Alpha Nutrition Health Education
Arthritis Drug Treatment
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The drug treatment of arthritis is often unsatisfactory. If you critically examine treatment regimens, there has been little progress beyond the basic drugs - aspirin and prednisone.
Stephen J. Gislason MD
Aspirin has been imitated by many other agents that have similar benefits, side effects and similar toxicity. The entire group is referred to as non-steroidal anti-inflammatory drugs or NSAIDs. Some NSAIDs have been removed for the prescription lists and are available over-the-counter: Advil and Motrin are examples. The steroids are represented by cortisone and prednisone. The steroids are the most potent anti-inflammatory drugs and can have dramatic benefits in short-term use - in long term use they extract penalties for the benefits offered.
The other drugs are mixed bag of oddities - accidental discoveries such as gold and anti-malarials that have benefits and toxic costs. No one knows why they work. Increasingly, drugs that inhibit or kill immune cells are used as anti-inflammatory drugs.
Part of the problem with arthritis therapy has been complacency attached to dogma. No one understands the cause of arthritis and the mechanisms that initiate and then maintain inflammation remain obscure. The treatments are inadequate and the suffering is great. Apparently, it has been easy for institutions to focus on coping with the ravages of arthritis - you have resources to help people cope with pain and loss of function. Pain control is seldom adequate and loss of function is often progressive and disabling. No resources are applied to prevention or emergency care of the arthritis attack. buy Naltrexone
Our attitude is different. What if you took the point of view that any an all inflammatory attacks on joints is a medical emergency. You got into the ambulance and were rushed to the joint ICU. Hours count. The onset of joint swelling and pain should be treated as an urgent problem to be solved. Inflammation damages joints and they cannot be repaired. Some can be replaced but this is hardly a satisfactory strategy.
Unfortunately, the usual treatment of acute inflammatory arthritis may be casual and indifferent. Often NSAIDs and physiotherapy are the only treatments prescribed and inflammation is given every opportunity to ravage tissues for month to years. We have seen countless patients, just treated with NSAIDs, who progressed rapidly to a severe disabling disease, often with poor pain control. In unlucky patients, severe deformities of joints accumulate in the first few months of a severe attack.
What if the attitude was - there has to be an immediate investigation into the cause so that the problem can be stopped at its source.
You ask important questions about the possible cause, even if you are not sure.
Is the cause in the Food? In the Air? Water?
What if the attitude was - in the face of uncertainty, why not make some simple assumptions and try simple, safe experiments to see if the problem can be avoided?
We propose diet revision as the experiment - not casual, haphazard, silly diet revision, but complete, thorough, thoughtful, disciplined diet revision.
Drugs may play a role in controlling the disease, but again the casual use of drugs without understanding, without a clearly-defined strategy, without goal and end-points to measure efficacy, drug use can be a great disappointment and a source of further suffering and disease.
Medication Summary
Convention drug treatments usually go in two or three steps, often but not necessarily in the following order:
Step 1 Salicylates or other nonsteroidal anti-inflammatory drugs. Modify prostaglandin production
Step 2 Gold injections, Plaquenil, penicillamine and Methotrexate .
Step 3 Steroids
Step 1 NSAIDs & Analgesics
Arthritis is usually treated with salicylates or related anti-inflammatory drugs generally referred to as NSAIDs . These drugs alleviate the pain of active arthritis but do not favorably affect the outcome of the disease. All anti-arthritic medication can produce asthma, chronic rhinitis and a variety of allergic skin rashes.
Gastrointestinal surface irritation, bleeding, and ulceration are routine problems of NSAIDs. Ulceration with bleeding and/or perforation of the bowel are the most serious and potentially life-threatening complications. Patients at higher risk as those with a history of ulcers, inflammatory bowel disease and the elderly. The concomitant use of a prostaglandin E1 analog, misoprostol (Cytotec), offers some protection against GIT ulceration and surface bleeding. The usual dose is 200 ug twice a day with food. One NSAID, Arthrotec, combines misoprotol and diclofenac tennis games
Long term administration of NSAIDs has been associated with kidney disease - nephritis, renal papillary necrosis, nephrotic syndrome. .A horrible possibility is that the NSAIDs make the intestinal tract more permeable to large molecules and actually promote the disease mechanism.
Analgesics
The pain of arthritis can be intense and prolonged. The pain-relieving effects of NSAIDs are sometimes inadequate.For decades aspirin (ASA) has been combined with codeine for enhanced pain relieving effects. Frosst's 292s have been popular and combine ASA 375 mg with codeine 30 mg per tablet. Two tablets very 6 hours will often be an improvement over ASA alone. Acetominophen (Tylenol) by itself is a poor analgesic, and has also been combined with codeine. The high doses of acetominophen required for pain relief over a long-term of months or years cannot be recommended because of the risk of liver and kidney toxicity. You would do better if you leave the acetominophen out and just take codeine.
Narcotics are the only drugs that relieve severe pain effectively and occasional, short-term use of Demerol or other medium-strength narcotics such as oxycodone may give arthritis sufferers much needed relief.
Step 2 Immune Suppressants
Penicillamine, chloraquine, gold injections and methotrexate emerge as favored drug therapies, beyond prednisone. All are potent drugs with major side effects and moderate to high risk. There is a trend to recommend more aggressive drug treatments, using drugs that inhibit the immune response.
Gold can prevent disease progression by injection or orally. Careful monitoring of gold therapy is important. Complete blood counts, platelet counts and urinalyses must be done at the time of each injection.
Plaquenil (hydroxychloroquine) is an anti-malarial agent with anti-inflammatory properties. Eye monitoring is necessary to check for visual loss at an early reversible stage. Patients should be seen by their eye doctors at least twice a year.
Penicillamine has been shown in controlled studies to be effective in reducing inflammatory It may cause a variety of problems including blood disorders and/or kidney problems. Complete blood counts, platelet counts and urinalyses should be done monthly for the first six months of therapy and every other month thereafter.
Methotrexate is an old anti-cancer drug and a real poison. By killing enough immune cells, immune-mediated inflammation can be reduced. Dosage: 3 to 9 tablets as a single dose administered weekly, only be given by physicians who are knowledgeable and experienced in its usage and monitor for toxicity - complete blood counts with differential and platelet counts, liver and renal function tests are required. Methotrexate may cause liver toxicity, lung problems, mouth ulcers, stomach ulcers. Obviously, if you kill too many immune cells you are at risk of getting a life-threatening infection.
Step 3: Steroids
Corticosteroids are the most potent anti-inflammatory agent; however they have negative effects in the long-term. A good drug is prednisone, but it is seldom used because it has long-term side effects, which scare both physicians and patients. These medications are useful in reducing the whole-body disease with symptoms such as fever, anemia, weight loss, neuropathy and vasculitis (blood vessel inflammation).
Osteoporosis is on of the most feared long-term effects of steroid use. If the dose of prednisone is more than 7.5 mg per day over six months, a bone scan should be done. If bone density is decreased, treatment with etidronate and calcium may prevent bone loss and permit the continued use of steroid therapy. Prednisone is the preferred agent because its cheap and effective.
Quick Action to stop inflammation:
Our preference is to try to stop the inflammatory activity as soon as possible. All inflammation is likened to a fire. You get out the fire extinguishers and go to work. Drugs are used as short-term tools. Diet revision is used to control the disease long-term.No matter what pattern the immune attack assumes, our standard defense can be tried:
- Food Holiday on Alpha ENF - 10 days minimum
- With or without prednisone until the fire is out.
- Pain-relievers, as required
- Rest; free movement, non-weight bearing ( warm pool is best)
Prednisone is often a magic drug that relieves terrible pain and suffering often in the first 48-72 hours of therapy. The problems with prednisone arise with long-term use. The secret of success is to use this drug for brief periods and attempt to control the disease with diet revision in the long-term. A medium to high dose of prednisone (20 - 60 mg per day) may be required for several days and then is reduced to an effective short-term maintenance level between 5 and 20 mg/day.
After pain and swelling have subsided, slow food reintroduction follows Alpha Nutrition sequence. Each food is carefully screened for arthritis-triggering effects. You hope that food allergy caused the problem and that food control can be successful controlling the disease in the long-term. Unfortunately, we do not have good data on how many un-selected patients would respond to this approach, but nothing is lost by taking this approach and complete control of the disease has been obtained. If strict food control proves to be inadequate, then other drug treatments - step 1 and 2 can be instituted to replace prednisone in the longer term.
Arthritis Treatment is Disappointing
A 1997 survey of 1,000 Canadian Arthritis sufferers showed that 60% developed the disease after age 40; 62% of those dissatisfied with the care they received cited "not getting better" as their chief complaint. Arthritis was one of the most reasons for visiting the family doctor in Canada and is the third most common reason for prescription drug use. The annual cost of Arthritis health care in Canada is $14.3 billion.
Try Diet Revision
We encourage everyone with arthritic conditions to give diet revision a try.
Alpha Nutrition Health Education Series List of Publications This discussion of inflammatory arthritis is continued in the Book of Arthritis. You can order an eBook or printed text version separately or as part of a Nutritional Rescue Starter Pack Order Arthritis Rescue Starter Pack Now