Whelehans pharmacy treatment options for rheumatoid arthritis part 2
Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie
This is the second of three articles on rheumatoid arthritis (RA). There are self-help activities to help your arthritis; for more information on these ask in Whelehans.
Physiotherapy and chiropody
Physiotherapy has a major benefit for control of RA. I will discuss the benefit of physiotherapy to RA sufferers in a few weeks in the Examiner. Also rheumatoid arthritis causes problems with the bones of the feet; this is a significant cause of pain, mobility impairment and functional limitation. A consultation with a chiropodist can help.
In Whelehans Pharmacy we offer both Physiotherapy and Chiropody services. You can contact our Physiotherapist Sinead Brogan at 083 1722171. We offer reduced physiotherapy rates for over 60’s and affiliated sports clubs. Chiropodist James Pedley has a twice weekly clinic at Whelehans Pharmacy on Tuesdays and Thursdays; he has reduced rates for over 60’s; call 04493 34591 to book.
Surgery
A number of RA sufferers will develop irreversible joint or tendon damage. For these, surgery can provide a return of functional ability, a decrease in symptoms and pain, and avoid deformity and disability, helping them return to a “normal” life. Typically, surgical interventions involve joint replacement (commonly hip, knee, shoulder, elbow and hand joints).
Medication
Current guidelines recommend early diagnosis and early referral (ideally within 3 months of symptom onset) to a rheumatologist for the introduction of disease modifying anti-rheumatic drugs (DMARDs).
Pain Control
Although DMARDs may be introduced at time of diagnosis, they have a slow onset of action and can take weeks for an improvement. Most patients will require at least initial courses of analgesics or non-steroidal anti-inflammatory drugs (NSAIDs). The need for painkillers may be reduced once the DMARDs start to exert their effect after a few weeks.
Paracetamol
Paracetamol on its own is seldom sufficient to control acute pain in RA; however there is evidence that regular dosing of paracetamol enhances the painkilling effects of NSAIDs in RA.
Opioid analgesics
Opioid analgesics such as tramadolmay be used during acute attacks of RA, especially in elderly patients who may not be able to tolerateNSAIDs. Their continuous / long-term use is not recommended due to the risk of addiction, cognitive impairment (eg) Memory loss, confusion, constipation andrespiratory depression.
Corticosteroids
Corticosteroidssuch a prednisolone (Deltacortil®) are useful in the management of acute pain and also have disease-modifying properties. However, their efficacy diminishes over time. The preferred method of administration of corticosteroids is intra-articular injection (directly into the joint) (eg) Depo-Medrone® injection. This produces rapid symptom relief and has fewer side effects than oral corticosteroids such as stomach irritation. However the effects of intra-articular steroid injections can wear off within a month so they are not a long term solution. Where there is multiple joints involved, local injection directly into the joints is not possible, so an intramuscular injection (e.g. 120mg methylprednisolone) may be given, while waiting for DMARDs to take effect. Long-term use of even low-dose corticosteroids may result in osteoporosis and other steroid-related side effects such as weight gain, thinning skin, easy bruising and high blood pressure.
NSAIDs
NSAIDsreduce swelling and stiffness in addition to providing pain relief. However side effects include gastric irritation, kidney damage, fluid retention and skin reactions, as well as evidence linking selective COX-2 inhibitors (eg. Arcoxia®, Celebrex®) to increased risk of heart attack. Diclofenac should be avoided in those with health problems. Long-term use of NSAIDs is not recommended, especially in those withheart and stomach problems.
Upcoming Rheumatoid Arthritis Talk
Whelehans Pharmacy in conjunction with Arthritis Ireland (Westmeath Branch) is hosting a Rheumatoid Arthritis Information evening on Tuesday April 28th at 7pm in the Greville Arms Hotel in Mullingar. Admission is free. There will be a number of guest speakers on the night. Call the Whelehans Pharmacy at 04493 34591 for more information or to book a place.
To be continued….Next week
This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans