either type of arthritis, analgesics and anti-inflammatory drugs are the most widely used. Beyond that, pharmacological management of OA and RA are quite different. For OA patients who are unresponsive or intolerant to standard NSAID or COX-2 inhibitor treatments, other options include localized intra-articular injections of corticosteroids or hyaluronic acid. While dietary supplements such as glucosamine and chondroitin have been shown to relieve pain and improve joint function in some studies of OA of the knee, there are still many who may not get benefit, and many more who don’t even attempt a trial of the supplements.

One fact that has emerged in recent years is that for OA patients who carry a few extra pounds, weight loss can provide some relief. Researchers suggest that for every one pound of weight lost, there is a four pound reduction in the load exerted on the knee and that weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.

As for the RA patient, there is a group of rather diverse drugs that are collectively known as the DMARDs. These disease-modifying antirheumatic drugs, including immunosuppressants, chemotherapeutic agents, antimetabolites, monoclonoal antibodies, antibiotics, antimalarial drugs and others, are all used in an attempt to slow the progression of the disease. Frequently they are used in combination with NSAIDs. Indeed, some of the newer biological agents, like the TNF Inhibitors, can significantly improve quality of life for RA patients, at least in the short term. But they do come with substantial price tags, invasive, albeit less frequent, dosing and the potential for some serious side effects. In 2008, the FDA placed a black box warning on all the TNF inhibitors regarding risk of infection and the possibility for malignancies from some.

Unfortunately, as with many diseases, there are no cures for arthritis – just symptomatic relief and perhaps some slowing of the progression. And. while neither OA or RA can be completely prevented, there are some things people can do to help reduce their risks, you know, the standards we hear (and preach) all the time - be physically active, lose weight and eat healthy. Of course, it is important to tell patients who have any pain in their joints to see their healthcare provider because the earlier the treatment is started (physical therapy, lifestyle changes, orthopedic bracing, medications, dietary supplements) the better is the prognosis.

Links - Arthritis
Center for Disease Control Chronic Disease Prevention from the National Center for Chronic Disease Prevention and Health Promotion

Arthritis Foundation is the only national not-for-profit organization that supports the more than 100 types of arthritis and related conditions with advocacy, programs, services and research.

The Arthritis Society is a voluntary organization with a mission to unite Canadians with arthritis and assist them in becoming more effective advocates.

Arthritis National Research Foundation has a primary goal to provide financial support to research studies aimed at discovering new knowledge for the prevention, treatment and cure of arthritis and other rheumatic diseases.

Arthritis Care is the UK’s largest voluntary organization working with and for people with arthritis. Information and articles about arthritis

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