Arthritis

Introduction

Welcome to the first of our latest therapy articles on arthritis. This disease is the most common cause of disability and handicap in Australia. Whilst many consider arthritis to be a disease of the older population, half of all people diagnosed are aged between 30 and 60 years. Arthritis has over 150 different types affecting all ages. Two of the most common types, Osteo and Rheumatoid Arthritis will be discussed with particular attention to the latest available treatments. We will examine the cause and effects for each of these to understand how the latest therapies work and what benefits they may offer in comparison to other therapy.

The end of bones located at a joint are covered with cartilage, this acts as a cushion allowing bones to move freely, smooth cartilage protects bone contact surfaces. Osteoarthritis is the most common type of arthritic disease and involves the breakdown of the protective cushioning in a joint. The disease becomes worse because of a breakdown in the smooth cushioning surface on bones; this leads to bone wear and local bone structure changes. The bone changes affect normal joint structure and it is commonly believed that changes to the joint structure cause the pain associated with Osteoarthritis.

The primary goal for future treatment of Osteoarthritis will look to cartilage replenishment and / or the prevention of cartilage breakdown. The speed with which cartilage breaks down is often caused by previous joint injury with cartilage damage, or long term wear in weight bearing joints often caused by being overweight.

Drugs in the pipeline

Drugs that inhibit enzymes associated with cartilage breakdown are presently being clinically investigated; these offer the greatest hope for preventative disease progression.

New Osteoarthritis Therapies Available

Replacement therapy
It is well known that the concentration of cartilage "building block" material is depleted in joint fluid in Osteoarthritis. Replacement therapy is a rational approach to Osteoarthritis treatment that aims to increase concentrations of cartilage and lubricant agents found in joint fluid. By increasing the concentration of cartilage components and joint lubricants in joint fluid it is believed the cartilage breakdown will be slowed. Replacement therapy can either be direct or indirect.

Synvisc is a product that has recently been made available in Australia; it is a large molecule with a gel like action for joint lubrication. It is also found in cartilage tissue and can be considered a replacement therapy. Doctors inject the product into the joint; the direct action has resulted in relief from symptoms for several months. For information regarding Synvisc go to www.synvisc.com or ask your Doctor.

Indirect Replacement therapy involves the use of dietary supplements to increase joint concentrations of cartilage and lubricant agents. The most popular supplement Glucosamine Hydrochloride is taken at doses of 1500mg daily and has been shown to improve patient symptoms. This supplement is a sugar and should not be used by Diabetics without consulting their Doctor. For information go to www.arthroaid.com or ask your Doctor.

Symptom Control
Pain Relief is the standard goal of symptom control in Osteoarthritis. The benefits associated with paracetamol pain relief and its low incidence of side effects has made it the drug of first choice for most patients. Whilst a large number of patients are treated with anti-inflammatory drugs their long-term use is often associated with stomach irritation and ulceration. The latest breakthrough in recent therapy is the arrival of COX-2 anti-inflammatory drugs.

All anti-inflammatory drugs inhibit the body's prostaglandin production; the problem is some prostaglandins are also necessary for normal body function. The lining of the stomach for example is protected from stomach acids by mucous secretions. Stomach mucous secretion is controlled by normal prostaglandins, by inhibiting the prostaglandin mucous function over a long-term period the result is acid stomach damage.

The COX-2 anti-inflammatory drugs selectively block prostaglandins associated with inflammation; they also allow the synthesis of normal body function prostaglandins. The balance of potential symptom relief versus long-term safety makes them a more suitable potential symptom control treatment than paracetamol. Ask your Doctor about Celebrex or go to www.celebrex.com for information.

This type of arthritis is most common in women between 30 and 50 years of age. Rheumatoid Arthritis is a disease caused by the body's own immune system which for some unknown reason attacks joint tissues. Rheumatoid Arthritis will normally affect the same joint types because the immune system is not selective, it affects both knees or both hands for example. Damage to joint tissue causes inflammation, pain and with time, joint deformity and loss of normal joint function. The primary goal in the latest treatment of Rheumatoid Arthritis is to prevent joint damage caused by the body's immune system, in doing so the pain, inflammation and progressive loss of joint function is reduced.

Latest Rheumatoid Arthritis Treatment

Drugs in the pipeline
Drugs that inhibit particular rheumatoid immune system antibodies and inflammatory markers are being clinically tested. These agents can be considered biological blockers and will likely require administration by injection, at least until further advances are made.

Symptom Control Therapy
The COX-2 inhibitors mentioned for Osteoarthritis are a useful addition to the symptomatic control of pain and inflammation associated with Rheumatoid Arthritis. Their advantage over other anti-inflammatories is less gastric irritation, they do not inhibit the body's immune reaction and associated joint damage which is necessary to slow disease progression.

Disease Modifying Rheumatoid Arthritis Drugs
Arava is the latest addition to Rheumatoid Arthritis treatment other than the COX-2 inhibitors previously mentioned in Osteoarthritis. Arava inhibits activated lymphocyte cells; these cells form part of the rheumatoid immune reaction and associated joint damage. Information can be obtained from your Specialist, Doctor or go to www.arava.com.