The first and most important activity a physician should do when the patient comes in is to create an accurate identification. This can be done with a careful history, physical examination, lab tests, and imaging processes. How long have you had the symptoms? What joints are involved? Is there a family history? Are there any other symptoms?
On physical examination, we analyze a patient from the surface of the head to the bottoms of their toes! The aims of treatment are simple. Weight-loss: many patients with low back pain, knee pain, and hip pain are obese. All the medicines in the world are not going to help until weight is fixed.
- Assistive devices: splints, braces, walkers, canes, etc. all may help.
- Exercise: non impact in addition to extending and strengthening play a role.
- Modification of lifestyle: occasionally habits will need to change and routines will need to be altered.
- Analgesics: These help reduce pain. They do not block inflammation. Analgesics may be habit-forming or addictive. They provide the possibility of side effects also. Examples: Tylenol, Ultram, Darvocet, Percodan.
- Anti-inflammatory medicines: These block inflammation and help with pain. There’s the possibility for side-effects such as the liver, kidneys, and cardiovascular systems. Examples: Naprosyn, Motrin, Celebrex. Disease-modifying medications: these drugs slow down the progression of arthritis. They’re used in combination with analgesics and anti inflammatory medicines.
- Wxamples: hydroxychloroquine (Plaquenil), methotrexate, azathioprine (Imuran). Biologic therapies: These really are lasers that target the immune abnormalities found in many kinds of arthritis. Examples: Enbrel, Humira, Remicade. Specifically for arthritis related pain we also use medications like GABA stimulators like gabapentin (neurontin) and pregabalin (Lyrica). Lidoderm patches also help as do topical agents like Myorx.
Sometimes shots of different types will be necessary. These shots may be combinations of local anesthetics and glucocorticoid or they may consist of materials like Botox. We’ve used the latter very successfully in patients with neck and low back problems. Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine in the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He’s a Fellow of the American College of Rheumatology and the American College of Physicians.