Searching for Osteoarthritis Pain Relief?

Osteoarthritis or degenerative joint disease is a wear and tear disease of the joints typically seen in the older adult (usually over 60 years of age). Cartilage within the joints breaks down causing pain as the bones rub against each other. Osteoarthritis is commonly found in the knees, hips, hands, spine, and feet.

Obesity is a risk factor for developing osteoarthritis in the knees and hips. These weight bearing joints carry much of the weight causing increased wear and tear. Weight loss can significantly reduce the chance of developing osteoarthritis and can alleviate pain in people who currently have osteoarthritis.

Currently osteoarthritis treatment is limited because no medications are capable of preventing or retarding the disease process. Osteoarthritis treatment involves focusing on pain relief, the maintenance of quality of life, and functional independence. Let us take a look at some of the treatments that currently exist for osteoarthritis.

Many doctors recommend Acetaminophen (Tylenol) as the initial analgesic (pain medication) of choice for the treatment of osteoarthritis. Acetaminophen has very few side effects. When using Acetaminophen as a pain reliever, remember to follow the directions correctly. Acetaminophen is commonly overused by patients. You are recommended to not exceed 4,000 mg of Acetaminophen in a twenty-four hour period. Acetaminophen is metabolized or processed by the liver. Excess Acetaminophen can cause damage to the liver. Acetaminophen is also found in other pain medications such as Darvocet, Percocet, and Tylenol Cold. In fact, Acetaminophen is found in quite a few prescription pain medications.

Traditionally NSAID's (nonsteroidal anti-inflammatory drugs) have been useful in the treatment of osteoarthritis associated pain. One major concern with the use of NSAID's is irritation to the stomach lining. In more severe cases, gastrointestinal bleeds or ulcers may form. NSAID's can affect the body's blood clotting ability and interfere with kidney function. NSAID's should always be taken with food to decrease stomach irritation or upset. Do not drink alcohol while taking NSAID's. However, these drugs should not be taken for extended periods of time unless directed otherwise by a qualified medical provider. Some common types of NSAID's are ibuprofen (Advil), naproxen (Aleve), and aspirin.

Cyclooxygenase-2 inhibitors (COX-2 inhibitors) are a class of NSAID's. COX-2 inhibitors suppress arthritis pain much the same way but with less stomach irritation. Many of us know of COX-2 inhibitors but not by this name. Vioxx (refecoxib), Celebrex (Celecoxib), and Bextra (valdecoxib) are COX-2 inhibitors. Vioxx and Bextra have been removed from the market. These drugs can significantly increase the risk for stroke and heart attack. Celebrex remains on the market but does have a black box warning stipulating this drug also can increase the risk for cardiovascular events and gastrointestinal bleeding.

Capsaicin (Capsagel, Zostrix) which is derived from chili peppers can be applied topically for the treatment of osteoarthritis pain. Capsaicin will cause vasodilation, itching, and burning to the skin but after repeated applications desensitization will occur, decreasing one's pain. Methyl salicylate creams such as Ben-gay can also be used for osteoarthritis pain. Studies have shown that oral glucosamine and chondroitin supplements have a mild to moderate analgesic effect with arthritis.

For osteoarthritis patients who cannot tolerate their pain, glucocorticoid injections may be done. Glucocorticoids are similar to the hormone cortisol in the body. Glucocorticoids help alleviate pain by decreasing inflammation and swelling within the joint. Side effects are typically seen if you receive these injections too frequently.

Hyaluronan (viscosupplementation) injections can be injected directly into the joint for treatment of osteoarthritis. This medication helps supplement the synovial fluid. The synovial fluid is a lubricating fluid allowing the bones to move smoothly within the joint. This injection should relieve pain and improve your mobility of the joint. This treatment involves 3-5 shots within 5 weeks. You may experience pain and swelling after the injections but this should dissipate. Reduced osteoarthritis pain may last up to 6 months.

