You've been suffering from a nagging pain for some days, and the stiffness just won't go away. At your first visit, your doctor arranged for you to visit your local hospital for x-rays and a simple blood test. Now the results are back.
"You've got early-stage osteoarthritis," says your doctor. "I'm afraid it's all part of growing older, just the wear and tear of life."
He might suggest some exercise before reaching for his pad to write out a prescription for an NSAID. It's the only response that medicine has to arthritis: a drug, and usually an NSAID (nonsteroidal anti-inflammatory drug) to alleviate the pain.
The drugs that control the symptoms are known as "first-line drugs" and include the NSAIDs, which can also reduce swelling in the joints, and the simple painkillers known as analgesics.
The second-line drugs will try to modify the condition, and are usually given for rheumatoid arthritis. They are known as DMARDs (disease modifying anti-rheumatic drugs) or SAARDs (slow-acting, anti-rheumatic drugs). Anti-malarials and gold injections are included in this category.
Other drugs used include the immunosuppressants, sometimes prescribed to treat lupus and rheumatoid arthritis, and steroids-which regulate immune response and inflammation-are taken to counter rheumatoid arthritis, lupus and polymyalgia rheumatica.
As a last resort, and in cases of severely damaged joints, replacement surgery can be offered, and, unless you have private health insurance, you are prepared to join the lengthening NHS queues.
No form of treatment for rheumatoid arthritis has a particularly good track record. One study tracked 112 rheumatoid arthritis (RA) patients receiving "aggressive" drug treatment over 22 years. More than half either died or became severely disabled. The authors concluded that it was "fallacious" to believe that arthritic drugs of any sort cause a remission in patients. With current treatment, they wrote, "the prognosis of rheumatoid arthritis is not good". Stated plainly, that means that none of these drugs does much good in stopping the disease from progressing.1
Professor P.A. Dieppe and other researchers from the University of Bristol believe that the entire approach to osteoarthritis has been "misdirected" by concentrating on the role of NSAIDs. These drugs primarily reduce inflammation as well as pain, whereas osteoarthritis causes only minor inflammation, which doesn't really account for most of the pain of the disease. Professor Dieppe and his associates say that simple painkillers have many advantages over NSAIDs. Besides being cheaper, they do not have the toxic effects of NSAIDs-particularly gastrointestinal damage, which is highest in elderly women, the very group in which osteoarthritis is most prevalent.