My wife is having swelling and severe pain in both hands and also knee and hip pain. She was diagnosed with arthritis and has been taking anti-inflammatories but they are not doing the trick. Any suggestions?
Arthritis is a broad diagnosis that includes many more specific conditions, and the appropriate treatments for different types of arthritis vary. Therefore it is important that your wife’s case be correctly diagnosed in order to determine the most appropriate treatments.
Rheumatoid arthritis, which is more common in women than in men, is probably the most likely diagnosis given her swelling and pain in the hands, as well as knees and hips. However degenerative arthritis, also called osteoarthritis, lupus, psoriatic arthritis, which is associated with psoriasis, and other rarer types could mimic rheumatoid arthritis.
The following comments on treatment are based on my assumption that your wife has rheumatoid arthritis.
Treatment of this condition typically involves physical therapy to maintain strength and joint flexibility, drug therapies, and occasionally in severe cases, surgery.
Anti-inflammatories are always the first approach in drug therapy. Many such drugs are now available, but there is not much evidence that any are better than plain old aspirin in terms of effectiveness. Aspirin is given in large doses, 3.6 to 4.8 grams per day, which equals 11 to 14 standard aspirin tablets per day. Aspirin is available in different formulations to try to reduce stomach irritation. It may be taken with food or milk, and another drug called misoprostol can also reduce stomach irritation due to aspirin or other anti-inflammatories. Newer anti-inflammatories which cause much less stomach irritation have been developed. They are referred to as COX-2 inhibitors and are nonsteroidal anti-inflammatories (NSAIDs). Celebrex and Vioxx are the two available in the U.S. The great advantage of aspirin is its cheapness compared to the others, although generic ibuprofen is getting pretty cheap.
If adequate doses of an anti-inflammatory are not effective, then methotrexate, originally developed as an anti-cancer drug, the anti-malarials chloroquine and hydroxychloroquine, and the drug sulfasalazine, originally developed for ulcerative colitis, have all been effective. Naturally they all carry the risk of different side effects.
Gold salts given by injection are an old and sometimes very effective treatment for rheumatoid arthritis. The side effects associated with gold require that blood and urine tests be done regularly. An oral form of gold is also now available, but may be less effective than the injectible forms of gold.
I have not mentioned cortisone-type drugs, although they are among the most potent anti-inflammatories available, because of the serious side effects they cause when given in the doses necessary to suppress the arthritic symptoms. They can be used by injection into specific inflamed joints, but the benefit may not last for more than a few months, and most experts are reluctant to inject joints repeatedly for fear of increasing the arthritic damage to the cartilage in the joints.
Many of these treatments are not commonly provided by general doctors, and therefore should probably be supervised by a specialist in rheumatic diseases. Referral to such a specialist would also be helpful if there is any question regarding the correct diagnosis in your wife’s case.