For Treating Arthritis, Start with Aspirin

Article excerpt

When John Milton included "joint-racking Rheums" (rheumatism) among the dire diseases mankind would suffer as a result of Eve's taste for apples (Paraside Lost, Book XI), he knew what he was writing about. The great English poet was afflicted with arthritis.

It is now known that arthritis is not a specific disease. The word itself means "joint inflammation," a symptom that can occur in over 100 conditions. In 17th century England, the time of Milton, gout and rheumatism were the names commonly given to this painful condition that has plagued humankind since before the centuries were counted.

Milton's biographers don't say how the poet's disease was treated. If Thomas Sydenham had been his doctor he might have been prescribed "a draught of small beer," a favorite remedy of the celebrated 17th century English physician, himself a victim of both gout and arthritis.

What would not have been prescribed were salicylates, one form of which is aspirin. Although willow bark and leaves, the original source in nature of these compounds, had been known as fever reducers since the time of Hippocrates, salicylates were not used to treat rheumatic diseases until 200 years after Milton's death.

Today, there are a variety of drugs used to treat arthritis, including more than a dozen that can provide significant relief from the pain, inflammation and swelling of the most common forms of arthritis. There are a number of other drugs that can slow and possibly halt the potentially crippling effects of rheumatoid arthritis, one of the most serious forms. Unfortunately, none will cure any of the arthritic conditions.

In all but the most severe or unresponsive cases, the drugs of choice for treatment of arthritis are the nonsteroidal anti-inflammatory drugs (NSAIDs). The name is significant, for its distinguishes this class of drugs from the steroids, cortisone-like compounds produced by the adrenal glands. Steroids are used only in very ill arthritis patients.

The NSAIDs are also called "prostaglandin inhibitors," since they interfere with the production of prostaglandins, unique compounds in the body's tissues that trigger inflammation. (See "Prostaglandins Are Regulators Extraordinary" in the February 1982 FDA Consumer.)

NSAID drugs, which can believe pain and reduce inflammation, often are the only therapy needed for patients who are able to move their joints with relative ease. Oldest of the NSAIDs is plain aspirin, still the most frequently prescribed arthritis drug. Aspirin, however, has its drawbacks. The large doses required for effective treatment--as many as 18 to 20 tablets a day--may cause stomach irritation and gastrointestinal bleeding. Ringing in the ears, temporary hearing loss, and interference with blood clotting are also common side effects. Som e of aspirin's side effects can be reduced by using buffered or timed-release versions.

In addition to aspirin, known technically as acetylsalicylic acid, there are a number of other salicylates for the treatment of arthritic conditions. (See accompanying article for a description of the various types of arthritis.) Choline magnesium trisalicylate and magnesium salicylate are used for the relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis and other musculoskeletal disorders. Diflunisal may be used for osteoarthritis as well as for mild to moderate pain from any cause.

Fortunately, there are other non-steroidal anti-inflammatory drugs that may provide relief from pain and inflammation in patients who cannot tolerate or who are not helped by aspirin. These drugs, availabe only by prescription, generally have fewer side effects and are more convenient since the patient needs to take fewer tablets a day.

Nine drug products are on the market for the treatment of osteoarthritis and rheumatoid arthritis: fenoprofen, ibuprofen, indomethacin, meclofenamate sodium, oxyphenbutazone, phenylbutazone, piroxicam, sulindac and tolmetin. …