Q: Do pain medications prevent arthritis from worsening, directly or indirectly? If I choose not to take medications for chronic arthritis pain due to a concern about potential side effects, am I allowing the arthritis to worsen?
A: It depends upon the type of arthritis. The most common reason people take arthritis medications is to relieve symptoms. Reducing the pain and stiffness of arthritis can dramatically improve a person’s quality of life. But there are other good reasons to take medications for arthritis, including maintenance of joint function and avoiding joint damage.
Function is also a key part of quality of life. For example, people with osteoarthritis of the knee may gradually walk less and less, reducing their independence over time. Drug therapy can’t directly change the wear and tear of osteoarthritis. However, with pain relief and other types of treatment, you can remain active.
For other types of arthritis, such as rheumatoid arthritis, taking medications is essential to prevent joint damage. Today, drug treatment of rheumatoid arthritis can prevent the destruction of joints that so often happened in the past.
In general, medications prescribed purely for pain do not prevent arthritis from worsening. However, some medications have multiple effects. They may reduce pain, improve function and protect the joints.
To answer your question directly, I would need to know the type of arthritis you have — there are more than 100 types — and the specific treatment you’re currently receiving or considering.
Here are three of the most common types of arthritis, some commonly prescribed medications for them, and some of these medications’ benefits:
1. Osteoarthritis (also called degenerative joint disease). This disease is commonly treated with acetaminophen or a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen. These medications only relieve pain and stiffness; they don’t prevent worsening of arthritis over time. No medication is clearly effective at preventing osteoarthritis from worsening.
2. Rheumatoid arthritis. While acetaminophen or NSAIDs can reduce symptoms, they don’t protect the joints. Disease-modifying agents can prevent joint damage, as well as relieve pain and improve function over time. Examples include hydroxychloroquine, sulfasalazine, methotrexate, and several biologic agents.
3. Gout. NSAIDs and corticosteroids (prednisone) are highly effective for reducing pain and inflammation related to attacks of gout. If attacks are frequent or severe, doctors prescribe a drug, such as allopurinol or febuxostat, to lower the uric acid blood level. This reduces the risk of future attacks and may protect joints from damage in the future.
Talk to your doctor about the specifics of your type of arthritis and the potential value of drug therapy. As you consider whether or not to take a recommended medication, you’ll make a better decision if you understand why it was prescribed, the expected risks and benefits of taking it, and the risks and benefits of not taking it.
(Howard LeWine, M.D., is an assistant professor of medicine at Harvard Medical School.)
(For additional consumer health information, please visit www.health.harvard.edu.)
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