For patients that have decreased function and mobility of the joint, surgical intervention may be necessary. Surgical involvement should also be considered in patients whose pain has progressed to unacceptable levels. However, good surgical candidates are usually considered ideal for surgery. Certain health conditions can affect post-operative rehabilitation and healing. Surgery can hold just as much of a health risk as medications have side effects.

Osteoarthritis is not curable but there is hope for the future with advancements in medicine. Along with the above treatments for pain management, it is also important to remain active and healthy. Exercising regularly can help maintain mobility of the joint. Exercise also creates natural pain relievers such as endorphins. Pain may be a part of osteoarthritis, but pain doesn't have to be a part of your life!

Copyright 2006 Kristy Haugen

Kristy is a mother and experienced nurse. She has a Bachelor in Biology and Chemistry and writes to inform individuals interested in health information.

Arthritis Cures And Determining The Correct Arthritis Symptoms

Arthritis is meant by 'Inflammation of the joints'. There are various types of arthritis. Osteoarthritis (OA) is the main arthritic disorder among human population. Rheumatoid arthritis, JRA (Juvenile Rheumatoid Arthritis), Gouty arthritis is the other prominent forms of arthritis.

The cause varies from one disease to the other. OA occurs when the defensive, cushion like articular cartilage wrapping the facing bones of a joint get destroyed, resulting into the bones rubbing against each other. This friction causes pain in the joint and swelling. As a result of this bone rubbing most medical examiners think there is no Arthritis Cures.

OA gets worse as the cartilage breaks down further bringing more and more bony surfaces into the rubbing process. The cause of Rheumatoid arthritis is miscalculation of body's natural defense system. This gives raise the joint lining to swell and pain. It also spreads to the surrounding tissues. Uric acid deposition in the joint spaces causes inflammation and pain in the joint.

JRA is genetically determined.

The modern concept of treating arthritis is to control the pain as to maintain a healthy, normal life and management of the deformity if any. It is important to understand the specific arthritis symptoms.

There are some drugs that can modify the disease process of Rheumatic fever but do not offer a cure for arthritis. But once arthritis is there, we have to stick to the basic principle of pain management.

The first thing to treat arthritis is lifestyle modification. Arthritic joints become weak and can not bear the weight that it was used to. So, reduction of weight is the first target area. Reduction of weight reduces the load in the joint and improves its function.

Arthritic patients tend to work less due to pain and sedentary lifestyle is predisposing factor for other diseases like hypertension, Diabetes, Coronary Heart Disease, Dyslipidemia etc. To combat this, light, free hand exercise is offered initially. Gradually, the method and frequency are changed that suits the patient.

Another effective and age old means to lower the pain is to apply temperature. Hot fomentation and hot water bath have a soothing effect over the tissues. Many people say this technique is the closest they get to an arthritis cure.

Normally the best arthritis cure is to keep the body stress free, which is critical to eliminate inflammation. Arthritis symptoms are sometimes not correct the first time they are discovered. Therefore, further tests may be needed to determine the best modern concept to treat different forms of arthritis.

Sometimes, cold compress may produce better analgesia (relieve of pain) than application of heat. That again depends upon the disease profile. Often, the patients suffering from arthritis become so crippled by pain, they tend to avoid the directions given by the doctor.

This includes the exercise part also. These patients need to be reassured, encouraged to accept the situation and to be injected moral support. They also need appropriate supervision towards suitable pain relief.

The first line of medication is still the Non Steroidal Anti- Inflammatory Drugs (NSAIDs). Paracetamol, Ibuprofen, Diclofenac, Nimesulide, Ketorolac are among the most preferred analgesics used by the rheumatologists.

Selective COX-2 inhibitors like Celecoxib, Rofecoxib and Valdecoxib have proven their worth for effective pain relief without increasing the gastric acid output, thus minimizing the acid peptic disorder. The invasive methods include intra articular injection of Steroids (Triamcenolone- Kenacort(TM)) and Hyaluronan. They produce valuable pain relief for a longer duration.

There is virtually NO CURE for Arthritis. Believe me, if you come across any website or anybody who claims that your arthritis will be completely cured by their management, you are in the wrong hands. Please do not pay attention to them and follow the advices given by your doctor.

