Alternatives To Nsaids For Arthritis

While most acute cases of arthritis recover in a matter of days or weeks, the chronic variety has to be managed in the long run, mostly with the help of Non Steroid Anti-Inflammatory Drugs or NSAIDs. Given their side effects and the fact that they may not be able to provide absolute relief, awareness of alternative treatments that can give relief can be a very handy tool.
Alternatives to NSAIDs for Arthritis
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Modern treatment of most types of arthritis centers around the use of Non steroid anti-inflammatory agents for mitigating pain and bringing relief. However, since these NSAIDs cause a number of adverse effects when used over long periods, alternatives to them must be kept in mind right from the beginning to reduce dependence on them as also to facilitate treatment.

 

Though non-steroid anti-inflammatory agents or NSAIDs are the most commonly used agents for this purpose, relief to a person suffering from arthritis can come in a form other than NSAID too. These alternatives are important for all those who are unable to

tolerate the side effects of NSAIDs, specially the gastric irritation caused by them.

For such persons, available options are medicines other than NSAIDs, alternative therapy and surgery.

I. MEDICINES FOR ARTHRITIS (OTHER THAN NSAIDs)

There are five major categories of medicine that can provide relief in arthritis. These include acetaminophen, opioid analgesics, steroids, disease modifying agents and biological response modifiers.

ACETAMINOPHEN is the most commonly used non-NSAID pain reliever. Though primarily used to manage fever, it is an effective alternative for NSAIDs and can be used alone or in combination with other medicines.

OPIOD ANALGESICS like CODEINE and DIAMORPHINE relieve pain by directly acting on the brain. They are useful in cases of severe pain, but also have a lot of side effects. They can cause dependence and also interfere in level of alertness. They are strict prescription drugs, to be used only in selective cases.

STEROIDS act primarily by reducing the swelling of arthritis. They cannot be used in long run, but can be fairly effective in short periods. They must not be stopped abruptly and need tapering of dose. Steroids also cause gastric irritation and must be used carefully with acid reducing agents.

DISEASE MODIFYING ANTI-RHEUMATIC AGENTS or DMARDs are medicines that are useful in those types of arthritis that result from an abnormal immune system, like Rheumatoid Arthritis and Juvenile Arthritis. They modify the immune system and modify the process of disease itself. Medicines in this category include medicines like METHOTREXATE, SULFASALAZINE, PENICILLAMINE and AZATHIOPRINE.

BIOLOGIC RESPONSE MODIFIERS interfere in the process of swelling of joint structures, by inhibiting the proteins which cause swelling, called 'cytokines'. Different medicines in this category target different proteins. ETANERCEPT and INFLIXIMAB inhibit the 'tumor necrosis factor' while ANAKINRA inhibits 'interluekin-1'. These medicines are now increasingly being used in long term and severe cases, but they are expensive and need to be given by injections.

II. OTHER MODES OF TREATMENT

Most of other modes of treatment need


local application on the painful joints and hence do not have any of the side effects of NSAIDs or other medicines. While they remain useful options, their efficacy may not be consistent, and different persons may have different preferences for them. Some of these are exemplified below.

AYURVEDIC BALMS are herbal ointments that provide relief from pain when applied topically. Usually their action is centred largely on the principle of counter-sensation, by which the severity of pain gets mitigated, although herbs also reduce inflammation to some extent. A famous balm is SIDDHALEPA, produced in Sri Lanka.

ACUPUNCTURE & ACUPRESSURE are traditional oriental treatments based on inserting hair thin needles or putting pressure on certain parts of the body, which provide relief from pain.

REFLEXOLOGY is similar to acupuncture but works by providing massage and pressure on the feet at specific points for different joints.

HYDROTHERAPY is a technique wherein immersion under water and massage with temperature modulation is used to provide relief.

YOGA is an ancient Indian technique of relaxation, exercises and meditation that provides relief from pain, reduces progression of disease and improves functionality of joints.

HOMEOPATHY is a system of alternative medicines wherein very dilute solutions of medicines are used to treat ailments.

III. SURGERY

This is one of the last resorts available to a patient of arthritis. It may be used to prevent further damage or to relieve pain. This is especially important in arthritis involving vertebrae, which causes pressure on the spinal cord and may even lead to paralysis, if not treated properly.

All these are alternative forms of treatment that may help in relieving pain in those persons who are not able to take the NSAIDs for any reason. In some they may be used in combination, sometimes along with NSAIDs, in others they may obviate the need for NSAIDs altogether.



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