The possibilities of pharmaceutical treatment
Pain relief can be a primary drug target for a rheumatologist. If there is any standard treatment (methotrexate, biological drugs, etc.) for the disease, the pain usually relieves better with that drug than with an analgesic drug. One of the goals of standard treatment of rheumatic diseases is to reduce the use of pain reliever drugs listed in Table 1 and which may be stressful to the body for prolonged use.
Pain relief in rheumatic diseases:
- Medicines taken by mouth;
- Anti-inflammatory drugs;
- Paracetamol (Paracetamol, Panadol, Para-Tabs, etc.);
- Pain-relieving drugs that affect the central nervous system (Skudexa, Tradolan, Tramal, Temgesic, Trampalgin, etc.);
- Drugs for osteoarthritis: glucosamine (Arthryl, Glucosamine et al.), Chondroitin (Cartexan, Chondroitin);
- Glucocorticoids, i.e., cortisone preparations (Prednisolon, Prednison et al.);
- Locally used medicine;
- Rheumasal alfalfa (Felden, Orudis, Piroxin, Solaraze, Voltaren, Mobilat) and Spray (Eeze);
- Capsaisin Plaster (Qutenza);
- cortisone Injections;
- Injections to treat osteoarthritis: Sodium hyaluronate (Hyalgan), hylan (Synvisc);
- Medicinal products according to situation.
As a first drug, you can always try the safe and costly drug paracetamol (also in case of rheumatoid arthritis). In general, however, the effect of antiinflammatory drugs is better. In osteoarthritis you can also use glucosamine or the prescription drug chondroitin. The efficacy of preparations intended for the treatment of osteoarthritis has been considered to be poor, but they are considered safe to use.
Medicinal products that affect the central nervous system are related to morphine, but tramadol, which is most used in rheumatic diseases, has very few intoxicating properties. Codein belonging to this group is used only in certain combination preparations (Panacod, Ardinex et al.). There is also an opportunity to relieve severe pain with prolonged-release effects (Norspan et al.). Of actual psychotropic drugs, amitriptyline (Triptyl) has already been thought to relieve pain in fibromyalgia at very low doses. Epilepsy drugs pregabalin (Lyrica et al) and gabapentin (Gapapentin, Gabrion, Neurontin) can help with fibromyalgia.
Cortisone should generally not be used as a pain reliever, but in inflammatory rheumatic diseases, the cortisone enhances the pain relief caused by other treatments and may be beneficial to the course of the disease. In the case of active rheumatic disease, it may be reasonable to supplement the treatment with a small dose of cortisone instead of striving to alleviate the pain only with anti-inflammatory drugs. Cortisone treatment is the only treatment for polymyalgia rheumatica, where a small prednisolone dose (about 10 mg / day) already provides excellent pain relief.
As a local drug treatment for latex and other similar inflammations, fingernail arthritis and other superficial pain conditions, rheumatic salts can be tested for application to the skin. Capsaisin patches (Qutenza) are intended for use in neuropathic pain, not in rheumatic diseases.
For the treatment of osteoarthritis mainly in the knee, sodium hyaluronate is used as in 3-5-syringes injected into the knee joint. Similarly, a substitute for ledsalva, hylan is administered. Cortisone injections, however, are seen in both rheumatoid arthritis and osteoarthritis as the primary injection treatment.
There is a wide range of anti-inflammatory drugs. The efficacy times vary widely, which should be taken into account when dosing. However, most of the short-acting drugs have produced slow-acting preparations, instead of taking three doses daily, it can handle only one dose. The tenderness and stiffness of the joints are best relieved by antiinflammatory drugs. The pain symptoms that are dominant in osteoarthritis and fibromyalgia are not alleviated to the same extent by these drugs.
- propionic acid;
- Ibuprofen (Burana, Ibumax et al);
- Ketoprofen (Ketorin, Orudis et al.);
- Naproxen (Naproxen, Pronaxen et al);
- acetic acid derivatives;
- Diclofenac (Arthrotec, Diclomex, Motifene, Voltaren, etc.);
- Indomethacin (Indomethin);
- salicylic acid derivatives;
- Acetylsalicylic Acid (ASA-Ratiopharm, Aspirin, Disperin, etc.);
- Etoricoxib (Arcoxia et al.);
- Celecoxib (Celebra, Celecoxib);
- Mefenamic acid (Ponstan);
- Meloxicam (Meloxicam, Mobic);
- Nabumeton (Relifex);
- Tolfenamic acid (Clotam).
Use of antiinflammatory drugs
The main mechanism of action of antiinflammatory drugs is inhibition of the enzyme cyclooxygenase-2 (COX-2), relieving the pain associated with inflammation. The inflammation of the lining behind a chronic rheumatic disease can not be clearly attenuated by antiinflammatory drugs and not nor does the drug affect the course of disease. Symptoms of those suffering from a rheumatic disease usually have a clear daily rhythm. By paying attention to it, you can optimize your medication and perhaps reduce the daily need for drugs. Medications that are slowly absorbed by the body or which are relatively long-acting, it is worth taking in the evening if you have an inflammatory rheumatic disease. At osteoarthritis they are taken in the morning. The effects of the medicine are individual, so you should replace the drug without delay if it does not appear to be effective. The body is affected by at least short-term medicines, which you will have to take several times a day if the pain is constant around the clock.