Want to read more information on alternative arthritis cures for various arthritis symptoms? Check out the best Arthritis Cures

Chronic Pain - Natural Remedies For A Safe And Effective Pain Relief

Chronic pain is defined as pain that lasts for more than six months at a stretch and there is nothing more debilitating than chronic pain. Chronic pain affects millions of people the world over. It can affect an individual at any time in life and in most cases it often long outlives the actual cause of pain. In the long run chronic pain is destructive to the body. Over time not only does the pain worsen but also unleashes a cascade of hormones like Cortisol which in turn destroys the immune systems and kidneys.

Most people with chronic pain inevitably resort to a gamut of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen, Aspirin, Piroxicam amongst others. These drugs have been implicated in causing serious gastrointestinal bleeding from ulcers, liver dysfunction and renal failure when taken for long duration (unfortunately most people with chronic pain do take them for long periods). The newer agents called as COX-II Inhibitors (Celecoxib, Rofecoxib, Valdecoxib) are marginally better in their gastrointestinal safety profile but have come under flak with some of them having been withdrawn from the markets due to serious cardiovascular morbidity and mortality. Thus the answer to chronic pain? Nothing safe though several are effective.

Chronic pain is very closely linked to depression because both conditions share the same neuronal circuits in the brain. Serotonin and Endorphins that regulate a healthy brain functioning also regulate depression. Chronic pain results in depletion of Serotonin from the neuronal cells leading to an aggravation of depression. In fact many physicians treat chronic pain with the same drugs used to treat depression. Chronic pain sufferers respond with increased pain to stressful stimuli.

Some common causes of Chronic Pain include: Osteoarthritis, rheumatoid arthritis, spondylitis, Fibromyalgia, Neuralgia, stiff joints, tendonitis, neck pains, low back pains, muscle and joint pains, carpal tunnel syndrome, shingles and pinched nerves and sprains. Cancer pain can be chronic but responds significantly only to Morphine-like drugs.

The pharmaceutical cupboard for the management of chronic pain is virtually threadbare and search is on for the ideal pain-killer. Is there anything natural that is not only effective but safe as well? Many herbs have the propensity to relieve pain while leaving the body intact! Some of these herbs include:

1. White Willow (Salix sp): The bark of this stately white willow has been used for centuries in China to relieve pain and lower fevers. The active ingredient is Salicin which the body converts to Salicylic acid. Thus the white willow is often called as the "herbal aspirin". At a cellular level the white willow helps lower the levels of Prostaglandins (a powerful chemical released at sites of pain and inflammation) and thus reduces pain and inflammation. People with arthritis who have used the bark of white willow have reported dramatic changes in pain intensity and also improved mobility after few weeks of use.

2. Lobelia inflata: Lobelia is a very powerful muscle relaxant and is rich in Vitamin A, C and Manganese. Lobeline, an active ingredient, stimulates the nervous system. Lobelia has helped treat mild depression, calm frayed nerves, ease muscle tension and reduce pain and inflammation.

3. Boswellia serrata: Also known as Indian Frankincense, the gummy resin of its bark called as salaai guggal has been known from centuries to help fight pain and inflammation. Boswellia is known to block the entry of inflammatory cells to the sites of inflammation, improve blood flow to sites of inflammation and block the pre-inflammatory chemicals. Boswellia has proven its merits in the management of pain in conditions like arthritis, in reducing inflammatory process in Crohn's disease and Ulcerative Colitis. Boswellia can be used both orally and also topically over the sites of pain and inflammation.

A combination of the white willow, Lobelia and Boswellia would be an ideal pain-killer that has the same efficacy (but without the potentially lethal side effects) as conventional pain-killers.

Tired of Chronic pain? Is chronic pain limiting your capabilities?

Fight chronic pain the natural way!

http://theonlinepharmacy.blogspot.com

Relief For Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. RA is a systemic disease, often affecting extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as other organs in the body.

Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect young children and adults older than age 50. About 60% of RA patients are unable to work 10 years after the onset of their disease. Rheumatoid arthritis is a common rheumatic disease, affecting more than two million people in the United States. The disease is three times more common in women as in men. It afflicts people of all races equally.

RA can affect any joint, but the most common places are the hands or feet. Rheumatoid arthritis (RA) causes redness, pain, swelling or a hot (or warm) feeling in the lining of a joint, the place where 2 or more bones come together. Worldwide, about 1% of people are believed to have rheumatoid arthritis, but the rate varies among different groups of people.

Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. Rheumatoid arthritis is rarely associated with pyoderma gangrenosum, a necrotizing, ulcerative, noninfectious neutrophilic dermatosis. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues.

Rheumatoid arthritis most often affects the smaller joints, such as those of the hands and/or feet, wrists, elbows, knees, and/or ankles. RA may start gradually or with a sudden, severe attack with flu-like symptoms. It's important to remember that RA symptoms vary from person to person. In some people the disease will be mild with periods of activity or joint inflammation and inactivity. Along with painful, inflamed joints, RA can cause inflammation in other body tissues and organs. In 20% of cases, lumps called rheumatoid nodules develop under the skin, often over bony areas.

Treatments for arthritis have improved in recent years. Corticosteroids. These medications, such as Prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint damage. Medications used to control RA fall into two categories: those that relieve symptoms and those that have the potential to modify the course of the disease. Exercise is also an important part of a treatment program. Immunosuppressants medications act to tame your immune system, which is out of control in rheumatoid arthritis.

Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection. Rituximab-Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. The most common antidepressants used for arthritis pain and nonrestorative sleep are amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).

Rheumatoid Arthritis Treatment Tips

1. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin and others), naproxen (Naprosyn, Aleve), Celecoxib (Celebrex) and many others.

2. Light exercise may be beneficial for improving blood circulation to joints.

3. Various anti-cytokine medications are now being used to treat painful disease states such as Rheumatoid Arthritis.

4. Nonsteroidal anti-inflammatory drugs (NSAIDs) is a type of medicine that reduces pain and swelling.

5. Severely affected joints may require joint replacement surgery, such as knee replacement.

6. Corticosteroids are man-made drugs that closely resemble cortisone, a hormone natural produced by the body.

7. Immunosuppressants medications act to tame your immune system, which is out of control in rheumatoid arthritis.

Juliet Cohen writes articles for health and fitness and diseases treatment. For more information visit our site at http://www.healthfitnesstips.org/.

Do Natural Arthritis Pain Relief Products Really Work?

Arthritis is the #1 cause of disability in America today. It is now one of the most prevalent chronic health problems. Shockingly, nearly 1 in 3 Americans (nearly 70 million) live with some form of arthritis, costing the United States $86 billion a year in healthcare costs related to treating the illness. New science confirms nutritional supplements glucosamine and chondroitin are the right combination for effective knee pain relief. The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), funded by NIH, rigorously evaluated the efficacy and safety of glucosamine and chondroitin in 1,258 people, concluding in its abstract that the "combination of glucosamine and chondroitin sulfate is effective in treating moderate to severe knee pain due to osteoarthritis."

GAIT lead researcher Daniel O. Clegg, M.D., Professor of Medicine and Chief of Rheumatology at the University of Utah, presented his landmark findings at the American College of Rheumatology's Scientific Meeting in San Diego, California.

Funded by NIH, the $14 million GAIT study is the largest placebo controlled, double blind, clinical trial ever conducted to test the effectiveness of glucosamine and chondroitin. All 1,258 patients who completed the study were over the age of 40 with knee pain and randomly assigned placebo; glucosamine 1500 mg; chondroitin 1200mg; glucosamine/chondroitin at above mentioned doses; or Celecoxib (Celebrex) 200 mg daily for 6 months. The abstract published each treatment group's response rate to pain. Of particular note, the group taking the glucosamine/chondroitin combination experienced greater relief for the treatment of moderate to severe knee pain than the Celebrex group.

GAIT was designed to test the safety and efficacy of glucosamine and chondroitin alone and in combination in reducing knee pain associated with osteoarthritis. The study's abstract concluded that when taken together, "glucosamine and chondroitin is effective in treating moderate to severe knee pain due to OA [osteoarthritis]."

Naturally occurring in the body, glucosamine stimulates the production of cartilage, the connective tissue which cushions joints. Chondroitin is also naturally occurring in the body and like glucosamine stimulates the production of cartilage. Previous research has indicated that glucosamine is just as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in reducing osteoarthritis pain and has fewer gastrointestinal side effects than NSAIDs.

After extensively researching treatment options for rheumatoid arthritis and osteoarthritis, a natural non-prescription treatment that seems to be gaining a lot of attention recently is a nutraceutical product called Flexcerin. This arthritis supplement contains all of the natural arthritis relieving nutrients, including glucosamine, chondroitin, MSM and other special ingredients to help reduce inflammation, swelling and stiffness as well as protect the joints and provide long lasting pain relief. World renowned arthritis speCialist, Dr. Andrew Weil MD., states "Supplements such as glucosamine sulfate and chondroitin sulfate may actually help restore damaged tissue structure in joints, perhaps because these two substances are natural constituents of healthy cartilage." Flexcerin could definitely provide relief from your painful arthritis. Widely used in Europe for years to treat osteoarthritis, glucosamine and chondroitin are safe and effective nutritional supplements, as proven by the GAIT abstract.

Whether you are interested in all things "natural," want to avoid side effects from prescription drugs, or want to leave no stone unturned in your quest for relief from arthritis pain you should realize that leaving yourself open to waiting for a viable option could prove to be a very unwise choice. Arthritis causes the most damage in the first six months if left untreated.

Janet Hanh is a published author in the field of pain management. Many of her insightful health related articles can be found online at http://www.consumerhealthdigest.com

My Son Has A Stiff Back When He Gets Up in the Morning - Is It Ankylosing Spondylitis?

Ankylosing Spondylitis is one of the more common forms of arthritis affecting about 0.5% of the population. It affects men more often than women in a ratio of about 2.4-5:1. The disease is categorized as a "spondyloarthropathy"... a type of arthritis that preferentially affects the spine. It usually starts in the sacroiliac joints- the joints that join the pelvis to the low back- and spreads upwards to involve the rest of the spine. Peak age of onset is between 15 and 30 years.

Typically, a patient will complain of stiffness in the low back or neck or both that is worse with rest and better with activity. Often, a young person will pursue sports as a way to relieve the pain they have! Stiffness during the day after inactivity is also common. Other joints affected include the hip, knee, wrists, shoulders, elbows, and ankles. Typically, patients will have not only joint symptoms but they will also have enthesopathy... meaning inflammation at points where tendons connect to bones. Fatigue is a very common symptom. Occasionally low grade fever, appetite loss, and weight loss may be seen.

Patients will sometimes present with the extra-articular (outside of the joint) symptoms. Examples include inflammation of the eye, lungs, and rarely, the heart. The most common extra-articular symptom is eye inflammation which occurs in about 40% of patients and must be diagnosed and treated aggressively. Blindness is a dreaded complication.

The physical exam will show limitation of range of motion in the low back. Chest expansion is also restricted since many patients with AS will have limited ability to expand their lungs due to involvement of the thoracic spine.

Occasionally, women with AS will have more symptoms in the neck than the low back.

Laboratory testing will show abnormalities that indicate the presence of inflammation. Patients with AS will also have the genetic marker HLA B27 in about 90% of cases.

Imaging studies such as magnetic resonance imaging will show the presence of inflammation in the sacroiliac joints. Inflammation of the tendon insertions at different affected joints will also be evident.

Treatment goals consist of relieving pain and stiffness as well as maintaining function.

A comprehensive program consists of a combination of anti-inflammatory medicines to help with symptoms as well as disease-modifying therapy to slow down the rate of progression. Examples of anti-inflammatory drugs are drugs such as ibuprofen (Motrin), naproxen (Naprosys), nabumetone (Relafen), etodolac (Lodine), meloxicam (Mobic), and Celecoxib (Celebrex). Disease-modifying drugs that are used extensively for this condition are sulfasalazine (Azulfidine) and methotrexate. Biologic therapies like etanercept (Enbrel), adalimumab (Humnira), and infliximab (Remcade) are considered important for inducing remission. A solid program of physical therapy to help with range of motion is also mandatory.

For patients with suspected eye disease, close supervision by an experienced ophthalmologist is also recommended.

Patients with far-advanced disease may suffer complications including compression of the spinal cord (cauda equina syndrome), and fractures of the neck. In particular, care should be exercised in preparing patients with AS for surgery. Intubation (placing a breathing tube into the airways) for general anesthesia carries the risk of inadvertent spine fracture.

Surgery is reserved for far advanced cases that have not responded to medical therapy.

The clinical course and prognosis is highly variable and also highly dependent on the rapidity of diagnosis and the effectiveness of therapy.

Dr. Wei (pronounced "way") is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: Types of Arthritis

How You Can Beat Rheumatoid Arthritis Part 5: "Putting It Into Remission"

The options available for treatment have expanded greatly in the last 10 years.

Non steroidal anti inflammatory drugs: These help to reduce pain and improve function. They do not have an effect on the underlying disease. Examples include ibuprofen, naproxyn, sulindac, etodolac, nabumatone, Celecoxib, and meloxicam.

These drugs are effective but they have potential side effects including peptic ulcer disease, kidney and liver damage, rashes, and fluid retention. Another problem associated with these drugs is the slight increase in cardiovascular events such as heart attack and stroke. These drugs require careful monitoring.

Corticosteroids: These drugs suppress inflammation but also have no effect on the underlying disease. Examples include Prednisone, methylprednisolone, and prednisolone. Used long term they may have undesirable side effects including ulcers, cataracts, osteoporosis, adrenal gland suppression, thinning of the skin, and diabetes.

Disease-modifying anti-rheumatic drugs (DMARDS): These drugs slow down the progression of rheumatoid arthritis. Examples would be medicines such as methotrexate, sulfasalazine (Azulfidine), leflunomide (Arava), hydroxychloroquine (Plaquenil), and cyclosporine (Sandimmune).

Most DMARDS act slowly.

The workhorse of DMARDS is probably methotrexate. All DMARDS have the potential for significant side-effects and must be monitored slowly.

Biologics: Most recently, biologic therapies such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and anakinra (Kineret) have helped tremendously.

These drugs target the cells and cytokines that are the primary cause of rheumatoid arthritis. These drugs work quickly. Etanercept, adalimumab, and infliximab are anti-TNF drugs. They block tumor necrosis factor- the major culprit in RA - and by doing so keep it from doing damage. These drugs have a slightly different mechanism of action from each other but they essentially all do the same thing. And they do it well. These drugs have revolutionized our approach to RA.

Rheumatologists are using this group of drugs earlier in the course of disease to hopefully prevent damage from occurring. There is also some evidence that early aggressive treatment may prevent some of the long term complications of rheumatoid arthritis such as lymphoma and cardiovascular events.

Potential side-effects of anti-TNF therapy include an increased susceptibility to infection, the reactivation of latent tuberculosis, and the development of lupus-like or MS-like syndromes.

Kineret, unfortunately, does not have the same salutary effect and is not used very often.

The second wave of biologic therapies are available and offers hope for patients who fail anti-TNF treatment. The two newest drugs are abatacept (Orencia) and rituximab (Rituxan).

Abatacept is a co-stimulatory blocker. This means it prevents T cells from being activated to produce cytokines. Rituximab is a B-cell depleter. It removes B cells from a patient's system. B-cells are felt to play a big role in the development of RA by some experts.

Both drugs are given by intravenous infusion. Side effects include infusion reactions and rashes. The long-term consequence of B-cell depletion is still uncertain.

More biologic therapies are on the horizon. These new drugs may prove to be more effective and safer than what is currently available.

In patients with more severe disease, a procedure where blood is passed through a special filter (Prosorba column) may be of use. As one might guess, it is not used very often.

Dr. Wei (pronounced "way") is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: Arthritis Treatment